file_create_date,run_id,name,tax_id,code,code type,code description,payer,plan_type,patient_class,gross charge,de-identified minimum negotiated charge,payer-specific negotiated charge,de-identified maximum negotiated charge,discounted cash price
,,,,,,,,,,,,,,
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",aetna,,I,190.07,49.10,114.84,190.07,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",aetna,,O,826.60,242.61,499.43,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,aetna,,O,290.12,59.69,116.72,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",aetna,,O,252.47,44.06,143.91,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42820,cpt,REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS),aetna,,O,18532.26,4720.05,10751.98,13899.20,3780.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1630,cpt,"INJECTION, HALOPERIDOL, UP TO 5 MG",aetna,,O,78.96,21.20,35.53,59.22,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,aetna,,O,3580.43,810.94,2193.35,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,aetna,,O,24173.14,2776.54,10597.85,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,aetna,,E,292.62,111.66,176.80,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",aetna,,O,101.45,25.33,57.83,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,aetna,,O,94.38,2.18,53.80,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",aetna,,O,365.14,61.44,208.13,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",aetna,,O,348.89,56.80,198.87,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52351,cpt,"DIAGNOSTIC EXAMINATION OF THE BLADDER, BLADDER CANAL (URETHRA), AND URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE",aetna,,O,17224.91,2833.20,9916.07,9916.07,10334.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64450,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO OTHER PERIPHERAL NERVE OR BRANCH,aetna,,O,1637.53,6489.10,12436.52,12436.52,982.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,aetna,,O,1343.10,94.48,765.57,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",aetna,,O,19538.26,2569.95,6683.89,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,aetna,,O,770.33,202.50,202.50,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",aetna,,O,50.01,4.43,30.22,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",aetna,,O,94.14,7.61,50.63,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,aetna,,O,3055.12,203.12,1741.42,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,aetna,,O,351.40,51.44,117.86,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",aetna,,O,114.43,3.13,44.40,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,aetna,,O,187.57,13.08,190.87,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,aetna,,O,36.32,5.40,20.70,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",aetna,,O,338.89,30.54,30.54,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,aetna,,O,42.58,6.02,24.27,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",aetna,,O,16.70,0.37,0.60,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",aetna,,O,56.26,6.34,32.07,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82085,cpt,ALDOLASE (ENZYME) LEVEL,aetna,,O,50.72,6.25,28.91,28.91,30.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90694,cpt,"INFLUENZA VIRUS VACCINE, QUADRIVALENT (AIIV4), INACTIVATED, ADJUVANTED, PRESERVATIVE FREE, FOR INJECTION INTO MUSCLE, 0.5 ML DOSAGE",aetna,,O,205.61,31.23,31.23,31.24,123.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",aetna,,O,98.78,7.87,41.96,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9395,cpt,"INJECTION, FULVESTRANT, 25 MG",aetna,,O,421.43,10.87,13.67,316.07,252.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,aetna,,O,5444.73,938.10,2951.34,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,aetna,,O,831.61,156.22,156.22,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,14041,cpt,"TISSUE TRANSFER REPAIR OF WOUND (10.1 TO 30.0 SQ CENTIMETERS) OF THE FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, UNDERARMS, GENITALS, HANDS, AND/OR FEET",aetna,,O,21598.45,13216.61,13216.61,13216.61,12959.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,aetna,,O,70.06,8.01,42.33,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21554,cpt,REMOVAL OF (5 CENTIMETERS OR GREATER) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,aetna,,O,20809.89,2244.32,11082.03,11082.03,12485.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,aetna,,O,348.63,85.16,85.16,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",aetna,,O,422.68,79.93,237.79,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",aetna,,I,225.50,61.14,381.34,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",aetna,,O,331.50,12.98,188.96,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",aetna,,O,5902.67,335.59,3174.08,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,aetna,,I,16915.97,4140.71,9339.74,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",aetna,,O,89.65,10.18,51.10,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,aetna,,O,8198.69,1161.40,1173.25,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",aetna,,O,240.10,61.44,136.86,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,aetna,,O,143.17,18.59,81.61,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9965,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 100-199 MG/ML IODINE CONCENTRATION, PER ML",aetna,,O,7.98,1.70,3.70,6.34,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",aetna,,O,365.24,8.63,208.19,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9202,cpt,"GOSERELIN ACETATE IMPLANT, PER 3.6 MG",aetna,,O,3100.29,142.49,607.90,647.44,1860.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),aetna,,O,126.23,10.13,71.95,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",aetna,,O,25.94,5.08,5.13,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,aetna,,O,176.37,11.81,100.53,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88313,cpt,SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE INCLUDING INTERPRETATION AND REPORT,aetna,,O,119.15,50.94,69.96,94.72,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",aetna,,O,116.79,7.81,38.56,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37799,cpt,OTHER PROCEDURE ON BLOOD VESSEL,aetna,,O,25554.94,3410.10,13483.00,13483.00,15332.