2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
EPO
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
EPO
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
HMO
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
HMO
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Medicaid
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Medicaid
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Medicare Part A
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Medicare Part A
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Medicare Part B
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Medicare Part B
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
POS
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
POS
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
PPO
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
PPO
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Workers Comp
I
11589.17
8691.88
8691.88
8691.88
6953.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0001
null
revCode
null
united healthcare
Workers Comp
O
17682.94
13621.21
13621.21
13621.21
10609.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
EPO
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
HMO
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
Medicaid
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
Medicare Part A
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
Medicare Part B
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
POS
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
PPO
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
aetna - medicare advantage
Workers Comp
I
378803.88
70257.44
108683.43
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
EPO
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
HMO
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
Medicaid
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
Medicare Part A
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
Medicare Part B
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
POS
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
PPO
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield
Workers Comp
I
378803.88
70257.44
148363.04
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
EPO
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
HMO
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
Medicaid
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
Medicare Part A
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
Medicare Part B
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
POS
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
PPO
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
blue cross blue shield - medicare advantage
Workers Comp
I
378803.88
70257.44
140121.38
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
EPO
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
HMO
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
Medicaid
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
Medicare Part A
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
Medicare Part B
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
POS
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
PPO
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
003
null
ms-drg
ecmo or tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck with major o.r. procedures
va
Workers Comp
I
378803.88
70257.44
70257.44
148363.04
227282.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
EPO
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
HMO
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
Medicaid
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
Medicare Part A
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
Medicare Part B
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
POS
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
PPO
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
humana - medicare advantage
Workers Comp
I
255142.72
60435.92
60435.92
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
EPO
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
HMO
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
Medicaid
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
Medicare Part A
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
Medicare Part B
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
POS
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
PPO
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
004
null
ms-drg
tracheostomy with mv >96 hours or principal diagnosis except face mouth and neck without major o.r. procedures
tricare
Workers Comp
I
255142.72
60435.92
87502.08
87502.08
153085.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
EPO
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
HMO
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
Medicaid
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
Medicare Part A
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
Medicare Part B
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
POS
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
PPO
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna
Workers Comp
I
1307.77
396.39
715.58
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
EPO
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
HMO
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
Medicaid
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
Medicare Part A
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
Medicare Part B
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
POS
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
PPO
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
aetna - medicare advantage
Workers Comp
I
1307.77
396.39
897.73
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
EPO
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
HMO
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
Medicaid
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
Medicare Part A
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
Medicare Part B
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
POS
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
PPO
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
cigna
Workers Comp
I
1307.77
396.39
772.62
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
EPO
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
HMO
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
Medicaid
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
Medicare Part A
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
Medicare Part B
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
POS
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
PPO
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare
Workers Comp
I
1307.77
396.39
790.02
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
EPO
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
HMO
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
Medicaid
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
Medicare Part A
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
Medicare Part B
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
POS
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
PPO
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
united healthcare - medicare advantage
Workers Comp
I
1307.77
396.39
546.92
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
EPO
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
HMO
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
Medicaid
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
Medicare Part A
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
Medicare Part B
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
POS
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
PPO
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
va
Workers Comp
I
1307.77
396.39
396.39
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
EPO
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
HMO
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
Medicaid
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
Medicare Part A
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
Medicare Part B
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
POS
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
PPO
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa
Workers Comp
I
1307.77
396.39
3754.79
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
EPO
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
HMO
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
Medicaid
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
Medicare Part A
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
Medicare Part B
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
POS
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
PPO
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0110
null
revCode
Room and Board Private (one bed) General
webtpa - medicare advantage
Workers Comp
I
1307.77
396.39
10261.86
10261.86
784.66


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
EPO
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
HMO
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
Medicaid
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
Medicare Part A
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
Medicare Part B
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
POS
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
PPO
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
aetna
Workers Comp
I
2075.74
506.01
1203.93
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
EPO
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
HMO
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
Medicaid
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
Medicare Part A
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
Medicare Part B
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
POS
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
PPO
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
va
Workers Comp
I
2075.74
506.01
506.01
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
EPO
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
HMO
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
Medicaid
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
Medicare Part A
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
Medicare Part B
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
POS
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
PPO
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0114
null
revCode
Room and Board Private (one bed) Psychiatric
webtpa
Workers Comp
I
2075.74
506.01
1618.97
1618.97
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
EPO
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
HMO
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
Medicaid
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
Medicare Part A
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
Medicare Part B
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
POS
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
PPO
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0118
null
revCode
Room and Board Private (one bed) Rehabilitation
webtpa
Workers Comp
I
2675.11
1872.58
1872.58
1872.58
1605.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
EPO
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
HMO
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
Medicaid
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
Medicare Part A
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
Medicare Part B
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
POS
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
PPO
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
aetna
Workers Comp
I
1233.75
337.83
685.16
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
EPO
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
HMO
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
Medicaid
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
Medicare Part A
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
Medicare Part B
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
POS
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
PPO
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
humana - medicare advantage
Workers Comp
I
1233.75
337.83
1233.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
EPO
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
HMO
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
Medicaid
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
Medicare Part A
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
Medicare Part B
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
POS
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
PPO
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
united healthcare
Workers Comp
I
1233.75
337.83
706.75
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
EPO
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
HMO
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
Medicaid
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
Medicare Part A
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
Medicare Part B
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
POS
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
PPO
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0120
null
revCode
Room and Board Semiprivate (two beds) General
va
Workers Comp
I
1233.75
337.83
337.83
1233.75
740.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
EPO
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
HMO
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
Medicaid
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
Medicare Part A
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
Medicare Part B
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
POS
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
PPO
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
aetna
Workers Comp
I
2075.74
734.76
734.76
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
EPO
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
HMO
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
Medicaid
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
Medicare Part A
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
Medicare Part B
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
POS
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
PPO
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0124
null
revCode
Room and Board Semiprivate (two beds) Psychiatric
humana - medicare advantage
Workers Comp
I
2075.74
734.76
849.40
849.40
1245.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
EPO
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
HMO
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
Medicaid
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
Medicare Part A
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
Medicare Part B
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
POS
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
PPO
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0128
null
revCode
Room and Board Semiprivate (two beds) Rehabilitation
humana - medicare advantage
Workers Comp
I
862.57
862.57
862.57
862.57
517.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
EPO
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
HMO
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
Medicaid
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
Medicare Part A
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
Medicare Part B
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
POS
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
PPO
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
01999
null
cpt
Anesthesia procedure
tricare
Workers Comp
O
20937.23
2683.82
2683.82
2683.82
12562.34


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
EPO
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
HMO
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
Medicaid
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
Medicare Part A
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
Medicare Part B
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
POS
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
PPO
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna
Workers Comp
I
5327.70
978.72
2573.10
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
EPO
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
HMO
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
Medicaid
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
Medicare Part A
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
Medicare Part B
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
POS
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
PPO
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
aetna - medicare advantage
Workers Comp
I
5327.70
978.72
3505.92
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
EPO
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
HMO
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
Medicaid
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
Medicare Part A
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
Medicare Part B
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
POS
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
PPO
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
cigna
Workers Comp
I
5327.70
978.72
3951.05
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
EPO
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
HMO
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
Medicaid
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
Medicare Part A
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
Medicare Part B
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
POS
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
PPO
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
humana - medicare advantage
Workers Comp
I
5327.70
978.72
2404.81
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
EPO
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
HMO
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
Medicaid
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
Medicare Part A
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
Medicare Part B
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
POS
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
PPO
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
united healthcare
Workers Comp
I
5327.70
978.72
3400.22
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
EPO
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
HMO
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
Medicaid
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
Medicare Part A
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
Medicare Part B
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
POS
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
PPO
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
va
Workers Comp
I
5327.70
978.72
978.72
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
EPO
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
HMO
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
Medicaid
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
Medicare Part A
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
Medicare Part B
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
POS
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
PPO
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
webtpa
Workers Comp
I
5327.70
978.72
5468.45
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
EPO
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
HMO
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
Medicaid
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
Medicare Part A
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
Medicare Part B
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
POS
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
PPO
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0200
null
revCode
Intensive Care Unit General
worker comp
Workers Comp
I
5327.70
978.72
4533.62
5468.45
3196.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
EPO
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
HMO
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
Medicaid
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
Medicare Part A
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
Medicare Part B
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
POS
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
PPO
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
humana - medicare advantage
Workers Comp
I
3870.06
587.28
587.28
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
EPO
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
HMO
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
Medicaid
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
Medicare Part A
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
Medicare Part B
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
POS
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
PPO
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0210
null
revCode
Coronary Care Unit General
united healthcare
Workers Comp
I
3870.06
587.28
2902.55
2902.55
2322.04


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
EPO
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
HMO
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
Medicaid
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
Medicare Part A
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
Medicare Part B
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
POS
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
PPO
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna
Workers Comp
I
3696.00
872.43
1727.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
EPO
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
HMO
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
Medicaid
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
Medicare Part A
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
Medicare Part B
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
POS
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
PPO
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
aetna - medicare advantage
Workers Comp
I
3696.00
872.43
1965.76
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
EPO
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
HMO
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
Medicaid
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
Medicare Part A
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
Medicare Part B
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
POS
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
PPO
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
cigna
Workers Comp
I
3696.00
872.43
2214.67
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
EPO
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
HMO
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
Medicaid
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
Medicare Part A
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
Medicare Part B
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
POS
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
PPO
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
humana - medicare advantage
Workers Comp
I
3696.00
872.43
1895.12
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
EPO
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
HMO
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
Medicaid
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
Medicare Part A
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
Medicare Part B
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
POS
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
PPO
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare
Workers Comp
I
3696.00
872.43
2138.15
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
EPO
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
HMO
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
Medicaid
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
Medicare Part A
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
Medicare Part B
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
POS
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
PPO
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
united healthcare - medicare advantage
Workers Comp
I
3696.00
872.43
1039.65
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
EPO
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
HMO
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
Medicaid
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
Medicare Part A
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
Medicare Part B
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
POS
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
PPO
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
va
Workers Comp
I
3696.00
872.43
872.43
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
EPO
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
HMO
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
Medicaid
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
Medicare Part A
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
Medicare Part B
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
POS
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
PPO
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
webtpa
Workers Comp
I
3696.00
872.43
11321.78
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
EPO
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
HMO
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
Medicaid
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
Medicare Part A
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
Medicare Part B
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
POS
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
PPO
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0214
null
revCode
Coronary Care Unit Intermediate CCU
worker comp
Workers Comp
I
3696.00
872.43
2235.54
11321.78
2217.60


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
EPO
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
HMO
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
Medicaid
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
Medicare Part A
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
Medicare Part B
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
POS
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
PPO
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
blue cross blue shield
Workers Comp
I
91639.97
25891.77
38716.69
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
EPO
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
HMO
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
Medicaid
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
Medicare Part A
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
Medicare Part B
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
POS
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
PPO
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
humana - medicare advantage
Workers Comp
I
91639.97
25891.77
25891.77
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
EPO
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
HMO
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
Medicaid
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
Medicare Part A
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
Medicare Part B
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
POS
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
PPO
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
025
null
ms-drg
craniotomy and endovascular intracranial procedures with mcc
tricare
Workers Comp
I
91639.97
25891.77
27959.42
38716.69
54983.98


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
EPO
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
EPO
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
HMO
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
HMO
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Medicaid
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Medicaid
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Medicare Part A
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Medicare Part A
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Medicare Part B
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Medicare Part B
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
POS
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
POS
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
PPO
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
PPO
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Workers Comp
I
9.63
2.41
8.12
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
aetna
Workers Comp
O
12.21
0.63
5.21
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
EPO
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
HMO
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
Medicaid
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
Medicare Part A
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
Medicare Part B
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
POS
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
PPO
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield
Workers Comp
O
12.21
0.63
4.35
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
EPO
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
HMO
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
Medicaid
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
Medicare Part A
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
Medicare Part B
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
POS
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
PPO
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
blue cross blue shield - medicare advantage
Workers Comp
O
12.21
0.63
4.39
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
EPO
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
EPO
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
HMO
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
HMO
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Medicaid
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Medicaid
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Medicare Part A
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Medicare Part A
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Medicare Part B
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Medicare Part B
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
POS
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
POS
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
PPO
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
PPO
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Workers Comp
I
9.63
2.41
8.35
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
cigna
Workers Comp
O
12.21
0.63
21.36
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
EPO
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
HMO
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
Medicaid
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
Medicare Part A
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
Medicare Part B
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
POS
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
PPO
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
geha
Workers Comp
O
12.21
0.63
29.18
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
EPO
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
HMO
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
Medicaid
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
Medicare Part A
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
Medicare Part B
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
POS
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
PPO
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
healthchoice
Workers Comp
O
12.21
0.63
0.63
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
EPO
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
EPO
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
HMO
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
HMO
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Medicaid
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Medicaid
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Medicare Part A
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Medicare Part A
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Medicare Part B
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Medicare Part B
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
POS
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
POS
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
PPO
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
PPO
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Workers Comp
I
9.63
2.41
10.52
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
humana - medicare advantage
Workers Comp
O
12.21
0.63
68.02
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
EPO
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
HMO
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
Medicaid
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
Medicare Part A
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
Medicare Part B
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
POS
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
PPO
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
medica
Workers Comp
O
12.21
0.63
3.26
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
EPO
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
EPO
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
HMO
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
HMO
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Medicaid
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Medicaid
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Medicare Part A
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Medicare Part A
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Medicare Part B
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Medicare Part B
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
POS
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
POS
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
PPO
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
PPO
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Workers Comp
I
9.63
2.41
9.04
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
united healthcare
Workers Comp
O
12.21
0.63
29.11
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
EPO
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
EPO
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
HMO
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
HMO
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Medicaid
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Medicaid
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Medicare Part A
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Medicare Part A
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Medicare Part B
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Medicare Part B
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
POS
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
POS
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
PPO
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
PPO
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Workers Comp
I
9.63
2.41
2.41
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
va
Workers Comp
O
12.21
0.63
24.22
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
EPO
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
HMO
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
Medicaid
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
Medicare Part A
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
Medicare Part B
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
POS
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
PPO
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
webtpa
Workers Comp
O
12.21
0.63
156.54
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
EPO
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
EPO
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
HMO
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
HMO
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Medicaid
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Medicaid
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Medicare Part A
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Medicare Part A
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Medicare Part B
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Medicare Part B
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
POS
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
POS
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
PPO
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
PPO
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Workers Comp
I
9.63
2.41
10.93
10.93
5.78


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0250
null
revCode
Pharmacy General
worker comp
Workers Comp
O
12.21
0.63
22.84
156.54
7.33