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17261,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",aetna,,O,1535.94,159.87,369.02,761.92,921.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",aetna,,O,50.72,7.45,30.65,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,aetna,,O,50.02,4.84,28.51,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",aetna,,O,212.59,22.86,94.37,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,aetna,,O,78.05,7.37,41.13,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",aetna,,O,365.14,48.65,208.13,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5117,cpt,"INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG",aetna,,O,320.89,24.34,35.31,107.23,192.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,aetna,,O,298.87,98.24,170.36,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",aetna,,O,41.28,5.10,19.94,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",aetna,,O,266.35,64.70,160.93,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",aetna,,O,91.30,18.02,18.02,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",aetna,,O,47.53,8.48,27.09,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3380,cpt,"INJECTION, VEDOLIZUMAB, 1 MG",aetna,,O,68.13,21.84,28.92,3747.37,40.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,aetna,,O,3055.12,205.61,1793.66,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",aetna,,I,217.58,127.74,127.74,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9201,cpt,"INJECTION, GEMCITABINE HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 200 MG",aetna,,O,32.61,3.97,3.97,24.46,19.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,aetna,,O,53.76,5.92,30.64,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74150,cpt,CT SCAN OF ABDOMEN WITHOUT CONTRAST,aetna,,O,1344.34,95.70,766.27,766.27,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",aetna,,O,65.11,10.15,37.11,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",aetna,,O,85.03,16.92,48.47,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,aetna,,O,116.31,18.99,66.30,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7030,cpt,"INFUSION, NORMAL SALINE SOLUTION , 1000 CC",aetna,,O,9.26,2.95,56.04,58.60,5.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9144,cpt,"INJECTION, DARATUMUMAB, 10 MG AND HYALURONIDASE-FIHJ",aetna,,O,148.31,44.88,46.23,48.33,88.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,aetna,,O,4054.33,324.17,2310.97,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,aetna,,O,106.28,8.57,60.58,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91037,cpt,MONITORING AND RECORDING OF ESOPHAGEAL FUNCTION THROUGH NASAL TUBE WITH ELECTRODE,aetna,,O,3401.95,370.13,1939.11,2397.37,2041.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",aetna,,O,40.11,3.87,22.86,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52005,cpt,INSERTION OF CATHETER INTO URINARY DUCT (URETER) USING AN ENDOSCOPE THROUGH THE BLADDER AREA,aetna,,O,15929.97,1594.04,8382.60,8382.60,9557.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",aetna,,O,65.06,17.18,29.42,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",aetna,,O,175.06,87.53,99.78,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9958,cpt,"HIGH OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML",aetna,,O,2.49,0.43,1.12,1.12,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,aetna,,O,83.78,3.34,33.71,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0419,revCode,"RESPIRATORY SERVICES, OTHER",aetna,,I,278.86,158.95,158.95,278.86,167.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",aetna,,O,158.29,56.98,70.80,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",aetna,,O,65.11,8.45,22.82,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,aetna,,O,40.11,4.18,22.86,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",aetna,,O,45.06,8.66,25.68,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,aetna,,O,1893.35,157.27,481.06,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",aetna,,O,51.68,6.81,2026.64,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",aetna,,O,212.36,14.48,121.05,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,aetna,,I,124.70,13.59,96.54,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,aetna,,O,50.01,3.11,28.51,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,aetna,,O,351.40,81.48,200.30,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0521,revCode,FREESTANDING CLINIC CLINIC VISIT BY MEMBER TORHC/FQHC,aetna,,O,290.00,111.87,255.96,255.96,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,aetna,,O,4630.63,693.07,1546.74,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,aetna,,O,2599.91,94.47,1526.41,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,aetna,,O,188.17,19.53,55.53,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,aetna,,O,2149.71,310.75,313.92,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),aetna,,O,166.34,27.39,94.81,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9305,cpt,"INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG",aetna,,O,280.11,3.19,3.19,76.83,168.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,aetna,,O,4054.33,319.17,2310.97,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",aetna,,O,233.84,30.94,85.96,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,aetna,,O,105.03,8.42,36.70,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11900,cpt,"INJECTION INTO SKIN GROWTH, 1-7 GROWTHS",aetna,,O,1269.35,159.63,578.82,1489.62,761.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",aetna,,O,502.71,78.63,286.54,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",aetna,,O,70.06,8.29,39.93,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",aetna,,O,103.81,18.28,59.17,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,aetna,,O,167.56,25.68,95.51,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3301,cpt,"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG",aetna,,O,21.30,1.21,9.59,9.59,12.