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
EPO
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
EPO
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
HMO
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
HMO
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Medicaid
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Medicaid
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Medicare Part A
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Medicare Part A
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Medicare Part B
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Medicare Part B
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
POS
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
POS
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
PPO
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
PPO
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Workers Comp
I
135.76
30.68
63.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
aetna
Workers Comp
O
105.71
1.75
21.58
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
EPO
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
HMO
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
Medicaid
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
Medicare Part A
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
Medicare Part B
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
POS
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
PPO
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield
Workers Comp
O
105.71
1.75
15.17
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
EPO
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
HMO
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
Medicaid
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
Medicare Part A
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
Medicare Part B
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
POS
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
PPO
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
blue cross blue shield - medicare advantage
Workers Comp
O
105.71
1.75
23.84
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
EPO
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
EPO
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
HMO
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
HMO
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Medicaid
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Medicaid
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Medicare Part A
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Medicare Part A
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Medicare Part B
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Medicare Part B
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
POS
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
POS
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
PPO
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
PPO
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Workers Comp
I
135.76
30.68
118.12
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
cigna
Workers Comp
O
105.71
1.75
78.55
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
EPO
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
HMO
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
Medicaid
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
Medicare Part A
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
Medicare Part B
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
POS
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
PPO
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
geha
Workers Comp
O
105.71
1.75
44.30
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
EPO
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
HMO
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
Medicaid
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
Medicare Part A
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
Medicare Part B
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
POS
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
PPO
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
healthchoice
Workers Comp
O
105.71
1.75
1.75
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
EPO
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
EPO
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
HMO
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
HMO
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Medicaid
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Medicaid
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Medicare Part A
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Medicare Part A
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Medicare Part B
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Medicare Part B
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
POS
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
POS
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
PPO
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
PPO
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Workers Comp
I
135.76
30.68
118.28
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
humana - medicare advantage
Workers Comp
O
105.71
1.75
103.83
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
EPO
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
HMO
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
Medicaid
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
Medicare Part A
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
Medicare Part B
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
POS
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
PPO
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
medica
Workers Comp
O
105.71
1.75
4.82
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
EPO
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
HMO
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
Medicaid
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
Medicare Part A
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
Medicare Part B
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
POS
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
PPO
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
united healthcare
Workers Comp
O
105.71
1.75
78.61
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
EPO
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
EPO
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
HMO
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
HMO
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Medicaid
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Medicaid
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Medicare Part A
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Medicare Part A
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Medicare Part B
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Medicare Part B
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
POS
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
POS
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
PPO
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
PPO
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Workers Comp
I
135.76
30.68
30.68
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
va
Workers Comp
O
105.71
1.75
12.40
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
EPO
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
EPO
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
HMO
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
HMO
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Medicaid
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Medicaid
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Medicare Part A
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Medicare Part A
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Medicare Part B
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Medicare Part B
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
POS
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
POS
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
PPO
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
PPO
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Workers Comp
I
135.76
30.68
162.00
162.00
81.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0258
null
revCode
Pharmacy IVsolutions
worker comp
Workers Comp
O
105.71
1.75
80.14
103.83
63.43


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
EPO
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
HMO
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
Medicaid
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
Medicare Part A
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
Medicare Part B
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
POS
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
PPO
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
aetna
Workers Comp
O
307.18
65.78
178.16
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
EPO
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
HMO
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
Medicaid
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
Medicare Part A
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
Medicare Part B
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
POS
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
PPO
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield
Workers Comp
O
307.18
65.78
139.89
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
EPO
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
HMO
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
Medicaid
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
Medicare Part A
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
Medicare Part B
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
POS
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
PPO
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
blue cross blue shield - medicare advantage
Workers Comp
O
307.18
65.78
75.73
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
EPO
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
HMO
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
Medicaid
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
Medicare Part A
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
Medicare Part B
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
POS
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
PPO
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
cigna
Workers Comp
O
307.18
65.78
205.08
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
EPO
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
EPO
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
HMO
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
HMO
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Medicaid
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Medicaid
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Medicare Part A
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Medicare Part A
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Medicare Part B
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Medicare Part B
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
POS
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
POS
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
PPO
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
PPO
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Workers Comp
I
907.09
907.09
907.09
907.09
544.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
humana - medicare advantage
Workers Comp
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
EPO
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
HMO
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
Medicaid
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
Medicare Part A
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
Medicare Part B
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
POS
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
PPO
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
tricare
Workers Comp
O
307.18
65.78
162.77
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
EPO
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
HMO
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
Medicaid
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
Medicare Part A
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
Medicare Part B
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
POS
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
PPO
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0260
null
revCode
IVTherapy General
va
Workers Comp
O
307.18
65.78
65.78
205.08
184.31


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
EPO
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
EPO
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
HMO
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
HMO
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Medicaid
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Medicaid
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Medicare Part A
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Medicare Part A
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Medicare Part B
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Medicare Part B
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
POS
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
POS
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
PPO
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
PPO
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Workers Comp
I
70.37
18.60
124.91
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna
Workers Comp
O
33.38
1.89
18.70
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
EPO
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
HMO
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
Medicaid
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
Medicare Part A
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
Medicare Part B
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
POS
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
PPO
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
aetna - medicare advantage
Workers Comp
O
33.38
1.89
12.72
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
EPO
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
HMO
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
Medicaid
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
Medicare Part A
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
Medicare Part B
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
POS
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
PPO
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield
Workers Comp
O
33.38
1.89
10.77
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
EPO
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
HMO
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
Medicaid
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
Medicare Part A
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
Medicare Part B
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
POS
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
PPO
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
blue cross blue shield - medicare advantage
Workers Comp
O
33.38
1.89
10.14
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
EPO
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
EPO
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
HMO
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
HMO
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Medicaid
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Medicaid
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Medicare Part A
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Medicare Part A
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Medicare Part B
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Medicare Part B
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
POS
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
POS
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
PPO
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
PPO
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Workers Comp
I
70.37
18.60
39.89
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
cigna
Workers Comp
O
33.38
1.89
27.86
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
EPO
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
HMO
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
Medicaid
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
Medicare Part A
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
Medicare Part B
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
POS
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
PPO
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
geha
Workers Comp
O
33.38
1.89
43.95
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
EPO
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
HMO
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
Medicaid
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
Medicare Part A
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
Medicare Part B
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
POS
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
PPO
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
healthchoice
Workers Comp
O
33.38
1.89
2.59
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
EPO
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
EPO
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
HMO
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
HMO
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Medicaid
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Medicaid
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Medicare Part A
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Medicare Part A
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Medicare Part B
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Medicare Part B
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
POS
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
POS
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
PPO
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
PPO
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Workers Comp
I
70.37
18.60
68.44
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
humana - medicare advantage
Workers Comp
O
33.38
1.89
42.64
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
EPO
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
HMO
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
Medicaid
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
Medicare Part A
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
Medicare Part B
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
POS
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
PPO
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
medica
Workers Comp
O
33.38
1.89
12.73
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
EPO
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
HMO
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
Medicaid
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
Medicare Part A
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
Medicare Part B
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
POS
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
PPO
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
tricare
Workers Comp
O
33.38
1.89
94.96
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
EPO
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
EPO
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
HMO
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
HMO
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Medicaid
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Medicaid
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Medicare Part A
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Medicare Part A
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Medicare Part B
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Medicare Part B
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
POS
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
POS
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
PPO
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
PPO
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Workers Comp
I
70.37
18.60
47.62
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare
Workers Comp
O
33.38
1.89
21.25
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
EPO
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
HMO
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
Medicaid
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
Medicare Part A
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
Medicare Part B
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
POS
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
PPO
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
united healthcare - medicare advantage
Workers Comp
O
33.38
1.89
1.89
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
EPO
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
EPO
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
HMO
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
HMO
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Medicaid
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Medicaid
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Medicare Part A
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Medicare Part A
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Medicare Part B
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Medicare Part B
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
POS
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
POS
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
PPO
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
PPO
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Workers Comp
I
70.37
18.60
18.60
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
va
Workers Comp
O
33.38
1.89
33.04
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
EPO
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
HMO
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
Medicaid
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
Medicare Part A
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
Medicare Part B
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
POS
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
PPO
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
webtpa
Workers Comp
O
33.38
1.89
16.34
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
EPO
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
EPO
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
HMO
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
HMO
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Medicaid
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Medicaid
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Medicare Part A
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Medicare Part A
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Medicare Part B
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Medicare Part B
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
POS
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
POS
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
PPO
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
PPO
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Workers Comp
I
70.37
18.60
148.88
148.88
42.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0270
null
revCode
Medical/Surgical Supplies and Devices General
worker comp
Workers Comp
O
33.38
1.89
25.92
94.96
20.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
EPO
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
HMO
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
Medicaid
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
Medicare Part A
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
Medicare Part B
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
POS
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
PPO
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
aetna
Workers Comp
O
89.04
13.18
36.27
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
EPO
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
HMO
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
Medicaid
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
Medicare Part A
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
Medicare Part B
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
POS
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
PPO
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield
Workers Comp
O
89.04
13.18
101.68
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
EPO
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
HMO
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
Medicaid
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
Medicare Part A
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
Medicare Part B
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
POS
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
PPO
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
blue cross blue shield - medicare advantage
Workers Comp
O
89.04
13.18
13.18
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
EPO
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
EPO
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
HMO
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
HMO
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Medicaid
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Medicaid
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Medicare Part A
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Medicare Part A
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Medicare Part B
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Medicare Part B
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
POS
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
POS
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
PPO
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
PPO
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Workers Comp
I
618.82
53.36
629.11
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
cigna
Workers Comp
O
89.04
13.18
256.75
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
EPO
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
HMO
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
Medicaid
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
Medicare Part A
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
Medicare Part B
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
POS
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
PPO
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
humana - medicare advantage
Workers Comp
I
618.82
53.36
345.56
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
EPO
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
HMO
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
Medicaid
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
Medicare Part A
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
Medicare Part B
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
POS
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
PPO
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
united healthcare
Workers Comp
O
89.04
13.18
259.17
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
EPO
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
EPO
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
HMO
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
HMO
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Medicaid
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Medicaid
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Medicare Part A
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Medicare Part A
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Medicare Part B
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Medicare Part B
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
POS
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
POS
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
PPO
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
PPO
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Workers Comp
I
618.82
53.36
53.36
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
va
Workers Comp
O
89.04
13.18
345.56
345.56
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
EPO
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
HMO
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
Medicaid
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
Medicare Part A
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
Medicare Part B
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
POS
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
PPO
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0272
null
revCode
Medical/Surgical Supplies and Devices Sterile
worker comp
Workers Comp
I
618.82
53.36
7151.82
7151.82
371.29


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
EPO
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
HMO
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
Medicaid
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
Medicare Part A
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
Medicare Part B
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
POS
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
PPO
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield
Workers Comp
O
89.04
7.44
7.44
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
EPO
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
HMO
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
Medicaid
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
Medicare Part A
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
Medicare Part B
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
POS
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
PPO
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
blue cross blue shield - medicare advantage
Workers Comp
O
89.04
7.44
19.98
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
EPO
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
HMO
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
Medicaid
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
Medicare Part A
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
Medicare Part B
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
POS
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
PPO
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
geha
Workers Comp
O
89.04
7.44
586.71
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
EPO
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
EPO
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
HMO
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
HMO
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Medicaid
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Medicaid
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Medicare Part A
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Medicare Part A
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Medicare Part B
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Medicare Part B
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
POS
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
POS
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
PPO
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
PPO
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Workers Comp
I
350.59
61.24
89.04
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
humana - medicare advantage
Workers Comp
O
89.04
7.44
156.49
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
EPO
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
HMO
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
Medicaid
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
Medicare Part A
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
Medicare Part B
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
POS
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
PPO
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
tricare
Workers Comp
O
89.04
7.44
94.38
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
EPO
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
HMO
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
Medicaid
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
Medicare Part A
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
Medicare Part B
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
POS
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
PPO
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
united healthcare
Workers Comp
O
89.04
7.44
14.39
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
EPO
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
EPO
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
HMO
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
HMO
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Medicaid
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Medicaid
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Medicare Part A
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Medicare Part A
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Medicare Part B
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Medicare Part B
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
POS
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
POS
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
PPO
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
PPO
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Workers Comp
I
350.59
61.24
61.24
89.04
210.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0274
null
revCode
Medical/Surgical Supplies and Devices Prosthetic/orthotic devices
va
Workers Comp
O
89.04
7.44
8.94
586.71
53.42


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
EPO
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
HMO
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
Medicaid
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
Medicare Part A
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
Medicare Part B
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
POS
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
PPO
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield
Workers Comp
O
2887.12
1372.53
1488.40
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
EPO
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
HMO
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
Medicaid
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
Medicare Part A
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
Medicare Part B
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
POS
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
PPO
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0275
null
revCode
Medical/Surgical Supplies and Devices Pacemaker
blue cross blue shield - medicare advantage
Workers Comp
O
2887.12
1372.53
1372.53
1488.40
1732.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
EPO
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
HMO
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
Medicaid
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
Medicare Part A
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
Medicare Part B
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
POS
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
PPO
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
aetna
Workers Comp
O
716.56
173.98
268.00
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
EPO
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
HMO
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
Medicaid
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
Medicare Part A
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
Medicare Part B
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
POS
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
PPO
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield
Workers Comp
O
716.56
173.98
184.38
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
EPO
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
HMO
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
Medicaid
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
Medicare Part A
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
Medicare Part B
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
POS
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
PPO
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0276
null
revCode
Medical/Surgical Supplies and Devices Intracular lens
blue cross blue shield - medicare advantage
Workers Comp
O
716.56
173.98
173.98
268.00
429.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
EPO
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
EPO
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
HMO
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
HMO
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Medicaid
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Medicaid
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Medicare Part A
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Medicare Part A
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Medicare Part B
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Medicare Part B
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
POS
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
POS
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
PPO
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
PPO
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Workers Comp
I
14323.19
563.65
1501.07
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
aetna
Workers Comp
O
1029.12
187.28
10720.32
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
EPO
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
HMO
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
Medicaid
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
Medicare Part A
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
Medicare Part B
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
POS
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
PPO
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield
Workers Comp
O
1029.12
187.28
301.37
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
EPO
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
HMO
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
Medicaid
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
Medicare Part A
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
Medicare Part B
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
POS
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
PPO
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
blue cross blue shield - medicare advantage
Workers Comp
O
1029.12
187.28
187.28
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
EPO
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
HMO
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
Medicaid
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
Medicare Part A
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
Medicare Part B
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
POS
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
PPO
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
cigna
Workers Comp
O
1029.12
187.28
3019.83
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
EPO
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
HMO
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
Medicaid
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
Medicare Part A
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
Medicare Part B
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
POS
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
PPO
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
humana - medicare advantage
Workers Comp
I
14323.19
563.65
4549.04
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
EPO
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
EPO
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
HMO
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
HMO
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Medicaid
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Medicaid
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Medicare Part A
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Medicare Part A
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Medicare Part B
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Medicare Part B
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
POS
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
POS
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
PPO
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
PPO
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Workers Comp
I
14323.19
563.65
563.65
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
united healthcare
Workers Comp
O
1029.12
187.28
781.49
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
EPO
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
EPO
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
HMO
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
HMO
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Medicaid
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Medicaid
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Medicare Part A
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Medicare Part A
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Medicare Part B
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Medicare Part B
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
POS
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
POS
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
PPO
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
PPO
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Workers Comp
I
14323.19
563.65
2181.77
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
va
Workers Comp
O
1029.12
187.28
794.15
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
EPO
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
HMO
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
Medicaid
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
Medicare Part A
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
Medicare Part B
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
POS
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
PPO
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
webtpa
Workers Comp
O
1029.12
187.28
14535.84
14535.84
617.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
EPO
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
HMO
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
Medicaid
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
Medicare Part A
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
Medicare Part B
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
POS
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
PPO
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0278
null
revCode
Medical/Surgical Supplies and Devices Other implants
worker comp
Workers Comp
I
14323.19
563.65
652.33
4549.04
8593.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
EPO
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
HMO
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
Medicaid
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
Medicare Part A
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
Medicare Part B
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
POS
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
PPO
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
028
null
ms-drg
spinal procedures with mcc
united healthcare
Workers Comp
I
109892.64
82419.49
82419.49
82419.49
65935.58


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
EPO
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
HMO
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
Medicaid
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
Medicare Part A
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
Medicare Part B
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
POS
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
PPO
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna
Workers Comp
O
181.41
23.80
101.94
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
EPO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
HMO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
Medicaid
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
Medicare Part A
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
Medicare Part B
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
POS
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
PPO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
aetna - medicare advantage
Workers Comp
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
EPO
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
HMO
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
Medicaid
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
Medicare Part A
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
Medicare Part B
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
POS
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
PPO
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield
Workers Comp
O
181.41
23.80
130.46
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
EPO
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
HMO
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
Medicaid
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
Medicare Part A
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
Medicare Part B
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
POS
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
PPO
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
blue cross blue shield - medicare advantage
Workers Comp
O
181.41
23.80
23.80
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
EPO
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
HMO
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
Medicaid
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
Medicare Part A
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
Medicare Part B
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
POS
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
PPO
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
cigna
Workers Comp
O
181.41
23.80
121.12
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
EPO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
HMO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
Medicaid
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
Medicare Part A
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
Medicare Part B
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
POS
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
PPO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
humana - medicare advantage
Workers Comp
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
EPO
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
HMO
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
Medicaid
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
Medicare Part A
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
Medicare Part B
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
POS
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
PPO
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
tricare
Workers Comp
O
181.41
23.80
48.73
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
EPO
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
HMO
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
Medicaid
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
Medicare Part A
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
Medicare Part B
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
POS
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
PPO
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare
Workers Comp
O
181.41
23.80
129.59
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
EPO
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
HMO
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
Medicaid
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
Medicare Part A
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
Medicare Part B
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
POS
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
PPO
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
united healthcare - medicare advantage
Workers Comp
O
181.41
23.80
47.76
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
EPO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
HMO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
Medicaid
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
Medicare Part A
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
Medicare Part B
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
POS
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
PPO
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
va
Workers Comp
O
181.41
23.80
49.29
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
EPO
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
HMO
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
Medicaid
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
Medicare Part A
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
Medicare Part B
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
POS
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
PPO
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0280
null
revCode
Oncology General
webtpa
Workers Comp
O
181.41
23.80
122.43
130.46
108.85


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
EPO
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
HMO
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
Medicaid
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
Medicare Part A
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
Medicare Part B
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
POS
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
PPO
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
029
null
ms-drg
spinal procedures with cc or spinal neurostimulators
blue cross blue shield
Workers Comp
I
49002.02
35301.61
35301.61
35301.61
29401.21


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
EPO
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
EPO
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
HMO
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
HMO
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Medicaid
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Medicaid
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Medicare Part A
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Medicare Part A
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Medicare Part B
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Medicare Part B
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
POS
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
POS
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
PPO
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
PPO
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Workers Comp
I
136.29
43.20
72.74
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna
Workers Comp
O
79.81
8.84
21.89
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
EPO
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
HMO
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
Medicaid
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
Medicare Part A
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
Medicare Part B
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
POS
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
PPO
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
aetna - medicare advantage
Workers Comp
O
79.81
8.84
9.71
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
EPO
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
HMO
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
Medicaid
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
Medicare Part A
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
Medicare Part B
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
POS
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
PPO
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield
Workers Comp
O
79.81
8.84
15.47
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
EPO
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
HMO
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
Medicaid
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
Medicare Part A
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
Medicare Part B
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
POS
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
PPO
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
blue cross blue shield - medicare advantage
Workers Comp
O
79.81
8.84
14.67
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
EPO
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
EPO
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
HMO
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
HMO
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Medicaid
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Medicaid
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Medicare Part A
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Medicare Part A
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Medicare Part B
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Medicare Part B
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
POS
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
POS
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
PPO
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
PPO
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Workers Comp
I
136.29
43.20
122.77
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
cigna
Workers Comp
O
79.81
8.84
55.95
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
EPO
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
HMO
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
Medicaid
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
Medicare Part A
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
Medicare Part B
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
POS
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
PPO
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
geha
Workers Comp
O
79.81
8.84
59.86
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
EPO
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
HMO
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
Medicaid
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
Medicare Part A
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
Medicare Part B
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
POS
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
PPO
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
healthchoice
Workers Comp
O
79.81
8.84
22.80
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
EPO
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
HMO
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
Medicaid
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
Medicare Part A
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
Medicare Part B
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
POS
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
PPO
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana
Workers Comp
O
79.81
8.84
61.53
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
EPO
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
EPO
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
HMO
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
HMO
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Medicaid
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Medicaid
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Medicare Part A
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Medicare Part A
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Medicare Part B
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Medicare Part B
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
POS
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
POS
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
PPO
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
PPO
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Workers Comp
I
136.29
43.20
111.13
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
humana - medicare advantage
Workers Comp
O
79.81
8.84
9.44
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
EPO
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
HMO
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
Medicaid
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
Medicare Part A
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
Medicare Part B
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
POS
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
PPO
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
medica
Workers Comp
O
79.81
8.84
14.00
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
EPO
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
HMO
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
Medicaid
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
Medicare Part A
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
Medicare Part B
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
POS
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
PPO
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
tricare
Workers Comp
O
79.81
8.84
10.37
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
EPO
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
EPO
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
HMO
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
HMO
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Medicaid
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Medicaid
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Medicare Part A
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Medicare Part A
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Medicare Part B
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Medicare Part B
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
POS
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
POS
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
PPO
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
PPO
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Workers Comp
I
136.29
43.20
108.18
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare
Workers Comp
O
79.81
8.84
54.26
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
EPO
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
HMO
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
Medicaid
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
Medicare Part A
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
Medicare Part B
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
POS
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
PPO
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
united healthcare - medicare advantage
Workers Comp
O
79.81
8.84
8.84
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
EPO
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
EPO
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
HMO
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
HMO
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Medicaid
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Medicaid
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Medicare Part A
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Medicare Part A
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Medicare Part B
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Medicare Part B
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
POS
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
POS
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
PPO
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
PPO
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Workers Comp
I
136.29
43.20
43.20
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
va
Workers Comp
O
79.81
8.84
8.96
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
EPO
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
HMO
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
Medicaid
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
Medicare Part A
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
Medicare Part B
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
POS
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
PPO
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
webtpa
Workers Comp
O
79.81
8.84
115.19
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
EPO
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
EPO
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
HMO
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
HMO
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Medicaid
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Medicaid
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Medicare Part A
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Medicare Part A
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Medicare Part B
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Medicare Part B
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
POS
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
POS
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
PPO
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
PPO
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Workers Comp
I
136.29
43.20
89.32
122.77
81.77


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0300
null
revCode
Laboratory General
worker comp
Workers Comp
O
79.81
8.84
45.68
115.19
47.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
EPO
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
EPO
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
HMO
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
HMO
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Medicaid
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Medicaid
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Medicare Part A
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Medicare Part A
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Medicare Part B
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Medicare Part B
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
POS
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
POS
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
PPO
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
PPO
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Workers Comp
I
169.17
43.81
98.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna
Workers Comp
O
28.38
2.92
57.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
EPO
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
HMO
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
Medicaid
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
Medicare Part A
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
Medicare Part B
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
POS
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
PPO
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
aetna - medicare advantage
Workers Comp
O
28.38
2.92
96.59
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
EPO
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
HMO
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
Medicaid
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
Medicare Part A
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
Medicare Part B
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
POS
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
PPO
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield
Workers Comp
O
28.38
2.92
19.87
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
EPO
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
HMO
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
Medicaid
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
Medicare Part A
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
Medicare Part B
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
POS
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
PPO
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
blue cross blue shield - medicare advantage
Workers Comp
O
28.38
2.92
7.37
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
EPO
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
HMO
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
Medicaid
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
Medicare Part A
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
Medicare Part B
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
POS
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
PPO
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
cigna
Workers Comp
I
169.17
43.81
119.71
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
EPO
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
EPO
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
HMO
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
HMO
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Medicaid
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Medicaid
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Medicare Part A
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Medicare Part A
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Medicare Part B
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Medicare Part B
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
POS
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
POS
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
PPO
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
PPO
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Workers Comp
I
169.17
43.81
169.17
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
humana - medicare advantage
Workers Comp
O
28.38
2.92
3.64
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
EPO
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
HMO
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
Medicaid
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
Medicare Part A
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
Medicare Part B
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
POS
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
PPO
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
tricare
Workers Comp
O
28.38
2.92
3.65
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
EPO
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
HMO
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
Medicaid
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
Medicare Part A
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
Medicare Part B
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
POS
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
PPO
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
united healthcare
Workers Comp
O
28.38
2.92
70.56
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
EPO
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
EPO
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
HMO
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
HMO
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Medicaid
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Medicaid
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Medicare Part A
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Medicare Part A
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Medicare Part B
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Medicare Part B
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
POS
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
POS
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
PPO
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
PPO
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Workers Comp
I
169.17
43.81
43.81
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
va
Workers Comp
O
28.38
2.92
2.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
EPO
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
HMO
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
Medicaid
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
Medicare Part A
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
Medicare Part B
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
POS
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
PPO
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
webtpa
Workers Comp
O
28.38
2.92
171.92
171.92
17.03


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
EPO
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
HMO
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
Medicaid
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
Medicare Part A
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
Medicare Part B
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
POS
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
PPO
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0301
null
revCode
Laboratory Chemistry
worker comp
Workers Comp
I
169.17
43.81
161.12
169.17
101.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
EPO
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
EPO
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
HMO
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
HMO
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Medicaid
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Medicaid
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Medicare Part A
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Medicare Part A
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Medicare Part B
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Medicare Part B
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
POS
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
POS
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
PPO
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
PPO
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Workers Comp
I
219.60
42.76
158.23
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
aetna
Workers Comp
O
238.18
32.09
138.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
EPO
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
HMO
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
Medicaid
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
Medicare Part A
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
Medicare Part B
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
POS
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
PPO
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield
Workers Comp
O
238.18
32.09
90.19
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
EPO
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
HMO
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
Medicaid
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
Medicare Part A
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
Medicare Part B
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
POS
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
PPO
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
blue cross blue shield - medicare advantage
Workers Comp
O
238.18
32.09
79.12
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
EPO
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
EPO
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
HMO
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
HMO
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Medicaid
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Medicaid
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Medicare Part A
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Medicare Part A
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Medicare Part B
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Medicare Part B
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
POS
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
POS
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
PPO
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
PPO
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Workers Comp
I
219.60
42.76
170.51
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
cigna
Workers Comp
O
238.18
32.09
159.02
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
EPO
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
HMO
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
Medicaid
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
Medicare Part A
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
Medicare Part B
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
POS
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
PPO
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
geha
Workers Comp
O
238.18
32.09
185.63
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
EPO
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
HMO
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
Medicaid
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
Medicare Part A
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
Medicare Part B
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
POS
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
PPO
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
healthchoice
Workers Comp
O
238.18
32.09
32.09
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
EPO
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
EPO
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
HMO
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
HMO
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Medicaid
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Medicaid
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Medicare Part A
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Medicare Part A
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Medicare Part B
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Medicare Part B
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
POS
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
POS
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
PPO
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
PPO
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Workers Comp
I
219.60
42.76
179.71
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
humana - medicare advantage
Workers Comp
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
EPO
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
HMO
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
Medicaid
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
Medicare Part A
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
Medicare Part B
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
POS
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
PPO
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
medica
Workers Comp
O
238.18
32.09
88.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
EPO
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
HMO
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
Medicaid
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
Medicare Part A
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
Medicare Part B
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
POS
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
PPO
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
tricare
Workers Comp
O
238.18
32.09
43.82
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
EPO
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
HMO
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
Medicaid
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
Medicare Part A
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
Medicare Part B
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
POS
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
PPO
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
united healthcare
Workers Comp
O
238.18
32.09
170.13
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
EPO
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
EPO
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
HMO
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
HMO
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Medicaid
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Medicaid
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Medicare Part A
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Medicare Part A
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Medicare Part B
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Medicare Part B
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
POS
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
POS
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
PPO
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
PPO
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Workers Comp
I
219.60
42.76
42.76
179.71
131.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
va
Workers Comp
O
238.18
32.09
200.34
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
EPO
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
HMO
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
Medicaid
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
Medicare Part A
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
Medicare Part B
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
POS
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
PPO
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
webtpa
Workers Comp
O
238.18
32.09
158.79
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
EPO
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
HMO
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
Medicaid
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
Medicare Part A
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
Medicare Part B
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
POS
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
PPO
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0310
null
revCode
Laboratory Pathology General
worker comp
Workers Comp
O
238.18
32.09
201.14
201.14
142.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
EPO
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
HMO
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
Medicaid
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
Medicare Part A
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
Medicare Part B
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
POS
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
PPO
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
aetna
Workers Comp
O
396.22
152.72
229.81
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
EPO
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
HMO
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
Medicaid
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
Medicare Part A
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
Medicare Part B
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
POS
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
PPO
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield
Workers Comp
O
396.22
152.72
154.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
EPO
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
HMO
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
Medicaid
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
Medicare Part A
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
Medicare Part B
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
POS
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
PPO
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
blue cross blue shield - medicare advantage
Workers Comp
O
396.22
152.72
152.72
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
EPO
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
HMO
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
Medicaid
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
Medicare Part A
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
Medicare Part B
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
POS
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
PPO
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
cigna
Workers Comp
O
396.22
152.72
272.46
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
EPO
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
EPO
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
HMO
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
HMO
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Medicaid
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Medicaid
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Medicare Part A
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Medicare Part A
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Medicare Part B
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Medicare Part B
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
POS
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
POS
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
PPO
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
PPO
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Workers Comp
I
396.22
73.67
396.22
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
humana - medicare advantage
Workers Comp
O
396.22
152.72
335.53
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
EPO
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
HMO
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
Medicaid
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
Medicare Part A
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
Medicare Part B
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
POS
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
PPO
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
tricare
Workers Comp
O
396.22
152.72
419.99
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
EPO
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
HMO
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
Medicaid
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
Medicare Part A
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
Medicare Part B
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
POS
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
PPO
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
united healthcare
Workers Comp
O
396.22
152.72
283.02
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
EPO
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
EPO
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
HMO
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
HMO
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Medicaid
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Medicaid
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Medicare Part A
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Medicare Part A
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Medicare Part B
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Medicare Part B
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
POS
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
POS
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
PPO
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
PPO
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Workers Comp
I
396.22
73.67
73.67
396.22
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0312
null
revCode
Laboratory Pathology Histology
va
Workers Comp
O
396.22
152.72
377.36
419.99
237.73