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,aetna,,O,414.89,93.99,223.10,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",aetna,,O,246.35,17.59,109.70,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",aetna,,O,519.10,54.18,295.89,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,aetna,,O,256.35,58.45,58.45,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",aetna,,O,250.10,18.15,142.56,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17003,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 2-14 GROWTHS",aetna,,O,1040.92,159.38,159.38,1315.38,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86870,cpt,IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,aetna,,O,303.20,21.62,172.82,263.51,181.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",aetna,,O,13.80,2.61,7.87,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,aetna,,O,754.07,203.12,204.36,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,aetna,,I,3055.12,820.73,1741.42,1741.42,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73650,cpt,"X-RAY OF HEEL, MINIMUM OF 2 VIEWS",aetna,,O,254.50,44.02,149.69,149.69,152.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88302,cpt,PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE,aetna,,O,148.64,44.04,89.81,89.81,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,aetna,,O,71.96,9.99,13.12,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",aetna,,O,252.47,43.75,143.91,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,aetna,,O,101.45,12.63,57.83,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",aetna,,O,1091.80,160.12,160.12,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64636,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, EACH ADDITIONAL FACET JOINT",aetna,,O,7684.84,1563.06,4212.43,4212.43,4610.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,aetna,,O,1952.12,159.41,1179.47,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,aetna,,O,3683.73,275.00,2316.97,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",aetna,,O,44.82,3.29,27.08,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36821,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, ANY SITE AS SEPARATE PROCEDURE",aetna,,O,21470.01,2569.92,8322.21,10309.61,12882.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0720,revCode,LABOR ROOM/DELIVERY GENERAL,aetna,,I,150.64,21.34,97.18,4826.59,90.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,aetna,,O,130.11,30.48,74.16,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,aetna,,O,107.35,17.69,63.03,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,aetna,,O,16541.64,1561.79,1573.05,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",aetna,,I,2293.53,512.55,903.80,903.80,1376.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",aetna,,I,231.34,60.43,131.86,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),aetna,,O,41.28,5.08,23.53,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,aetna,,O,784.37,233.55,1949.28,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,aetna,,I,84785.32,12190.37,26367.84,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",aetna,,O,88.24,14.05,41.18,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",aetna,,E,1724.51,232.62,1041.95,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93281,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT MULTIPLE LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",aetna,,O,257.60,30.44,30.63,136.53,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",aetna,,O,3191.43,324.07,1767.64,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,aetna,,I,50.02,8.77,28.51,39.77,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,aetna,,O,60.16,9.91,34.29,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",aetna,,O,231.34,36.97,135.82,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",aetna,,O,1680.75,111.66,1039.99,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,aetna,,O,2261.82,101.22,101.22,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,aetna,,O,42.51,2.00,24.23,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,aetna,,O,187.57,14.84,100.59,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",aetna,,O,650.28,61.44,370.66,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",aetna,,O,50.72,5.89,5.95,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1040,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG",aetna,,O,105.67,41.27,41.27,103.80,63.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9354,cpt,"INJECTION, ADO-TRASTUZUMAB EMTANSINE, 1 MG",aetna,,O,131.30,30.33,37.57,43.44,78.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,aetna,,O,175.06,87.53,102.78,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",aetna,,O,35.00,2.32,19.95,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,aetna,,E,880.03,214.07,506.35,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,aetna,,O,3595.37,280.86,2049.36,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,aetna,,O,3953.80,1077.08,1484.96,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12052,cpt,"REPAIR OF WOUND (2.6 TO 5.0 CENTIMETERS) OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MOUTH",aetna,,O,2739.04,984.24,1248.81,1248.81,1643.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,aetna,,O,67.58,5.08,38.52,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,aetna,,O,3055.12,204.95,1741.42,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,aetna,,O,178.08,50.28,50.28,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11424,cpt,"REMOVAL OF GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",aetna,,O,15617.60,1304.33,9370.59,9370.59,9370.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17280,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS OR LESS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",aetna,,O,1675.86,159.23,410.05,410.05,1005.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",aetna,,O,190.94,53.23,130.03,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",aetna,,O,107.59,3.13,42.33,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",aetna,,O,19.52,4.40,8.78,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,aetna,,O,40.11,4.65,22.86,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",aetna,,O,52.60,5.67,29.98,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,aetna,,O,50.01,5.20,29.37,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",aetna,,O,184.32,70.33,105.06,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),aetna,,O,8588.52,489.94,7783.98,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,aetna,,O,52.60,6.75,30.88,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19301,cpt,PARTIAL REMOVAL OF BREAST,aetna,,O,31896.98,2805.32,5148.44,12984.24,19138.