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
EPO
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
HMO
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
Medicaid
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
Medicare Part A
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
Medicare Part B
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
POS
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
PPO
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna
Workers Comp
O
316.94
31.41
180.10
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
EPO
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
HMO
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
Medicaid
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
Medicare Part A
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
Medicare Part B
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
POS
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
PPO
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
aetna - medicare advantage
Workers Comp
O
316.94
31.41
95.85
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
EPO
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
HMO
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
Medicaid
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
Medicare Part A
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
Medicare Part B
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
POS
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
PPO
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield
Workers Comp
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
EPO
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
HMO
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
Medicaid
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
Medicare Part A
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
Medicare Part B
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
POS
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
PPO
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
blue cross blue shield - medicare advantage
Workers Comp
O
316.94
31.41
61.44
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
EPO
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
EPO
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
HMO
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
HMO
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Medicaid
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Medicaid
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Medicare Part A
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Medicare Part A
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Medicare Part B
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Medicare Part B
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
POS
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
POS
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
PPO
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
PPO
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Workers Comp
I
253.76
56.00
204.77
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
cigna
Workers Comp
O
316.94
31.41
207.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
EPO
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
HMO
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
Medicaid
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
Medicare Part A
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
Medicare Part B
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
POS
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
PPO
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
healthchoice
Workers Comp
O
316.94
31.41
64.17
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
EPO
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
EPO
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
HMO
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
HMO
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Medicaid
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Medicaid
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Medicare Part A
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Medicare Part A
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Medicare Part B
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Medicare Part B
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
POS
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
POS
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
PPO
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
PPO
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Workers Comp
I
253.76
56.00
237.52
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
humana - medicare advantage
Workers Comp
O
316.94
31.41
96.51
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
EPO
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
HMO
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
Medicaid
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
Medicare Part A
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
Medicare Part B
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
POS
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
PPO
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
medica
Workers Comp
O
316.94
31.41
119.42
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
EPO
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
HMO
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
Medicaid
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
Medicare Part A
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
Medicare Part B
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
POS
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
PPO
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
tricare
Workers Comp
O
316.94
31.41
89.99
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
EPO
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
EPO
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
HMO
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
HMO
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Medicaid
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Medicaid
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Medicare Part A
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Medicare Part A
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Medicare Part B
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Medicare Part B
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
POS
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
POS
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
PPO
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
PPO
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Workers Comp
I
253.76
56.00
221.80
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare
Workers Comp
O
316.94
31.41
232.89
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
EPO
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
HMO
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
Medicaid
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
Medicare Part A
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
Medicare Part B
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
POS
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
PPO
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
united healthcare - medicare advantage
Workers Comp
O
316.94
31.41
97.31
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
EPO
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
EPO
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
HMO
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
HMO
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Medicaid
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Medicaid
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Medicare Part A
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Medicare Part A
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Medicare Part B
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Medicare Part B
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
POS
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
POS
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
PPO
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
PPO
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Workers Comp
I
253.76
56.00
56.00
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
va
Workers Comp
O
316.94
31.41
31.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
EPO
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
HMO
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
Medicaid
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
Medicare Part A
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
Medicare Part B
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
POS
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
PPO
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
webtpa
Workers Comp
O
316.94
31.41
273.41
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
EPO
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
EPO
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
HMO
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
HMO
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Medicaid
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Medicaid
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Medicare Part A
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Medicare Part A
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Medicare Part B
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Medicare Part B
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
POS
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
POS
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
PPO
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
PPO
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Workers Comp
I
253.76
56.00
241.68
241.68
152.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0320
null
revCode
Radiology Diagnostic General
worker comp
Workers Comp
O
316.94
31.41
100.70
273.41
190.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
EPO
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
HMO
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
Medicaid
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
Medicare Part A
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
Medicare Part B
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
POS
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
PPO
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield
Workers Comp
O
9051.34
1936.18
1936.18
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
EPO
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
HMO
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
Medicaid
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
Medicare Part A
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
Medicare Part B
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
POS
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
PPO
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
blue cross blue shield - medicare advantage
Workers Comp
O
9051.34
1936.18
2229.51
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
EPO
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
EPO
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
HMO
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
HMO
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Medicaid
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Medicaid
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Medicare Part A
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Medicare Part A
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Medicare Part B
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Medicare Part B
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
POS
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
POS
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
PPO
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
PPO
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Workers Comp
I
921.56
220.44
552.45
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
humana - medicare advantage
Workers Comp
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
EPO
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
HMO
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
Medicaid
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
Medicare Part A
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
Medicare Part B
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
POS
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
PPO
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
tricare
Workers Comp
O
9051.34
1936.18
2455.02
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
EPO
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
EPO
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
HMO
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
HMO
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Medicaid
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Medicaid
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Medicare Part A
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Medicare Part A
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Medicare Part B
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Medicare Part B
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
POS
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
POS
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
PPO
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
PPO
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Workers Comp
I
921.56
220.44
220.44
552.45
552.94


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0321
null
revCode
Radiology Diagnostic Angiocardiography
va
Workers Comp
O
9051.34
1936.18
2534.31
2534.31
5430.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
EPO
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
HMO
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
Medicaid
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
Medicare Part A
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
Medicare Part B
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
POS
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
PPO
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield
Workers Comp
O
1252.12
200.59
258.56
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
EPO
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
HMO
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
Medicaid
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
Medicare Part A
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
Medicare Part B
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
POS
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
PPO
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
blue cross blue shield - medicare advantage
Workers Comp
O
1252.12
200.59
272.87
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
EPO
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
HMO
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
Medicaid
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
Medicare Part A
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
Medicare Part B
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
POS
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
PPO
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
humana - medicare advantage
Workers Comp
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
EPO
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
HMO
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
Medicaid
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
Medicare Part A
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
Medicare Part B
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
POS
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
PPO
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
tricare
Workers Comp
O
1252.12
200.59
338.27
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
EPO
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
HMO
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
Medicaid
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
Medicare Part A
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
Medicare Part B
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
POS
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
PPO
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0322
null
revCode
Radiology Diagnostic Arthrography
va
Workers Comp
O
1252.12
200.59
200.59
338.27
751.27


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
EPO
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
EPO
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
HMO
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
HMO
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Medicaid
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Medicaid
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Medicare Part A
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Medicare Part A
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Medicare Part B
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Medicare Part B
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
POS
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
POS
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
PPO
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
PPO
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Workers Comp
I
212.58
71.31
123.30
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna
Workers Comp
O
324.99
3.64
188.49
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
EPO
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
HMO
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
Medicaid
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
Medicare Part A
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
Medicare Part B
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
POS
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
PPO
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
aetna - medicare advantage
Workers Comp
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
EPO
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
HMO
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
Medicaid
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
Medicare Part A
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
Medicare Part B
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
POS
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
PPO
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield
Workers Comp
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
EPO
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
HMO
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
Medicaid
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
Medicare Part A
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
Medicare Part B
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
POS
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
PPO
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
blue cross blue shield - medicare advantage
Workers Comp
O
324.99
3.64
61.44
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
EPO
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
EPO
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
HMO
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
HMO
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Medicaid
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Medicaid
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Medicare Part A
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Medicare Part A
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Medicare Part B
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Medicare Part B
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
POS
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
POS
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
PPO
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
PPO
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Workers Comp
I
212.58
71.31
176.45
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
cigna
Workers Comp
O
324.99
3.64
216.97
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
EPO
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
HMO
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
Medicaid
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
Medicare Part A
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
Medicare Part B
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
POS
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
PPO
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
healthchoice
Workers Comp
O
324.99
3.64
3.64
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
EPO
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
EPO
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
HMO
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
HMO
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Medicaid
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Medicaid
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Medicare Part A
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Medicare Part A
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Medicare Part B
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Medicare Part B
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
POS
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
POS
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
PPO
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
PPO
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Workers Comp
I
212.58
71.31
212.58
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
humana - medicare advantage
Workers Comp
O
324.99
3.64
71.18
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
EPO
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
HMO
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
Medicaid
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
Medicare Part A
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
Medicare Part B
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
POS
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
PPO
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
medica
Workers Comp
O
324.99
3.64
120.25
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
EPO
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
HMO
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
Medicaid
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
Medicare Part A
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
Medicare Part B
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
POS
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
PPO
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
tricare
Workers Comp
O
324.99
3.64
70.70
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
EPO
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
EPO
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
HMO
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
HMO
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Medicaid
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Medicaid
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Medicare Part A
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Medicare Part A
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Medicare Part B
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Medicare Part B
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
POS
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
POS
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
PPO
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
PPO
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Workers Comp
I
212.58
71.31
151.84
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare
Workers Comp
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
EPO
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
HMO
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
Medicaid
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
Medicare Part A
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
Medicare Part B
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
POS
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
PPO
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
united healthcare - medicare advantage
Workers Comp
O
324.99
3.64
69.69
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
EPO
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
EPO
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
HMO
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
HMO
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Medicaid
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Medicaid
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Medicare Part A
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Medicare Part A
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Medicare Part B
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Medicare Part B
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
POS
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
POS
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
PPO
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
PPO
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Workers Comp
I
212.58
71.31
71.31
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
va
Workers Comp
O
324.99
3.64
71.65
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
EPO
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
HMO
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
Medicaid
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
Medicare Part A
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
Medicare Part B
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
POS
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
PPO
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
webtpa
Workers Comp
O
324.99
3.64
216.66
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
EPO
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
EPO
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
HMO
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
HMO
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Medicaid
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Medicaid
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Medicare Part A
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Medicare Part A
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Medicare Part B
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Medicare Part B
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
POS
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
POS
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
PPO
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
PPO
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Workers Comp
I
212.58
71.31
219.36
219.36
127.55


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0324
null
revCode
Radiology Diagnostic Chest X-ray
worker comp
Workers Comp
O
324.99
3.64
232.14
232.14
194.99


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
EPO
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
HMO
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
Medicaid
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
Medicare Part A
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
Medicare Part B
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
POS
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
PPO
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0330
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration General
united healthcare
Workers Comp
O
2058.52
1543.89
1543.89
1543.89
1235.11


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
EPO
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
HMO
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
Medicaid
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
Medicare Part A
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
Medicare Part B
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
POS
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
PPO
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna
Workers Comp
O
224.82
26.28
130.40
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
EPO
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
HMO
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
Medicaid
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
Medicare Part A
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
Medicare Part B
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
POS
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
PPO
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
aetna - medicare advantage
Workers Comp
O
224.82
26.28
26.28
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
EPO
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
HMO
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
Medicaid
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
Medicare Part A
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
Medicare Part B
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
POS
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
PPO
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield
Workers Comp
O
224.82
26.28
51.44
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
EPO
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
HMO
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
Medicaid
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
Medicare Part A
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
Medicare Part B
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
POS
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
PPO
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
blue cross blue shield - medicare advantage
Workers Comp
O
224.82
26.28
53.78
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
EPO
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
HMO
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
Medicaid
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
Medicare Part A
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
Medicare Part B
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
POS
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
PPO
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
cigna
Workers Comp
O
224.82
26.28
150.10
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
EPO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
HMO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
Medicaid
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
Medicare Part A
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
Medicare Part B
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
POS
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
PPO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
humana - medicare advantage
Workers Comp
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
EPO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
HMO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
Medicaid
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
Medicare Part A
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
Medicare Part B
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
POS
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
PPO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
tricare
Workers Comp
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
EPO
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
HMO
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
Medicaid
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
Medicare Part A
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
Medicare Part B
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
POS
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
PPO
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare
Workers Comp
O
224.82
26.28
176.89
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
EPO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
HMO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
Medicaid
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
Medicare Part A
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
Medicare Part B
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
POS
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
PPO
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
united healthcare - medicare advantage
Workers Comp
O
224.82
26.28
53.57
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
EPO
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
HMO
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
Medicaid
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
Medicare Part A
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
Medicare Part B
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
POS
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
PPO
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
va
Workers Comp
O
224.82
26.28
54.88
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
EPO
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
HMO
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
Medicaid
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
Medicare Part A
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
Medicare Part B
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
POS
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
PPO
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0331
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration - injection
webtpa
Workers Comp
O
224.82
26.28
3168.72
3168.72
134.89


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
EPO
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
HMO
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
Medicaid
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
Medicare Part A
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
Medicare Part B
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
POS
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
PPO
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna
Workers Comp
O
933.20
205.21
510.62
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
EPO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
HMO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
Medicaid
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
Medicare Part A
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
Medicare Part B
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
POS
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
PPO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
aetna - medicare advantage
Workers Comp
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
EPO
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
HMO
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
Medicaid
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
Medicare Part A
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
Medicare Part B
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
POS
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
PPO
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield
Workers Comp
O
933.20
205.21
660.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
EPO
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
HMO
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
Medicaid
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
Medicare Part A
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
Medicare Part B
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
POS
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
PPO
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
blue cross blue shield - medicare advantage
Workers Comp
O
933.20
205.21
585.95
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
EPO
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
HMO
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
Medicaid
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
Medicare Part A
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
Medicare Part B
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
POS
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
PPO
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
cigna
Workers Comp
O
933.20
205.21
622.98
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
EPO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
HMO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
Medicaid
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
Medicare Part A
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
Medicare Part B
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
POS
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
PPO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
humana - medicare advantage
Workers Comp
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
EPO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
HMO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
Medicaid
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
Medicare Part A
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
Medicare Part B
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
POS
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
PPO
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
tricare
Workers Comp
O
933.20
205.21
214.04
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
EPO
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
HMO
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
Medicaid
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
Medicare Part A
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
Medicare Part B
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
POS
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
PPO
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare
Workers Comp
O
933.20
205.21
716.28
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
EPO
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
HMO
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
Medicaid
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
Medicare Part A
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
Medicare Part B
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
POS
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
PPO
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
united healthcare - medicare advantage
Workers Comp
O
933.20
205.21
205.21
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
EPO
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
HMO
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
Medicaid
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
Medicare Part A
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
Medicare Part B
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
POS
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
PPO
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
va
Workers Comp
O
933.20
205.21
480.49
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
EPO
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
HMO
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
Medicaid
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
Medicare Part A
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
Medicare Part B
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
POS
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
PPO
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
webtpa
Workers Comp
O
933.20
205.21
1454.16
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
EPO
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
HMO
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
Medicaid
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
Medicare Part A
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
Medicare Part B
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
POS
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
PPO
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0333
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Radiation therapy
worker comp
Workers Comp
O
933.20
205.21
628.85
1454.16
559.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
EPO
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
HMO
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
Medicaid
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
Medicare Part A
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
Medicare Part B
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
POS
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
PPO
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna
Workers Comp
O
481.24
83.56
132.33
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
EPO
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
HMO
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
Medicaid
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
Medicare Part A
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
Medicare Part B
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
POS
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
PPO
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
aetna - medicare advantage
Workers Comp
O
481.24
83.56
275.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
EPO
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
HMO
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
Medicaid
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
Medicare Part A
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
Medicare Part B
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
POS
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
PPO
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield
Workers Comp
O
481.24
83.56
104.22
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
EPO
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
HMO
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
Medicaid
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
Medicare Part A
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
Medicare Part B
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
POS
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
PPO
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
blue cross blue shield - medicare advantage
Workers Comp
O
481.24
83.56
83.56
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
EPO
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
HMO
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
Medicaid
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
Medicare Part A
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
Medicare Part B
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
POS
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
PPO
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
cigna
Workers Comp
O
481.24
83.56
331.41
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
EPO
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
HMO
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
Medicaid
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
Medicare Part A
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
Medicare Part B
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
POS
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
PPO
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
humana - medicare advantage
Workers Comp
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
EPO
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
HMO
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
Medicaid
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
Medicare Part A
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
Medicare Part B
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
POS
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
PPO
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
tricare
Workers Comp
O
481.24
83.56
274.27
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
EPO
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
HMO
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
Medicaid
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
Medicare Part A
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
Medicare Part B
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
POS
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
PPO
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare
Workers Comp
O
481.24
83.56
348.21
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
EPO
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
HMO
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
Medicaid
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
Medicare Part A
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
Medicare Part B
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
POS
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
PPO
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
united healthcare - medicare advantage
Workers Comp
O
481.24
83.56
269.89
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
EPO
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
HMO
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
Medicaid
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
Medicare Part A
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
Medicare Part B
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
POS
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
PPO
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
va
Workers Comp
O
481.24
83.56
127.39
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
EPO
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
HMO
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
Medicaid
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
Medicare Part A
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
Medicare Part B
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
POS
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
PPO
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0335
null
revCode
Radiology Therapeutic and/of Chemotherapy Administration Chemotherapy administration -IV
webtpa
Workers Comp
O
481.24
83.56
10843.32
10843.32
288.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
EPO
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
HMO
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
Medicaid
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
Medicare Part A
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
Medicare Part B
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
POS
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
PPO
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0340
null
revCode
Nuclear Medicine General
blue cross blue shield
Workers Comp
O
1708.12
1195.84
1195.84
1195.84
1024.87