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,aetna,,O,93.19,11.22,53.12,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",aetna,,O,1029.19,93.54,96.92,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",aetna,,I,1997.14,545.14,8562.36,19187.06,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,882,ms-drg,NEUROSES EXCEPT DEPRESSIVE,aetna,,I,14589.21,3863.55,7472.78,11557.84,8753.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,aetna,,O,547.73,91.89,285.60,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,aetna,,O,3222.12,719.92,1727.39,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",aetna,,O,1893.35,485.97,485.97,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",aetna,,O,85.39,17.80,36.25,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,aetna,,O,3055.12,206.42,1741.42,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,aetna,,O,195.07,21.19,111.19,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38525,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, OPEN PROCEDURE",aetna,,O,34276.96,4931.97,5148.44,12984.24,20566.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,aetna,,I,1031.60,200.87,225.16,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,aetna,,O,41.26,8.55,19.25,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,aetna,,O,1446.95,312.71,323.84,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",aetna,,O,83.33,15.97,47.50,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,aetna,,I,5986.20,1090.17,3514.50,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0640,cpt,"INJECTION, LEUCOVORIN CALCIUM, PER 50 MG",aetna,,O,24.48,4.06,4.41,38.80,14.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),aetna,,O,60.03,6.83,34.22,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,aetna,,I,16.88,6.25,10.23,10.23,10.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,aetna,,I,18651.11,4387.85,6911.27,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88341,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, EACH ADDITIONAL PROCEDURE",aetna,,O,128.79,24.89,75.55,132.54,77.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",aetna,,O,130.95,13.50,76.88,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,aetna,,O,792.84,92.74,451.92,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,aetna,,O,3055.12,320.47,1741.42,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",aetna,,O,209.99,16.56,51.10,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9022,cpt,"INJECTION, ATEZOLIZUMAB, 10 MG",aetna,,O,156.30,38.92,80.42,82.27,93.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",aetna,,O,3595.37,208.18,1531.84,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",aetna,,O,754.07,158.88,204.19,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0744,cpt,"INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG",aetna,,O,67.52,16.35,30.38,50.64,40.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,aetna,,O,71.96,15.59,43.47,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,aetna,,O,87.53,4.18,27.06,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73000,cpt,X-RAY OF COLLAR BONE,aetna,,O,267.61,51.43,152.54,152.54,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,aetna,,O,811.59,92.97,490.36,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,aetna,,O,50.00,8.06,30.21,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,aetna,,O,252.59,54.84,55.68,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,aetna,,O,3055.12,202.50,1642.85,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19285,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",aetna,,O,31940.44,2805.32,5148.44,7734.30,19164.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,aetna,,I,84.46,20.40,54.90,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",aetna,,O,468.95,93.59,283.34,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99215,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 40 MINUTES",aetna,,O,569.98,60.00,357.12,427.48,341.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",aetna,,O,39.88,13.23,17.99,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",aetna,,O,93.19,13.33,13.34,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9539,cpt,"TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES",aetna,,O,225.10,85.93,128.31,231.85,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,aetna,,O,287.62,21.62,77.06,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,aetna,,O,6833.06,1646.56,2240.10,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",aetna,,O,734.07,114.82,418.42,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,aetna,,O,303.87,29.81,58.45,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,aetna,,O,3055.12,204.02,1741.42,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",aetna,,O,108.88,10.16,39.34,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",aetna,,O,4.22,1.00,1.68,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",aetna,,O,90.84,9.28,51.78,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28292,cpt,CORRECTION OF BUNION WITH REMOVAL OF THE BASE OF THE GREAT TOE,aetna,,O,33825.97,4160.28,20996.90,20996.90,20295.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0170,revCode,NURSERY GENERAL,aetna,,I,1569.44,869.27,869.27,3331.37,941.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",aetna,,O,3583.92,323.18,323.18,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,aetna,,O,4318.19,810.94,2461.37,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9537,cpt,"TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES",aetna,,O,245.09,59.33,148.08,157.