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
EPO
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
HMO
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
Medicaid
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
Medicare Part A
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
Medicare Part B
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
POS
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
PPO
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna
Workers Comp
O
5253.36
920.97
2951.89
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
EPO
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
HMO
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
Medicaid
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
Medicare Part A
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
Medicare Part B
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
POS
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
PPO
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
aetna - medicare advantage
Workers Comp
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
EPO
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
HMO
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
Medicaid
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
Medicare Part A
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
Medicare Part B
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
POS
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
PPO
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield
Workers Comp
O
5253.36
920.97
995.51
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
EPO
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
HMO
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
Medicaid
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
Medicare Part A
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
Medicare Part B
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
POS
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
PPO
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
blue cross blue shield - medicare advantage
Workers Comp
O
5253.36
920.97
920.97
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
EPO
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
HMO
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
Medicaid
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
Medicare Part A
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
Medicare Part B
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
POS
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
PPO
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
cigna
Workers Comp
O
5253.36
920.97
3507.24
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
EPO
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
HMO
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
Medicaid
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
Medicare Part A
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
Medicare Part B
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
POS
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
PPO
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
humana - medicare advantage
Workers Comp
O
5253.36
920.97
1156.59
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
EPO
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
HMO
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
Medicaid
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
Medicare Part A
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
Medicare Part B
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
POS
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
PPO
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
tricare
Workers Comp
O
5253.36
920.97
1127.01
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
EPO
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
EPO
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
HMO
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
HMO
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Medicaid
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Medicaid
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Medicare Part A
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Medicare Part A
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Medicare Part B
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Medicare Part B
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
POS
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
POS
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
PPO
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
PPO
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Workers Comp
I
5003.20
1572.40
2906.52
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare
Workers Comp
O
5253.36
920.97
3752.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
EPO
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
HMO
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
Medicaid
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
Medicare Part A
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
Medicare Part B
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
POS
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
PPO
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
united healthcare - medicare advantage
Workers Comp
O
5253.36
920.97
1255.91
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
EPO
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
EPO
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
HMO
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
HMO
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Medicaid
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Medicaid
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Medicare Part A
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Medicare Part A
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Medicare Part B
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Medicare Part B
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
POS
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
POS
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
PPO
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
PPO
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Workers Comp
I
5003.20
1572.40
1572.40
2906.52
3001.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
va
Workers Comp
O
5253.36
920.97
1156.55
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
EPO
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
HMO
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
Medicaid
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
Medicare Part A
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
Medicare Part B
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
POS
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
PPO
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
webtpa
Workers Comp
O
5253.36
920.97
3805.40
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
EPO
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
HMO
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
Medicaid
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
Medicare Part A
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
Medicare Part B
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
POS
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
PPO
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0341
null
revCode
Nuclear Medicine Diagnostic
worker comp
Workers Comp
O
5253.36
920.97
5091.98
5091.98
3152.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
EPO
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
HMO
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
Medicaid
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
Medicare Part A
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
Medicare Part B
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
POS
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
PPO
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
blue cross blue shield - medicare advantage
Workers Comp
O
548.70
210.31
494.33
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
EPO
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
HMO
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
Medicaid
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
Medicare Part A
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
Medicare Part B
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
POS
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
PPO
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0342
null
revCode
Nuclear Medicine Therapeutic
humana - medicare advantage
Workers Comp
O
548.70
210.31
210.31
494.33
329.22


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
EPO
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
HMO
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
Medicaid
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
Medicare Part A
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
Medicare Part B
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
POS
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
PPO
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna
Workers Comp
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
EPO
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
HMO
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
Medicaid
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
Medicare Part A
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
Medicare Part B
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
POS
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
PPO
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
aetna - medicare advantage
Workers Comp
O
653.33
123.81
367.11
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
EPO
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
HMO
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
Medicaid
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
Medicare Part A
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
Medicare Part B
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
POS
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
PPO
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield
Workers Comp
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
EPO
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
HMO
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
Medicaid
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
Medicare Part A
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
Medicare Part B
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
POS
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
PPO
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
blue cross blue shield - medicare advantage
Workers Comp
O
653.33
123.81
123.81
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
EPO
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
EPO
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
HMO
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
HMO
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Medicaid
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Medicaid
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Medicare Part A
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Medicare Part A
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Medicare Part B
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Medicare Part B
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
POS
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
POS
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
PPO
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
PPO
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Workers Comp
I
637.78
195.55
308.06
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
united healthcare
Workers Comp
O
653.33
123.81
466.67
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
EPO
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
EPO
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
HMO
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
HMO
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Medicaid
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Medicaid
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Medicare Part A
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Medicare Part A
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Medicare Part B
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Medicare Part B
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
POS
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
POS
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
PPO
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
PPO
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Workers Comp
I
637.78
195.55
195.55
308.06
382.67


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
va
Workers Comp
O
653.33
123.81
622.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
EPO
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
HMO
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
Medicaid
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
Medicare Part A
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
Medicare Part B
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
POS
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
PPO
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
webtpa
Workers Comp
O
653.33
123.81
2513.99
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
EPO
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
HMO
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
Medicaid
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
Medicare Part A
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
Medicare Part B
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
POS
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
PPO
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0343
null
revCode
Nuclear Medicine Diagnostic radiopharmaceuticals
worker comp
Workers Comp
O
653.33
123.81
1046.22
2513.99
392.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
EPO
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
HMO
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
Medicaid
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
Medicare Part A
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
Medicare Part B
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
POS
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
PPO
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0344
null
revCode
Nuclear Medicine Therapeutic radiopharmaceuticals
humana - medicare advantage
Workers Comp
O
461.89
103.51
103.51
103.51
277.13


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
EPO
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
HMO
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
Medicaid
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
Medicare Part A
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
Medicare Part B
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
POS
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
PPO
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
035
null
ms-drg
carotid artery stent procedures with cc
humana - medicare advantage
Workers Comp
I
50323.37
14428.53
14428.53
14428.53
30194.02


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
EPO
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
EPO
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
HMO
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
HMO
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Medicaid
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Medicaid
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Medicare Part A
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Medicare Part A
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Medicare Part B
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Medicare Part B
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
POS
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
POS
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
PPO
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
PPO
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Workers Comp
I
3199.87
815.07
1855.92
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna
Workers Comp
O
3199.87
326.01
1798.03
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
EPO
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
HMO
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
Medicaid
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
Medicare Part A
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
Medicare Part B
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
POS
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
PPO
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
aetna - medicare advantage
Workers Comp
O
3199.87
326.01
326.37
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
EPO
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
HMO
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
Medicaid
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
Medicare Part A
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
Medicare Part B
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
POS
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
PPO
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield
Workers Comp
O
3199.87
326.01
546.57
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
EPO
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
HMO
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
Medicaid
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
Medicare Part A
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
Medicare Part B
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
POS
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
PPO
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
blue cross blue shield - medicare advantage
Workers Comp
O
3199.87
326.01
549.90
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
EPO
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
EPO
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
HMO
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
HMO
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Medicaid
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Medicaid
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Medicare Part A
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Medicare Part A
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Medicare Part B
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Medicare Part B
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
POS
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
POS
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
PPO
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
PPO
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Workers Comp
I
3199.87
815.07
1804.25
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
cigna
Workers Comp
O
3199.87
326.01
2136.30
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
EPO
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
EPO
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
HMO
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
HMO
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Medicaid
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Medicaid
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Medicare Part A
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Medicare Part A
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Medicare Part B
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Medicare Part B
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
POS
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
POS
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
PPO
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
PPO
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Workers Comp
I
3199.87
815.07
2526.39
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
humana - medicare advantage
Workers Comp
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
EPO
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
HMO
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
Medicaid
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
Medicare Part A
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
Medicare Part B
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
POS
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
PPO
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
tricare
Workers Comp
O
3199.87
326.01
338.27
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
EPO
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
HMO
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
Medicaid
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
Medicare Part A
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
Medicare Part B
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
POS
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
PPO
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare
Workers Comp
O
3199.87
326.01
2285.63
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
EPO
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
HMO
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
Medicaid
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
Medicare Part A
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
Medicare Part B
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
POS
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
PPO
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
united healthcare - medicare advantage
Workers Comp
O
3199.87
326.01
331.51
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
EPO
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
EPO
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
HMO
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
HMO
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Medicaid
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Medicaid
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Medicare Part A
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Medicare Part A
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Medicare Part B
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Medicare Part B
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
POS
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
POS
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
PPO
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
PPO
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Workers Comp
I
3199.87
815.07
815.07
2526.39
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
va
Workers Comp
O
3199.87
326.01
326.01
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
EPO
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
HMO
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
Medicaid
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
Medicare Part A
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
Medicare Part B
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
POS
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
PPO
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0350
null
revCode
CT Scan General
webtpa
Workers Comp
O
3199.87
326.01
2032.95
2285.63
1919.92


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
EPO
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
EPO
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
HMO
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
HMO
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Medicaid
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Medicaid
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Medicare Part A
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Medicare Part A
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Medicare Part B
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Medicare Part B
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
POS
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
POS
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
PPO
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
PPO
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Workers Comp
I
2313.92
668.00
1321.14
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna
Workers Comp
O
1879.85
97.90
741.10
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
EPO
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
HMO
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
Medicaid
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
Medicare Part A
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
Medicare Part B
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
POS
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
PPO
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
aetna - medicare advantage
Workers Comp
O
1879.85
97.90
192.46
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
EPO
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
HMO
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
Medicaid
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
Medicare Part A
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
Medicare Part B
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
POS
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
PPO
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield
Workers Comp
O
1879.85
97.90
401.11
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
EPO
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
HMO
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
Medicaid
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
Medicare Part A
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
Medicare Part B
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
POS
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
PPO
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
blue cross blue shield - medicare advantage
Workers Comp
O
1879.85
97.90
228.66
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
EPO
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
HMO
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
Medicaid
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
Medicare Part A
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
Medicare Part B
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
POS
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
PPO
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
cigna
Workers Comp
I
2313.92
668.00
1817.21
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
EPO
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
EPO
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
HMO
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
HMO
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Medicaid
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Medicaid
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Medicare Part A
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Medicare Part A
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Medicare Part B
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Medicare Part B
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
POS
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
POS
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
PPO
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
PPO
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Workers Comp
I
2313.92
668.00
2313.92
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
humana - medicare advantage
Workers Comp
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
EPO
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
HMO
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
Medicaid
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
Medicare Part A
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
Medicare Part B
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
POS
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
PPO
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
tricare
Workers Comp
O
1879.85
97.90
99.29
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
EPO
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
HMO
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
Medicaid
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
Medicare Part A
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
Medicare Part B
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
POS
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
PPO
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare
Workers Comp
O
1879.85
97.90
1424.09
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
EPO
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
HMO
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
Medicaid
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
Medicare Part A
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
Medicare Part B
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
POS
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
PPO
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
united healthcare - medicare advantage
Workers Comp
O
1879.85
97.90
97.90
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
EPO
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
EPO
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
HMO
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
HMO
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Medicaid
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Medicaid
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Medicare Part A
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Medicare Part A
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Medicare Part B
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Medicare Part B
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
POS
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
POS
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
PPO
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
PPO
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Workers Comp
I
2313.92
668.00
668.00
2313.92
1388.35


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
va
Workers Comp
O
1879.85
97.90
108.04
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
EPO
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
HMO
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
Medicaid
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
Medicare Part A
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
Medicare Part B
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
POS
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
PPO
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0351
null
revCode
CT Scan Head scan
webtpa
Workers Comp
O
1879.85
97.90
796.91
1424.09
1127.91