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",aetna,,O,41.28,3.01,15.71,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,aetna,,I,1274.16,335.11,726.27,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",aetna,,O,1434.39,436.85,817.60,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",aetna,,O,238.30,63.70,135.83,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,aetna,,O,266.35,64.70,156.38,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,aetna,,O,401.42,94.39,228.81,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",aetna,,O,357.64,32.78,209.97,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",aetna,,O,96.29,17.55,54.89,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",aetna,,O,1099.23,114.80,626.56,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,aetna,,O,647.78,94.48,369.23,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),aetna,,O,50.01,5.20,29.37,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",aetna,,O,96.29,11.40,40.88,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",aetna,,O,300.00,109.46,190.35,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,aetna,,O,22.60,4.56,7.91,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,aetna,,O,694.00,180.07,395.58,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11643,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",aetna,,O,5466.42,1248.81,1248.81,1304.93,3279.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",aetna,,O,267.61,46.08,152.54,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82375,cpt,CARBOXYHEMOGLOBIN (PROTEIN) LEVEL,aetna,,O,116.29,15.40,66.29,119.78,14.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,aetna,,O,90.02,12.05,51.31,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58563,cpt,EXAMINATION OF UTERUS WITH DESTRUCTION OF UTERINE LINING USING AN ENDOSCOPE,aetna,,O,30147.26,4351.66,10114.68,12495.98,18088.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",aetna,,O,245.09,44.06,139.70,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",aetna,,O,50.02,5.17,28.51,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",aetna,,O,140.04,24.64,58.22,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,aetna,,O,989.19,218.69,230.10,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",aetna,,O,281.00,8.75,2461.37,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,aetna,,O,19028.38,1098.56,3744.57,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",aetna,,O,2069.24,93.35,1191.71,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",aetna,,O,117.54,58.77,117.54,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",aetna,,O,71.96,7.91,41.02,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,aetna,,I,1704.46,353.32,1295.63,2409.63,1022.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,aetna,,O,213.87,28.75,125.57,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,aetna,,O,76.68,5.83,43.71,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",aetna,,O,348.89,61.44,210.80,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,aetna,,O,132.54,29.82,75.55,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",aetna,,I,2599.91,780.60,1481.95,1949.93,1559.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,aetna,,O,402.67,93.28,216.53,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,aetna,,O,323.88,75.26,184.61,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",aetna,,O,4184.57,938.10,2287.58,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64480,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",aetna,,O,6973.44,739.73,739.73,2920.54,4184.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88312,cpt,SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,aetna,,O,63.70,17.04,37.40,63.70,38.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,aetna,,O,647.78,92.64,369.23,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",aetna,,I,238.84,62.82,136.14,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,aetna,,O,41.28,5.78,23.53,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,aetna,,O,122.03,31.49,69.56,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17270,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS) OF SCALP, NECK, HANDS, FEET, OR GENITALS",aetna,,O,1733.91,160.86,160.86,507.74,1040.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19281,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MAMMOGRAPHIC GUIDANCE, FIRST LESION",aetna,,O,21298.80,131.53,5148.44,5148.44,12779.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,aetna,,O,7543.40,1294.20,2813.04,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",aetna,,O,218.83,30.93,81.42,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",aetna,,O,1997.14,430.17,1138.37,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,aetna,,O,1880.84,106.44,568.20,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,aetna,,O,83.76,6.73,47.74,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1781,cpt,MESH (IMPLANTABLE),aetna,,O,2029.44,404.71,404.71,814.49,1217.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77002,cpt,FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE,aetna,,O,1932.70,187.94,1101.64,1101.64,1159.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",aetna,,I,145.15,30.77,104.60,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",aetna,,O,223.91,73.72,127.63,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,aetna,,O,1952.12,344.86,1112.71,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",aetna,,O,36.32,6.91,20.70,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,aetna,,O,42.58,3.22,24.27,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",aetna,,O,345.14,75.82,171.51,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",aetna,,O,117.54,25.46,58.45,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,aetna,,O,203.82,49.80,50.08,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,aetna,,O,65.11,6.57,21.87,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,aetna,,O,41.19,1.80,15.07,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,aetna,,O,5902.67,923.22,3174.08,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",aetna,,O,226.34,61.44,129.01,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",aetna,,O,135.66,14.84,50.09,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,aetna,,I,36086.42,12423.48,14664.11,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",aetna,,O,13.78,1.69,4.25,