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
EPO
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
EPO
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
HMO
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
HMO
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Medicaid
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Medicaid
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Medicare Part A
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Medicare Part A
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Medicare Part B
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Medicare Part B
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
POS
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
POS
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
PPO
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
PPO
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Workers Comp
I
1673.95
540.61
970.89
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna
Workers Comp
O
1594.24
47.08
955.75
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
EPO
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
HMO
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
Medicaid
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
Medicare Part A
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
Medicare Part B
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
POS
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
PPO
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
aetna - medicare advantage
Workers Comp
O
1594.24
47.08
159.82
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
EPO
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
HMO
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
Medicaid
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
Medicare Part A
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
Medicare Part B
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
POS
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
PPO
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield
Workers Comp
O
1594.24
47.08
405.24
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
EPO
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
HMO
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
Medicaid
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
Medicare Part A
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
Medicare Part B
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
POS
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
PPO
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
blue cross blue shield - medicare advantage
Workers Comp
O
1594.24
47.08
454.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
EPO
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
HMO
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
Medicaid
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
Medicare Part A
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
Medicare Part B
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
POS
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
PPO
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
cigna
Workers Comp
O
1594.24
47.08
1117.56
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
EPO
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
HMO
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
Medicaid
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
Medicare Part A
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
Medicare Part B
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
POS
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
PPO
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
healthchoice
Workers Comp
O
1594.24
47.08
47.08
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
EPO
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
EPO
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
HMO
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
HMO
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Medicaid
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Medicaid
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Medicare Part A
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Medicare Part A
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Medicare Part B
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Medicare Part B
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
POS
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
POS
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
PPO
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
PPO
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Workers Comp
I
1673.95
540.61
1512.97
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
humana - medicare advantage
Workers Comp
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
EPO
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
HMO
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
Medicaid
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
Medicare Part A
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
Medicare Part B
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
POS
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
PPO
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
tricare
Workers Comp
O
1594.24
47.08
99.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
EPO
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
EPO
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
HMO
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
HMO
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Medicaid
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Medicaid
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Medicare Part A
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Medicare Part A
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Medicare Part B
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Medicare Part B
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
POS
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
POS
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
PPO
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
PPO
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Workers Comp
I
1673.95
540.61
1205.62
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare
Workers Comp
O
1594.24
47.08
1195.68
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
EPO
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
HMO
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
Medicaid
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
Medicare Part A
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
Medicare Part B
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
POS
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
PPO
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
united healthcare - medicare advantage
Workers Comp
O
1594.24
47.08
130.36
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
EPO
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
EPO
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
HMO
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
HMO
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Medicaid
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Medicaid
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Medicare Part A
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Medicare Part A
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Medicare Part B
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Medicare Part B
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
POS
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
POS
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
PPO
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
PPO
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Workers Comp
I
1673.95
540.61
540.61
1512.97
1004.37


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
va
Workers Comp
O
1594.24
47.08
119.90
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
EPO
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
HMO
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
Medicaid
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
Medicare Part A
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
Medicare Part B
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
POS
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
PPO
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa
Workers Comp
O
1594.24
47.08
1092.29
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
EPO
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
HMO
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
Medicaid
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
Medicare Part A
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
Medicare Part B
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
POS
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
PPO
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
webtpa - medicare advantage
Workers Comp
O
1594.24
47.08
1382.86
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
EPO
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
HMO
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
Medicaid
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
Medicare Part A
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
Medicare Part B
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
POS
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
PPO
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0352
null
revCode
CT Scan Body scan
worker comp
Workers Comp
O
1594.24
47.08
1068.88
1382.86
956.54


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
EPO
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
HMO
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicaid
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part A
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
Medicare Part B
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
POS
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
PPO
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
blue cross blue shield - medicare advantage
Workers Comp
I
43613.42
11980.78
20336.07
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
EPO
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
HMO
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
Medicaid
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
POS
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
PPO
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
036
null
ms-drg
carotid artery stent procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
43613.42
11980.78
11980.78
20336.07
26168.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
EPO
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
HMO
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
Medicaid
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
Medicare Part A
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
Medicare Part B
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
POS
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
PPO
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna
Workers Comp
O
9091.27
1841.32
4789.34
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
EPO
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
HMO
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
Medicaid
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
Medicare Part A
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
Medicare Part B
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
POS
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
PPO
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
aetna - medicare advantage
Workers Comp
O
9091.27
1841.32
2494.71
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
EPO
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
HMO
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
Medicaid
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
Medicare Part A
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
Medicare Part B
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
POS
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
PPO
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield
Workers Comp
O
9091.27
1841.32
2734.85
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
EPO
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
HMO
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
Medicaid
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
Medicare Part A
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
Medicare Part B
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
POS
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
PPO
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
blue cross blue shield - medicare advantage
Workers Comp
O
9091.27
1841.32
2227.69
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
EPO
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
EPO
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
HMO
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
HMO
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Medicaid
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Medicaid
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Medicare Part A
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Medicare Part A
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Medicare Part B
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Medicare Part B
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
POS
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
POS
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
PPO
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
PPO
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Workers Comp
I
1060.08
160.22
1122.93
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
cigna
Workers Comp
O
9091.27
1841.32
8493.00
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
EPO
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
HMO
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
Medicaid
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
Medicare Part A
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
Medicare Part B
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
POS
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
PPO
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
geha
Workers Comp
O
9091.27
1841.32
7560.45
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
EPO
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
EPO
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
HMO
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
HMO
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Medicaid
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Medicaid
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Medicare Part A
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Medicare Part A
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Medicare Part B
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Medicare Part B
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
POS
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
POS
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
PPO
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
PPO
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Workers Comp
I
1060.08
160.22
160.22
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
humana - medicare advantage
Workers Comp
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
EPO
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
HMO
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
Medicaid
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
Medicare Part A
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
Medicare Part B
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
POS
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
PPO
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
tricare
Workers Comp
O
9091.27
1841.32
2683.82
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
EPO
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
HMO
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
Medicaid
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
Medicare Part A
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
Medicare Part B
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
POS
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
PPO
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare
Workers Comp
O
9091.27
1841.32
5739.63
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
EPO
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
HMO
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
Medicaid
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
Medicare Part A
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
Medicare Part B
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
POS
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
PPO
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
united healthcare - medicare advantage
Workers Comp
O
9091.27
1841.32
2455.02
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
EPO
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
EPO
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
HMO
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
HMO
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Medicaid
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Medicaid
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Medicare Part A
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Medicare Part A
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Medicare Part B
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Medicare Part B
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
POS
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
POS
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
PPO
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
PPO
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Workers Comp
I
1060.08
160.22
228.75
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
va
Workers Comp
O
9091.27
1841.32
1841.32
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
EPO
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
HMO
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
Medicaid
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
Medicare Part A
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
Medicare Part B
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
POS
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
PPO
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
webtpa
Workers Comp
O
9091.27
1841.32
13256.75
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
EPO
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
EPO
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
HMO
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
HMO
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Medicaid
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Medicaid
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Medicare Part A
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Medicare Part A
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Medicare Part B
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Medicare Part B
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
POS
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
POS
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
PPO
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
PPO
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Workers Comp
I
1060.08
160.22
585.37
1122.93
636.05


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0360
null
revCode
Operating Room Services General
worker comp
Workers Comp
O
9091.27
1841.32
7016.67
13256.75
5454.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
EPO
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
HMO
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
Medicaid
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
Medicare Part A
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
Medicare Part B
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
POS
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
PPO
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna
Workers Comp
O
1965.24
271.88
418.92
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
EPO
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
HMO
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
Medicaid
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
Medicare Part A
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
Medicare Part B
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
POS
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
PPO
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
aetna - medicare advantage
Workers Comp
O
1965.24
271.88
355.49
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
EPO
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
HMO
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
Medicaid
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
Medicare Part A
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
Medicare Part B
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
POS
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
PPO
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield
Workers Comp
O
1965.24
271.88
614.10
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
EPO
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
HMO
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
Medicaid
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
Medicare Part A
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
Medicare Part B
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
POS
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
PPO
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
blue cross blue shield - medicare advantage
Workers Comp
O
1965.24
271.88
271.88
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
EPO
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
HMO
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
Medicaid
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
Medicare Part A
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
Medicare Part B
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
POS
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
PPO
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
cigna
Workers Comp
I
1952.48
276.63
2461.02
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
EPO
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
HMO
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
Medicaid
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
Medicare Part A
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
Medicare Part B
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
POS
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
PPO
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
humana - medicare advantage
Workers Comp
O
1965.24
271.88
859.60
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
EPO
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
HMO
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
Medicaid
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
Medicare Part A
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
Medicare Part B
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
POS
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
PPO
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
tricare
Workers Comp
O
1965.24
271.88
550.84
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
EPO
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
HMO
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
Medicaid
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
Medicare Part A
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
Medicare Part B
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
POS
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
PPO
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare
Workers Comp
O
1965.24
271.88
484.50
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
EPO
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
HMO
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
Medicaid
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
Medicare Part A
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
Medicare Part B
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
POS
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
PPO
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
united healthcare - medicare advantage
Workers Comp
O
1965.24
271.88
1162.46
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
EPO
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
EPO
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
HMO
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
HMO
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Medicaid
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Medicaid
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Medicare Part A
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Medicare Part A
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Medicare Part B
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Medicare Part B
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
POS
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
POS
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
PPO
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
PPO
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Workers Comp
I
1952.48
276.63
276.63
2461.02
1171.49


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
va
Workers Comp
O
1965.24
271.88
716.99
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
EPO
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
HMO
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
Medicaid
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
Medicare Part A
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
Medicare Part B
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
POS
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
PPO
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0361
null
revCode
Operating Room Services Minor surgery
webtpa
Workers Comp
O
1965.24
271.88
2026.55
2026.55
1179.14


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
EPO
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
EPO
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
HMO
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
HMO
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Medicaid
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Medicaid
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Medicare Part A
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Medicare Part A
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Medicare Part B
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Medicare Part B
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
POS
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
POS
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
PPO
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
PPO
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Workers Comp
I
798.00
181.60
186.37
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
aetna
Workers Comp
O
645.54
191.58
318.37
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
EPO
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
HMO
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
Medicaid
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
Medicare Part A
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
Medicare Part B
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
POS
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
PPO
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield
Workers Comp
O
645.54
191.58
218.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
EPO
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
HMO
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
Medicaid
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
Medicare Part A
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
Medicare Part B
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
POS
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
PPO
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
blue cross blue shield - medicare advantage
Workers Comp
O
645.54
191.58
191.58
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
EPO
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
EPO
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
HMO
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
HMO
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Medicaid
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Medicaid
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Medicare Part A
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Medicare Part A
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Medicare Part B
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Medicare Part B
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
POS
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
POS
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
PPO
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
PPO
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Workers Comp
I
798.00
181.60
357.17
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
cigna
Workers Comp
O
645.54
191.58
607.22
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
EPO
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
HMO
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
Medicaid
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
Medicare Part A
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
Medicare Part B
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
POS
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
PPO
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
geha
Workers Comp
O
645.54
191.58
527.09
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
EPO
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
EPO
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
HMO
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
HMO
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Medicaid
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Medicaid
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Medicare Part A
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Medicare Part A
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Medicare Part B
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Medicare Part B
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
POS
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
POS
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
PPO
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
PPO
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Workers Comp
I
798.00
181.60
707.85
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
humana - medicare advantage
Workers Comp
O
645.54
191.58
591.03
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
EPO
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
EPO
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
HMO
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
HMO
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Medicaid
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Medicaid
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Medicare Part A
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Medicare Part A
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Medicare Part B
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Medicare Part B
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
POS
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
POS
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
PPO
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
PPO
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Workers Comp
I
798.00
181.60
478.39
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
united healthcare
Workers Comp
O
645.54
191.58
441.23
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
EPO
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
EPO
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
HMO
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
HMO
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Medicaid
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Medicaid
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Medicare Part A
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Medicare Part A
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Medicare Part B
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Medicare Part B
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
POS
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
POS
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
PPO
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
PPO
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Workers Comp
I
798.00
181.60
181.60
707.85
478.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
va
Workers Comp
O
645.54
191.58
645.54
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
EPO
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
HMO
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
Medicaid
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
Medicare Part A
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
Medicare Part B
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
POS
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
PPO
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0370
null
revCode
Anesthesia General
worker comp
Workers Comp
O
645.54
191.58
484.16
645.54
387.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
EPO
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
HMO
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
Medicaid
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
Medicare Part A
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
Medicare Part B
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
POS
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
PPO
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
aetna
Workers Comp
I
44.52
7.65
26.90
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
EPO
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
HMO
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
Medicaid
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
Medicare Part A
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
Medicare Part B
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
POS
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
PPO
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield
Workers Comp
O
44.52
9.62
9.62
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
EPO
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
HMO
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
Medicaid
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
Medicare Part A
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
Medicare Part B
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
POS
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
PPO
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
blue cross blue shield - medicare advantage
Workers Comp
O
44.52
9.62
15.72
15.72
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
EPO
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
HMO
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
Medicaid
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
Medicare Part A
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
Medicare Part B
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
POS
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
PPO
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
humana - medicare advantage
Workers Comp
I
44.52
7.65
44.52
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
EPO
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
HMO
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
Medicaid
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
Medicare Part A
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
Medicare Part B
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
POS
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
PPO
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
united healthcare
Workers Comp
I
44.52
7.65
31.80
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
EPO
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
HMO
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
Medicaid
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
Medicare Part A
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
Medicare Part B
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
POS
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
PPO
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0371
null
revCode
Anesthesia Incident to radiology
va
Workers Comp
I
44.52
7.65
7.65
44.52
26.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
EPO
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
HMO
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
Medicaid
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
Medicare Part A
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
Medicare Part B
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
POS
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
PPO
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
aetna
Workers Comp
O
42.40
19.41
25.02
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
EPO
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
HMO
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
Medicaid
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
Medicare Part A
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
Medicare Part B
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
POS
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
PPO
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield
Workers Comp
O
42.40
19.41
19.41
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
EPO
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
HMO
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
Medicaid
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
Medicare Part A
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
Medicare Part B
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
POS
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
PPO
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
blue cross blue shield - medicare advantage
Workers Comp
O
42.40
19.41
27.27
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
EPO
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
HMO
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
Medicaid
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
Medicare Part A
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
Medicare Part B
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
POS
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
PPO
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
cigna
Workers Comp
O
42.40
19.41
29.72
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
EPO
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
HMO
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
Medicaid
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
Medicare Part A
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
Medicare Part B
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
POS
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
PPO
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0372
null
revCode
Anesthesia incident to Other Diagnostic services
va
Workers Comp
O
42.40
19.41
42.40
42.40
25.44


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
EPO
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
HMO
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
Medicaid
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
Medicare Part A
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
Medicare Part B
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
POS
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
PPO
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
038
null
ms-drg
extracranial procedures with cc
humana - medicare advantage
Workers Comp
I
31824.37
9969.85
9969.85
9969.85
19094.62


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
EPO
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
HMO
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
Medicaid
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
Medicare Part A
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
Medicare Part B
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
POS
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
PPO
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
blue cross blue shield
Workers Comp
I
25973.02
7469.73
9339.77
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
EPO
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
HMO
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
Medicaid
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
Medicare Part A
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
Medicare Part B
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
POS
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
PPO
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
humana - medicare advantage
Workers Comp
I
25973.02
7469.73
7469.73
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
EPO
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
HMO
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
Medicaid
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
Medicare Part A
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
Medicare Part B
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
POS
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
PPO
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
039
null
ms-drg
extracranial procedures without cc/mcc
va
Workers Comp
I
25973.02
7469.73
7515.30
9339.77
15583.81


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
EPO
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
HMO
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
Medicaid
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
Medicare Part A
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
Medicare Part B
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
POS
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
PPO
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
aetna - medicare advantage
Workers Comp
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
EPO
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
HMO
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
Medicaid
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
Medicare Part A
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
Medicare Part B
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
POS
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
PPO
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield
Workers Comp
O
713.43
188.35
574.90
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
EPO
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
HMO
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
Medicaid
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
Medicare Part A
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
Medicare Part B
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
POS
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
PPO
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
blue cross blue shield - medicare advantage
Workers Comp
O
713.43
188.35
462.20
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
EPO
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
HMO
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
Medicaid
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
Medicare Part A
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
Medicare Part B
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
POS
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
PPO
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
cigna
Workers Comp
I
714.50
139.98
505.60
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
EPO
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
EPO
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
HMO
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
HMO
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Medicaid
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Medicaid
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Medicare Part A
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Medicare Part A
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Medicare Part B
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Medicare Part B
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
POS
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
POS
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
PPO
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
PPO
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Workers Comp
I
714.50
139.98
220.37
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
humana - medicare advantage
Workers Comp
O
713.43
188.35
262.76
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
EPO
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
HMO
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
Medicaid
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
Medicare Part A
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
Medicare Part B
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
POS
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
PPO
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
tricare
Workers Comp
O
713.43
188.35
188.35
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
EPO
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
EPO
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
HMO
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
HMO
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Medicaid
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Medicaid
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Medicare Part A
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Medicare Part A
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Medicare Part B
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Medicare Part B
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
POS
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
POS
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
PPO
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
PPO
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Workers Comp
I
714.50
139.98
139.98
505.60
428.70


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0390
null
revCode
Administration Processing and Storage for Blood and Blood Components General
va
Workers Comp
O
713.43
188.35
665.38
665.38
428.06


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
EPO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
HMO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
Medicaid
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
Medicare Part A
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
Medicare Part B
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
POS
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
PPO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna
Workers Comp
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
EPO
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
HMO
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
Medicaid
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
Medicare Part A
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
Medicare Part B
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
POS
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
PPO
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
aetna - medicare advantage
Workers Comp
O
463.00
280.77
351.65
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
EPO
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
HMO
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
Medicaid
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
Medicare Part A
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
Medicare Part B
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
POS
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
PPO
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield
Workers Comp
O
463.00
280.77
304.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
EPO
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
HMO
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
Medicaid
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
Medicare Part A
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
Medicare Part B
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
POS
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
PPO
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
blue cross blue shield - medicare advantage
Workers Comp
O
463.00
280.77
280.77
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
EPO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
HMO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
Medicaid
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
Medicare Part A
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
Medicare Part B
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
POS
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
PPO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
humana - medicare advantage
Workers Comp
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
EPO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
HMO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
Medicaid
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
Medicare Part A
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
Medicare Part B
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
POS
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
PPO
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
tricare
Workers Comp
O
463.00
280.77
343.76
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
EPO
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
EPO
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
HMO
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
HMO
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Medicaid
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Medicaid
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Medicare Part A
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Medicare Part A
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Medicare Part B
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Medicare Part B
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
POS
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
POS
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
PPO
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
PPO
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Workers Comp
I
490.78
109.96
109.96
109.96
294.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0391
null
revCode
Administration Processing and Storage for Blood and Blood Components Administration (e.g. transfusions)
va
Workers Comp
O
463.00
280.77
407.32
407.32
277.80


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
EPO
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
HMO
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
Medicaid
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
Medicare Part A
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
Medicare Part B
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
POS
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
PPO
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
aetna - medicare advantage
Workers Comp
O
253.34
80.51
82.93
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
EPO
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
HMO
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
Medicaid
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
Medicare Part A
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
Medicare Part B
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
POS
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
PPO
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield
Workers Comp
O
253.34
80.51
107.77
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
EPO
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
HMO
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
Medicaid
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
Medicare Part A
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
Medicare Part B
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
POS
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
PPO
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
blue cross blue shield - medicare advantage
Workers Comp
O
253.34
80.51
115.62
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
EPO
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
HMO
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
Medicaid
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
Medicare Part A
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
Medicare Part B
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
POS
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
PPO
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
humana - medicare advantage
Workers Comp
O
253.34
80.51
80.51
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
EPO
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
HMO
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
Medicaid
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
Medicare Part A
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
Medicare Part B
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
POS
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
PPO
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
tricare
Workers Comp
O
253.34
80.51
93.39
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
EPO
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
HMO
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
Medicaid
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
Medicare Part A
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
Medicare Part B
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
POS
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
PPO
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare
Workers Comp
O
253.34
80.51
186.43
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
EPO
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
HMO
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
Medicaid
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
Medicare Part A
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
Medicare Part B
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
POS
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
PPO
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
united healthcare - medicare advantage
Workers Comp
O
253.34
80.51
82.10
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
EPO
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
HMO
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
Medicaid
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
Medicare Part A
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
Medicare Part B
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
POS
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
PPO
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
va
Workers Comp
O
253.34
80.51
91.73
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
EPO
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
HMO
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
Medicaid
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
Medicare Part A
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
Medicare Part B
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
POS
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
PPO
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0401
null
revCode
Other Imaging Services Diagnostic mammography
webtpa
Workers Comp
O
253.34
80.51
177.87
186.43
152.00


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
EPO
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
EPO
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
HMO
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
HMO
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Medicaid
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Medicaid
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Medicare Part A
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Medicare Part A
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Medicare Part B
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Medicare Part B
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
POS
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
POS
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
PPO
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
PPO
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Workers Comp
I
670.02
147.85
204.64
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna
Workers Comp
O
549.08
84.08
334.39
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
EPO
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
HMO
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
Medicaid
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
Medicare Part A
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
Medicare Part B
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
POS
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
PPO
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
aetna - medicare advantage
Workers Comp
O
549.08
84.08
84.08
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
EPO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
HMO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
Medicaid
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
Medicare Part A
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
Medicare Part B
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
POS
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
PPO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield
Workers Comp
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
EPO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
HMO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
Medicaid
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
Medicare Part A
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
Medicare Part B
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
POS
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
PPO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
blue cross blue shield - medicare advantage
Workers Comp
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
EPO
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
HMO
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
Medicaid
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
Medicare Part A
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
Medicare Part B
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
POS
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
PPO
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
cigna
Workers Comp
O
549.08
84.08
396.44
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
EPO
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
HMO
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
Medicaid
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
Medicare Part A
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
Medicare Part B
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
POS
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
PPO
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
geha
Workers Comp
O
549.08
84.08
268.72
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
EPO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
HMO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
Medicaid
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
Medicare Part A
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
Medicare Part B
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
POS
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
PPO
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
healthchoice
Workers Comp
O
549.08
84.08
216.32
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
EPO
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
HMO
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
Medicaid
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
Medicare Part A
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
Medicare Part B
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
POS
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
PPO
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana
Workers Comp
O
549.08
84.08
308.02
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
EPO
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
EPO
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
HMO
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
HMO
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Medicaid
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Medicaid
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Medicare Part A
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Medicare Part A
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Medicare Part B
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Medicare Part B
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
POS
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
POS
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
PPO
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
PPO
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Workers Comp
I
670.02
147.85
709.00
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
humana - medicare advantage
Workers Comp
O
549.08
84.08
96.51
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
EPO
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
HMO
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
Medicaid
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
Medicare Part A
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
Medicare Part B
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
POS
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
PPO
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
tricare
Workers Comp
O
549.08
84.08
99.29
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
EPO
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
EPO
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
HMO
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
HMO
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Medicaid
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Medicaid
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Medicare Part A
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Medicare Part A
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Medicare Part B
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Medicare Part B
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
POS
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
POS
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
PPO
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
PPO
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Workers Comp
I
670.02
147.85
154.48
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare
Workers Comp
O
549.08
84.08
322.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
EPO
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
HMO
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
Medicaid
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
Medicare Part A
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
Medicare Part B
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
POS
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
PPO
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
united healthcare - medicare advantage
Workers Comp
O
549.08
84.08
95.28
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
EPO
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
EPO
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
HMO
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
HMO
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Medicaid
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Medicaid
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Medicare Part A
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Medicare Part A
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Medicare Part B
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Medicare Part B
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
POS
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
POS
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
PPO
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
PPO
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Workers Comp
I
670.02
147.85
147.85
709.00
402.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
va
Workers Comp
O
549.08
84.08
96.50
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
EPO
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
HMO
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
Medicaid
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
Medicare Part A
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
Medicare Part B
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
POS
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
PPO
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0402
null
revCode
Other Imaging Services Ultrasound
webtpa
Workers Comp
O
549.08
84.08
380.97
396.44
329.45


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
EPO
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
HMO
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
Medicaid
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
Medicare Part A
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
Medicare Part B
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
POS
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
PPO
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna
Workers Comp
O
297.86
85.12
87.76
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
EPO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
HMO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
Medicaid
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
Medicare Part A
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
Medicare Part B
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
POS
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
PPO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
aetna - medicare advantage
Workers Comp
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
EPO
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
HMO
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
Medicaid
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
Medicare Part A
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
Medicare Part B
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
POS
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
PPO
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield
Workers Comp
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
EPO
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
HMO
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
Medicaid
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
Medicare Part A
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
Medicare Part B
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
POS
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
PPO
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
blue cross blue shield - medicare advantage
Workers Comp
O
297.86
85.12
167.23
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
EPO
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
HMO
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
Medicaid
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
Medicare Part A
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
Medicare Part B
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
POS
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
PPO
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
cigna
Workers Comp
O
297.86
85.12
165.83
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
EPO
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
HMO
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
Medicaid
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
Medicare Part A
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
Medicare Part B
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
POS
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
PPO
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana
Workers Comp
O
297.86
85.12
234.56
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
EPO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
HMO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
Medicaid
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
Medicare Part A
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
Medicare Part B
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
POS
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
PPO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
humana - medicare advantage
Workers Comp
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
EPO
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
HMO
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
Medicaid
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
Medicare Part A
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
Medicare Part B
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
POS
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
PPO
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
medica
Workers Comp
O
297.86
85.12
89.98
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
EPO
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
HMO
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
Medicaid
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
Medicare Part A
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
Medicare Part B
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
POS
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
PPO
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
tricare
Workers Comp
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
EPO
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
HMO
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
Medicaid
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
Medicare Part A
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
Medicare Part B
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
POS
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
PPO
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare
Workers Comp
O
297.86
85.12
223.40
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
EPO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
HMO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
Medicaid
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
Medicare Part A
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
Medicare Part B
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
POS
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
PPO
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
united healthcare - medicare advantage
Workers Comp
O
297.86
85.12
85.12
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
EPO
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
HMO
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
Medicaid
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
Medicare Part A
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
Medicare Part B
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
POS
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
PPO
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
va
Workers Comp
O
297.86
85.12
88.57
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
EPO
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
HMO
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
Medicaid
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
Medicare Part A
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
Medicare Part B
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
POS
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
PPO
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
webtpa
Workers Comp
O
297.86
85.12
324.25
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
EPO
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
HMO
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
Medicaid
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
Medicare Part A
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
Medicare Part B
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
POS
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
PPO
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0403
null
revCode
Other Imaging Services Screening mammography
worker comp
Workers Comp
O
297.86
85.12
173.71
324.25
178.72


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
EPO
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
HMO
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
Medicaid
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
Medicare Part A
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
Medicare Part B
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
POS
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
PPO
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0409
null
revCode
Other Imaging Services Other
blue cross blue shield
Workers Comp
O
694.51
173.70
173.70
173.70
416.71


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
EPO
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
HMO
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
Medicaid
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
Medicare Part A
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
Medicare Part B
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
POS
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
PPO
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
aetna
Workers Comp
I
201.80
67.67
115.77
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
EPO
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
HMO
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
Medicaid
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
Medicare Part A
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
Medicare Part B
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
POS
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
PPO
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield
Workers Comp
O
187.54
57.76
57.76
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
EPO
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
HMO
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
Medicaid
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
Medicare Part A
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
Medicare Part B
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
POS
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
PPO
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
blue cross blue shield - medicare advantage
Workers Comp
O
187.54
57.76
69.39
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
EPO
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
HMO
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
Medicaid
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
Medicare Part A
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
Medicare Part B
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
POS
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
PPO
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
cigna
Workers Comp
I
201.80
67.67
125.79
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
EPO
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
HMO
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
Medicaid
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
Medicare Part A
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
Medicare Part B
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
POS
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
PPO
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
humana - medicare advantage
Workers Comp
I
201.80
67.67
125.37
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
EPO
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
HMO
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
Medicaid
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
Medicare Part A
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
Medicare Part B
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
POS
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
PPO
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
united healthcare
Workers Comp
O
187.54
57.76
138.33
138.33
112.52


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
EPO
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
HMO
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
Medicaid
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
Medicare Part A
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
Medicare Part B
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
POS
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
PPO
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
va
Workers Comp
I
201.80
67.67
67.67
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
EPO
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
HMO
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
Medicaid
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
Medicare Part A
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
Medicare Part B
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
POS
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
PPO
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0410
null
revCode
Respiratory Services General
worker comp
Workers Comp
I
201.80
67.67
450.98
450.98
121.08


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
EPO
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
HMO
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
Medicaid
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
Medicare Part A
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
Medicare Part B
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
POS
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
PPO
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0412
null
revCode
Respiratory Services Inhalation services
va
Workers Comp
I
1801.94
225.87
225.87
225.87
1081.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
EPO
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
HMO
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
Medicaid
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
Medicare Part A
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
Medicare Part B
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
POS
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
PPO
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
blue cross blue shield
Workers Comp
O
730.12
105.64
245.62
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
EPO
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
HMO
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
Medicaid
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
Medicare Part A
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
Medicare Part B
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
POS
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
PPO
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0413
null
revCode
Respiratory Services Hyperbaric oxygen therapy
humana - medicare advantage
Workers Comp
O
730.12
105.64
105.64
245.62
438.07


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
EPO
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
HMO
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
Medicaid
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
Medicare Part A
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
Medicare Part B
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
POS
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
PPO
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
blue cross blue shield - medicare advantage
Workers Comp
O
156.93
22.40
121.83
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
EPO
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
HMO
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
Medicaid
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
Medicare Part A
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
Medicare Part B
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
POS
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
PPO
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
healthchoice
Workers Comp
O
156.93
22.40
35.71
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
EPO
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
EPO
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
HMO
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
HMO
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Medicaid
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Medicaid
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Medicare Part A
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Medicare Part A
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Medicare Part B
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Medicare Part B
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
POS
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
POS
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
PPO
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
PPO
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Workers Comp
I
163.61
34.80
230.32
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
humana - medicare advantage
Workers Comp
O
156.93
22.40
22.40
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
EPO
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
HMO
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
Medicaid
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
Medicare Part A
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
Medicare Part B
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
POS
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
PPO
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
va
Workers Comp
I
163.61
34.80
34.80
230.32
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
EPO
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
HMO
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
Medicaid
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
Medicare Part A
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
Medicare Part B
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
POS
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
PPO
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
webtpa
Workers Comp
O
156.93
22.40
171.77
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
EPO
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
HMO
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
Medicaid
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
Medicare Part A
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
Medicare Part B
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
POS
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
PPO
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0420
null
revCode
Physical Therapy General
worker comp
Workers Comp
O
156.93
22.40
109.07
171.77
94.16