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,aetna,,O,752.83,92.79,441.98,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,aetna,,O,67.58,3.47,38.52,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,aetna,,I,22023.98,6812.39,12004.75,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",aetna,,O,238.30,71.54,135.83,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,aetna,,O,842.86,94.39,480.43,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",aetna,,O,1007.94,158.30,167.30,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10060,cpt,SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS,aetna,,O,1091.80,417.40,417.40,1495.21,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",aetna,,O,290.00,66.00,255.96,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",aetna,,O,183.82,20.21,80.69,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5103,cpt,"INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG",aetna,,O,109.30,19.12,51.37,109.12,65.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",aetna,,O,199.37,74.90,113.64,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",aetna,,O,1040.92,159.87,159.87,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,aetna,,O,2289.17,554.60,1304.83,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,aetna,,I,12315.58,3063.82,5744.73,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,aetna,,O,4852.19,224.32,2931.69,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1788,cpt,"PORT, INDWELLING (IMPLANTABLE)",aetna,,O,1737.02,466.81,644.43,1737.02,1042.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57522,cpt,REMOVAL OR DESTRUCTION OF CERVIX WITH ELECTRICAL CAUTERY,aetna,,O,19085.48,2436.56,4813.02,5572.53,11451.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,aetna,,O,3238.42,206.67,2310.97,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,aetna,,O,3055.12,202.81,1741.42,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36598,cpt,CONTRAST INJECTIONS FOR X-RAY IMAGING PROCEDURE TO EVALUATE CENTRAL VENOUS ACCESS DEVICE,aetna,,O,1193.73,178.95,178.95,915.85,716.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,aetna,,O,30.08,5.04,17.15,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73070,cpt,"X-RAY OF ELBOW, 2 VIEWS",aetna,,O,252.59,40.91,143.98,143.98,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",aetna,,O,226.34,61.44,129.01,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",aetna,,O,183.82,24.23,104.78,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,794,ms-drg,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,aetna,,I,5174.39,2904.57,2904.57,30750.68,3104.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",aetna,,O,47.53,3.60,37.03,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,aetna,,O,330.33,24.94,199.58,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50435,cpt,REPLACEMENT OF KIDNEY DRAINAGE CATHETER ACCESSED THROUGH THE SKIN WITH IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION,aetna,,O,6267.51,1629.55,2445.94,2445.94,3760.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2540,cpt,"INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS",aetna,,O,10.32,4.64,4.64,4.64,6.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",aetna,,O,105.03,12.96,36.70,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,aetna,,O,351.40,92.60,200.30,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,aetna,,O,531.48,100.50,302.94,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,aetna,,O,3099.12,461.58,1817.95,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0105,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK,aetna,,O,3209.39,717.96,719.92,719.92,1925.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,aetna,,O,3055.12,202.94,1741.42,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",aetna,,O,151.46,8.03,86.33,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,aetna,,O,73.83,11.51,42.08,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",aetna,,O,157.91,56.85,71.06,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",aetna,,O,70.78,13.97,40.34,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,aetna,,O,36.32,4.67,16.80,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64635,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, SINGLE FACET JOINT",aetna,,O,7687.98,1563.06,2892.60,2892.60,4612.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,aetna,,O,1481.91,158.58,158.58,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45331,cpt,BIOPSY OF THE LOWER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY),aetna,,O,4384.17,710.14,3171.63,3810.64,2630.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",aetna,,O,183.82,20.70,84.56,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",aetna,,O,10827.72,2513.53,3794.91,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,aetna,,O,101.33,11.74,57.76,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",aetna,,I,1356.71,52.51,1902.95,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,351,ms-drg,INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,aetna,,I,45894.48,9716.46,9716.46,9716.46,27536.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",aetna,,O,298.47,66.35,170.13,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9263,cpt,"INJECTION, OXALIPLATIN, 0.5 MG",aetna,,O,8.74,0.07,0.07,24.00,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86039,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, TITER",aetna,,O,294.94,10.94,168.12,168.12,176.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),aetna,,O,50.01,5.20,30.22,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",aetna,,O,1138.00,159.38,159.38,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",aetna,,O,36.32,4.04,21.94,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",aetna,,O,38.92,3.91,3.96,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11403,cpt,"REMOVAL OF GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",aetna,,O,12550.24,933.20,9600.53,9600.53,7530.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",aetna,,O,411.42,47.57,234.51,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91010,cpt,MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT,aetna,,O,3386.38,370.13,1939.11,2423.62,2031.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",aetna,,O,373.90,92.59,213.12,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1756,cpt,"INJECTION, IRON SUCROSE, 1 MG",aetna,,O,2.08,0.23,0.94,0.94,1.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",aetna,,O,318.12,56.64,139.78,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",aetna,,O,4496.04,1078.59,1959.38,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20680,cpt,REMOVAL OF DEEP IMPLANT FROM BONE,aetna,,O,22681.09,2246.95,12436.52,12436.52,13608.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0882,cpt,"INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRD ON DIALYSIS)",aetna,,O,16.51,7.43,7.43,7.43,9.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,aetna,,I,48.06,11.46,41.09,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,aetna,,O,31.24,2.94,8.40,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",aetna,,O,350.39,39.08,199.72,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17271,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF SCALP, NECK, HANDS, FEET, OR GENITALS",aetna,,O,1881.00,241.28,241.28,1015.48,1128.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15004,cpt,"PREPARATION OF GRAFT SITE OF FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, EYE REGION, GENITALS, HANDS, FEET, AND/OR MULTIPLE FINGERS OR TOES (FIRST 100 SQ CM OR 1% BODY AREA OF INFANTS AND CHILDREN)",aetna,,O,23319.30,13216.61,13216.61,13216.61,13991.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",aetna,,O,513.19,16.80,301.30,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,aetna,,O,396.41,290.00,313.92,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",aetna,,O,85.94,24.92,38.67,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,aetna,,O,3055.12,206.42,1692.14,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97164,cpt,"RE-EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",aetna,,O,133.30,44.40,75.98,75.98,79.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",aetna,,O,100.04,20.74,56.30,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,aetna,,O,4054.33,327.84,1386.02,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",aetna,,O,547.73,117.10,288.14,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,aetna,,O,521.47,92.78,297.24,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,aetna,,O,56.62,7.92,31.13,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87172,cpt,PINWORM TEST,tricare,,O,37.50,4.29,4.29,4.29,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37765,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, 10-20 INCISIONS",aetna,,O,23967.03,2586.52,13483.00,13483.00,14380.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,aetna,,O,513.11,156.86,310.02,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58661,cpt,REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE,aetna,,O,27191.57,4592.49,13225.91,23996.68,16314.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,aetna,,O,101.45,3.58,57.83,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",aetna,,O,66.26,9.83,9.83,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,aetna,,I,19597.90,4492.16,10078.62,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,aetna,,I,5902.00,1055.41,28002.03,28002.03,3541.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37193,cpt,"REMOVAL OF VENA CAVA FILTER BY ENDOVASCULAR APPROACH, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",aetna,,O,18945.29,8355.15,8355.15,8355.15,11367.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,aetna,,I,752.83,203.26,404.83,719.74,451.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",aetna,,O,82.61,19.42,37.17,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",aetna,,O,41.06,11.36,18.48,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",aetna,,O,1645.73,583.80,994.35,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",aetna,,O,826.60,239.39,499.43,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",aetna,,O,52.60,8.84,29.98,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,aetna,,O,101.45,15.87,15.87,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,aetna,,O,440.18,84.89,204.36,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",aetna,,I,551.43,162.47,279.74,1560.66,330.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",aetna,,O,122.56,1.48,69.86,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,aetna,,O,69.59,7.80,40.86,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",aetna,,O,88.56,20.43,44.52,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,aetna,,O,89.65,6.58,54.16,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",aetna,,O,154.76,24.25,69.64,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,aetna,,O,30.49,2.32,17.38,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,aetna,,O,1620.71,439.39,979.23,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,aetna,,O,188.17,66.99,198.82,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",aetna,,O,16.23,1.83,7.30,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,aetna,,O,60.03,7.19,34.22,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,aetna,,I,18614.53,3748.00,10610.28,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",aetna,,O,362.65,61.08,206.71,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",aetna,,O,238.84,35.53,136.14,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",aetna,,O,107.59,3.13,42.33,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",aetna,,O,60.16,6.38,34.29,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",aetna,,O,4.12,1.10,1.85,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95806,cpt,"UNATTENDED SLEEP STUDY WITH RECORDING OF HEART RATE, OXYGEN, RESPIRATORY AIRFLOW AND EFFORT",aetna,,O,1695.75,59.68,966.58,1348.12,1017.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,aetna,,O,1205.09,132.64,7783.98,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",aetna,,O,126.23,16.29,71.95,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2765,cpt,"INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG",aetna,,O,79.57,14.40,35.96,59.62,47.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9190,cpt,"INJECTION, FLUOROURACIL, 500 MG",aetna,,O,9.25,1.74,1.95,20.90,5.