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
EPO
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
HMO
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
Medicaid
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
Medicare Part A
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
Medicare Part B
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
POS
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
PPO
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna
Workers Comp
O
163.61
23.94
73.08
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
EPO
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
HMO
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
Medicaid
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
Medicare Part A
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
Medicare Part B
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
POS
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
PPO
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
aetna - medicare advantage
Workers Comp
O
163.61
23.94
24.52
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
EPO
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
HMO
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
Medicaid
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
Medicare Part A
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
Medicare Part B
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
POS
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
PPO
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield
Workers Comp
O
163.61
23.94
56.18
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
EPO
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
HMO
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
Medicaid
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
Medicare Part A
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
Medicare Part B
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
POS
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
PPO
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
blue cross blue shield - medicare advantage
Workers Comp
O
163.61
23.94
49.50
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
EPO
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
HMO
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
Medicaid
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
Medicare Part A
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
Medicare Part B
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
POS
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
PPO
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
cigna
Workers Comp
O
163.61
23.94
115.78
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
EPO
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
HMO
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
Medicaid
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
Medicare Part A
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
Medicare Part B
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
POS
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
PPO
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
humana - medicare advantage
Workers Comp
O
163.61
23.94
24.55
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
EPO
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
HMO
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
Medicaid
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
Medicare Part A
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
Medicare Part B
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
POS
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
PPO
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
tricare
Workers Comp
O
163.61
23.94
29.66
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
EPO
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
HMO
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
Medicaid
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
Medicare Part A
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
Medicare Part B
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
POS
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
PPO
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
united healthcare
Workers Comp
O
163.61
23.94
116.87
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
EPO
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
HMO
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
Medicaid
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
Medicare Part A
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
Medicare Part B
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
POS
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
PPO
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
va
Workers Comp
O
163.61
23.94
23.94
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
EPO
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
HMO
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
Medicaid
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
Medicare Part A
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
Medicare Part B
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
POS
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
PPO
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
webtpa
Workers Comp
O
163.61
23.94
164.70
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
EPO
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
HMO
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
Medicaid
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
Medicare Part A
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
Medicare Part B
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
POS
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
PPO
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0421
null
revCode
Physical Therapy Visit charge
worker comp
Workers Comp
O
163.61
23.94
40.77
164.70
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
EPO
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
HMO
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
Medicaid
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
Medicare Part A
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
Medicare Part B
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
POS
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
PPO
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0423
null
revCode
Physical Therapy Group rate
va
Workers Comp
I
123.86
22.12
22.12
22.12
74.32


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
EPO
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
EPO
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
HMO
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
HMO
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Medicaid
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Medicaid
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Medicare Part A
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Medicare Part A
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Medicare Part B
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Medicare Part B
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
POS
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
POS
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
PPO
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
PPO
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Workers Comp
I
281.58
64.46
106.81
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
aetna
Workers Comp
O
212.10
63.35
121.10
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
EPO
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
HMO
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
Medicaid
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
Medicare Part A
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
Medicare Part B
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
POS
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
PPO
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield
Workers Comp
O
212.10
63.35
73.08
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
EPO
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
HMO
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicaid
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicare Part A
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicare Part B
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
POS
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
PPO
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Workers Comp
O
212.10
63.35
63.35
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
EPO
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
EPO
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
HMO
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
HMO
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Medicaid
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Medicaid
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Medicare Part A
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Medicare Part A
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Medicare Part B
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Medicare Part B
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
POS
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
POS
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
PPO
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
PPO
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Workers Comp
I
281.58
64.46
161.49
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
cigna
Workers Comp
O
212.10
63.35
133.59
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
EPO
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
EPO
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
HMO
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
HMO
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Medicaid
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Medicaid
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part A
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part A
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part B
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part B
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
POS
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
POS
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
PPO
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
PPO
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Workers Comp
I
281.58
64.46
258.21
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
humana - medicare advantage
Workers Comp
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
EPO
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
HMO
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
Medicaid
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
Medicare Part A
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
Medicare Part B
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
POS
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
PPO
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
tricare
Workers Comp
O
212.10
63.35
82.61
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
EPO
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
HMO
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
Medicaid
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
Medicare Part A
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
Medicare Part B
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
POS
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
PPO
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
united healthcare
Workers Comp
O
212.10
63.35
151.50
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
EPO
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
EPO
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
HMO
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
HMO
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Medicaid
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Medicaid
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Medicare Part A
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Medicare Part A
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Medicare Part B
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Medicare Part B
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
POS
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
POS
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
PPO
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
PPO
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Workers Comp
I
281.58
64.46
64.46
258.21
168.95


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
va
Workers Comp
O
212.10
63.35
95.98
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
EPO
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
HMO
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
Medicaid
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
Medicare Part A
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
Medicare Part B
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
POS
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
PPO
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
webtpa
Workers Comp
O
212.10
63.35
263.00
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
EPO
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
HMO
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
Medicaid
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
Medicare Part A
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
Medicare Part B
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
POS
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
PPO
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0424
null
revCode
Physical Therapy Evaluation or reevaluation
worker comp
Workers Comp
O
212.10
63.35
67.40
263.00
127.26


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
EPO
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
HMO
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
Medicaid
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
Medicare Part A
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
Medicare Part B
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
POS
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
PPO
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
aetna
Workers Comp
I
177.93
30.72
136.53
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
EPO
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
HMO
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Medicaid
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Medicare Part A
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Medicare Part B
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
POS
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
PPO
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Workers Comp
O
52.60
29.17
82.40
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
EPO
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
EPO
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
HMO
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
HMO
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicaid
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicaid
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part A
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part A
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part B
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part B
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
POS
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
POS
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
PPO
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
PPO
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Workers Comp
I
177.93
30.72
163.61
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
humana - medicare advantage
Workers Comp
O
52.60
29.17
29.17
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
EPO
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
HMO
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
Medicaid
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
Medicare Part A
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
Medicare Part B
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
POS
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
PPO
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
tricare
Workers Comp
O
52.60
29.17
46.81
82.40
31.56


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
EPO
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
HMO
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
Medicaid
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
Medicare Part A
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
Medicare Part B
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
POS
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
PPO
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0430
null
revCode
Occupational Therapy General
va
Workers Comp
I
177.93
30.72
30.72
163.61
106.76


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
EPO
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
HMO
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
Medicaid
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
Medicare Part A
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
Medicare Part B
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
POS
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
PPO
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna
Workers Comp
O
163.61
23.94
73.47
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
EPO
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
HMO
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
Medicaid
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
Medicare Part A
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
Medicare Part B
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
POS
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
PPO
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
aetna - medicare advantage
Workers Comp
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
EPO
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
HMO
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Medicaid
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Medicare Part A
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Medicare Part B
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
POS
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
PPO
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Workers Comp
O
163.61
23.94
62.54
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
EPO
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
HMO
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Medicaid
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Medicare Part A
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Medicare Part B
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
POS
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
PPO
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Workers Comp
O
163.61
23.94
53.70
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
EPO
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
HMO
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Medicaid
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Medicare Part A
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Medicare Part B
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
POS
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
PPO
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Workers Comp
O
163.61
23.94
24.45
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
EPO
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
HMO
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
Medicaid
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
Medicare Part A
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
Medicare Part B
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
POS
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
PPO
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
tricare
Workers Comp
O
163.61
23.94
29.66
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
EPO
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
HMO
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
Medicaid
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
Medicare Part A
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
Medicare Part B
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
POS
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
PPO
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
united healthcare
Workers Comp
O
163.61
23.94
116.87
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
EPO
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
HMO
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
Medicaid
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
Medicare Part A
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
Medicare Part B
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
POS
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
PPO
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
va
Workers Comp
O
163.61
23.94
23.94
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
EPO
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
HMO
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
Medicaid
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
Medicare Part A
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
Medicare Part B
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
POS
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
PPO
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
webtpa
Workers Comp
O
163.61
23.94
147.25
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
EPO
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
HMO
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
Medicaid
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
Medicare Part A
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
Medicare Part B
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
POS
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
PPO
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0431
null
revCode
Occupational Therapy Visit charge
worker comp
Workers Comp
O
163.61
23.94
51.99
147.25
98.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
EPO
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
HMO
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Medicaid
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Medicare Part A
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Medicare Part B
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
POS
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
PPO
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Workers Comp
I
357.27
78.40
141.21
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
EPO
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
HMO
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
Medicaid
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
Medicare Part A
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
Medicare Part B
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
POS
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
PPO
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield
Workers Comp
O
238.50
83.24
83.24
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
EPO
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
HMO
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicaid
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicare Part A
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicare Part B
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
POS
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
PPO
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Workers Comp
O
238.50
83.24
122.09
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
EPO
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
EPO
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
HMO
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
HMO
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicaid
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicaid
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part A
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part A
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part B
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part B
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
POS
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
POS
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
PPO
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
PPO
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Workers Comp
I
357.27
78.40
357.27
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Workers Comp
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
EPO
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
HMO
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Medicaid
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Medicare Part A
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Medicare Part B
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
POS
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
PPO
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Workers Comp
O
238.50
83.24
87.08
122.09
143.10


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
EPO
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
HMO
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicaid
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicare Part A
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicare Part B
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
POS
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
PPO
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0434
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Workers Comp
I
357.27
78.40
78.40
357.27
214.36


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
EPO
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
HMO
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
Medicaid
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
Medicare Part A
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
Medicare Part B
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
POS
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
PPO
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield
Workers Comp
O
237.44
54.67
112.88
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
EPO
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
HMO
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Medicaid
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Medicare Part A
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Medicare Part B
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
POS
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
PPO
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
blue cross blue shield - medicare advantage
Workers Comp
O
237.44
54.67
54.67
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
EPO
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
EPO
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
HMO
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
HMO
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicaid
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicaid
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part A
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part A
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part B
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Medicare Part B
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
POS
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
POS
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
PPO
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
PPO
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Workers Comp
I
338.35
83.73
348.50
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
humana - medicare advantage
Workers Comp
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
EPO
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
HMO
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
Medicaid
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
Medicare Part A
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
Medicare Part B
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
POS
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
PPO
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
tricare
Workers Comp
O
237.44
54.67
76.83
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
EPO
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
EPO
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
HMO
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
HMO
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Medicaid
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Medicaid
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Medicare Part A
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Medicare Part A
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Medicare Part B
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Medicare Part B
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
POS
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
POS
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
PPO
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
PPO
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Workers Comp
I
338.35
83.73
241.68
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
united healthcare
Workers Comp
O
237.44
54.67
178.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
EPO
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
EPO
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
HMO
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
HMO
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Medicaid
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Medicaid
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Medicare Part A
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Medicare Part A
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Medicare Part B
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Medicare Part B
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
POS
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
POS
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
PPO
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
PPO
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Workers Comp
I
338.35
83.73
83.73
348.50
203.01


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0440
null
revCode
Occupational Therapy General
va
Workers Comp
O
237.44
54.67
74.08
178.08
142.46


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
EPO
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
HMO
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
Medicaid
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
Medicare Part A
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
Medicare Part B
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
POS
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
PPO
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
aetna
Workers Comp
O
310.29
81.63
232.39
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
EPO
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
HMO
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Medicaid
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Medicare Part A
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Medicare Part B
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
POS
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
PPO
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield
Workers Comp
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
EPO
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
HMO
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Medicaid
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Medicare Part A
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Medicare Part B
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
POS
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
PPO
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
blue cross blue shield - medicare advantage
Workers Comp
O
310.29
81.63
105.98
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
EPO
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
HMO
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Medicaid
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Medicare Part A
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Medicare Part B
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
POS
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
PPO
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
humana - medicare advantage
Workers Comp
O
310.29
81.63
81.63
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
EPO
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
HMO
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
Medicaid
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
Medicare Part A
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
Medicare Part B
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
POS
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
PPO
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
tricare
Workers Comp
O
310.29
81.63
84.29
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
EPO
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
EPO
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
HMO
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
HMO
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Medicaid
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Medicaid
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Medicare Part A
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Medicare Part A
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Medicare Part B
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Medicare Part B
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
POS
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
POS
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
PPO
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
PPO
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Workers Comp
I
575.42
141.00
141.00
141.00
345.25


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0441
null
revCode
Occupational Therapy Visit charge
va
Workers Comp
O
310.29
81.63
87.95
232.39
186.17


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
EPO
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
HMO
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
Medicaid
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
Medicare Part A
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
Medicare Part B
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
POS
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
PPO
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0442
null
revCode
Occupational Therapy Hourly charge
va
Workers Comp
I
407.71
60.49
60.49
60.49
244.63


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
EPO
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
HMO
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Medicaid
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Medicare Part A
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Medicare Part B
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
POS
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
PPO
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
aetna
Workers Comp
I
494.17
119.90
143.31
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
EPO
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
HMO
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicaid
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicare Part A
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Medicare Part B
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
POS
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
PPO
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
blue cross blue shield - medicare advantage
Workers Comp
O
494.17
115.04
115.04
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
EPO
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
HMO
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
Medicaid
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
Medicare Part A
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
Medicare Part B
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
POS
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
PPO
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
cigna
Workers Comp
I
494.17
119.90
470.64
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
EPO
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
HMO
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicaid
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part A
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Medicare Part B
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
POS
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
PPO
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
humana - medicare advantage
Workers Comp
O
494.17
115.04
205.38
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
EPO
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
HMO
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Medicaid
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Medicare Part A
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Medicare Part B
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
POS
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
PPO
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
tricare
Workers Comp
O
494.17
115.04
188.13
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
EPO
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
EPO
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
HMO
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
HMO
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicaid
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicaid
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicare Part A
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicare Part A
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicare Part B
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Medicare Part B
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
POS
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
POS
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
PPO
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
PPO
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Workers Comp
I
494.17
119.90
119.90
470.64
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0444
null
revCode
Occupational Therapy Evaluation or reevaluation
va
Workers Comp
O
494.17
115.04
222.62
222.62
296.50


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
EPO
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
HMO
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
Medicaid
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
Medicare Part A
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
Medicare Part B
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
POS
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
PPO
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
aetna
Workers Comp
I
891.24
303.56
538.65
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
EPO
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
HMO
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
Medicaid
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
Medicare Part A
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
Medicare Part B
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
POS
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
PPO
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
cigna
Workers Comp
I
891.24
303.56
602.76
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
EPO
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
HMO
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
Medicaid
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
Medicare Part A
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
Medicare Part B
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
POS
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
PPO
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
humana - medicare advantage
Workers Comp
I
891.24
303.56
637.57
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
EPO
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
HMO
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
Medicaid
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
Medicare Part A
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
Medicare Part B
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
POS
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
PPO
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
united healthcare
Workers Comp
I
891.24
303.56
318.40
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
EPO
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
HMO
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
Medicaid
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
Medicare Part A
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
Medicare Part B
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
POS
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
PPO
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
va
Workers Comp
I
891.24
303.56
303.56
637.57
534.74


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
EPO
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
HMO
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
Medicaid
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
Medicare Part A
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
Medicare Part B
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
POS
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
PPO
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
webtpa
Workers Comp
O
2635.78
536.42
1437.90
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
worker comp
EPO
O
2635.78
536.42
536.42
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
0450
null
revCode
Emergency Room General
worker comp
HMO
O
2635.78
536.42
536.42
1437.90
1581.47


2022-01-12
1.5_93b1e6d0-73f1-11ec-a348-bb9d9ee62eaa
Comanche County Memorial Hospital
73-6061037
045