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,aetna,,O,2112.19,159.37,1203.95,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,aetna,,O,152.18,14.75,86.74,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,aetna,,O,9.11,0.50,4.96,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",aetna,,O,31.88,3.63,108.34,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",aetna,,I,142.55,29.95,81.25,151.10,85.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",aetna,,O,422.68,79.92,240.93,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",aetna,,O,60.03,13.90,34.22,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",aetna,,O,635.27,137.73,313.92,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",aetna,,O,148.64,16.43,84.72,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",aetna,,O,100.03,11.76,58.73,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0114,revCode,ROOM AND BOARD PRIVATE (ONE BED) PSYCHIATRIC,aetna,,I,2332.29,629.26,1329.41,3095.92,1399.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",aetna,,O,162.48,33.29,73.12,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,aetna,,O,1479.41,92.59,92.59,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,aetna,,O,3055.12,206.42,1845.90,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",aetna,,O,15729.98,1862.99,5888.50,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87425,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ROTAVIRUS,aetna,,O,84.93,10.39,51.31,51.31,50.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,aetna,,I,16808.50,4145.69,15572.15,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",aetna,,I,1952.12,434.32,1012.08,1952.12,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",aetna,,O,45.06,8.39,25.68,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,aetna,,I,14759.59,3312.91,10029.42,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",aetna,,O,1.42,0.39,0.64,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",aetna,,I,72264.74,40625.03,40625.03,40625.03,43358.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",aetna,,O,1015.48,95.84,95.84,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",aetna,,O,125.04,27.28,58.45,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,aetna,,I,6.27,0.90,3.57,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",aetna,,O,70.01,13.01,31.50,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",aetna,,O,4116.84,594.86,1248.81,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,aetna,,O,2687.44,201.24,1148.88,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",aetna,,O,1997.14,273.93,440.30,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",aetna,,O,135.66,25.29,77.33,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",aetna,,O,3919.67,159.22,9370.59,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",aetna,,O,7.91,1.68,3.56,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",aetna,,O,67.24,14.75,38.33,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",aetna,,O,91.30,6.24,52.04,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",aetna,,O,270.00,64.89,254.67,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74455,cpt,REVIEW BY RADIOLOGIST OF URINARY BLADDER AND URETHRA IMAGES WITH CONTRAST AND AFTER PASSING URINE,aetna,,O,1067.98,182.43,608.75,608.75,640.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",aetna,,O,35.39,4.06,21.38,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,aetna,,O,28365.62,4521.08,6249.33,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",aetna,,O,281.36,90.50,165.19,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",aetna,,O,38.92,2.65,22.85,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",aetna,,I,212.36,46.07,170.13,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,aetna,,I,163.02,40.45,324.89,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5116,cpt,"INJECTION, TRASTUZUMAB-QYYP, BIOSIMILAR, (TRAZIMERA), 10 MG",aetna,,O,249.43,27.71,39.21,187.07,149.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,aetna,,O,60.16,11.87,36.34,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43244,cpt,TYING OF DILATED VEINS OF STOMACH AND/OR ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,aetna,,O,5449.41,1441.59,1441.59,1539.44,3269.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",aetna,,O,241.34,30.35,137.56,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,aetna,,O,567.74,115.42,288.14,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64479,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",aetna,,O,7223.75,739.73,739.73,2764.46,4334.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",aetna,,O,331.51,119.35,200.30,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28740,cpt,FUSION OF FOOT IN THE MIDFOOT REGION,aetna,,O,45471.26,5845.48,20996.90,20996.90,27282.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",aetna,,O,12.72,0.71,7.25,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),aetna,,O,91.30,14.31,52.04,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,aetna,,O,345.14,124.25,196.73,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",aetna,,O,2042.16,944.83,1198.95,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,aetna,,O,419.99,136.22,246.57,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",aetna,,O,73.14,3.60,3.60,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,aetna,,O,184.32,70.33,105.06,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",aetna,,O,2073.43,311.07,1252.76,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,aetna,,O,183.82,20.77,89.47,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",aetna,,O,113.79,13.73,29.56,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",aetna,,O,50.02,5.00,28.51,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",aetna,,O,369.82,61.44,198.87,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10180,cpt,COMPLEX DRAINAGE OF WOUND INFECTION AFTER SURGERY,aetna,,O,19831.00,324.08,11072.05,11072.05,11898.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9173,cpt,"INJECTION, DURVALUMAB, 10 MG",aetna,,O,267.80,77.11,77.58,87.07,160.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90653,cpt,"VACCINE FOR INFLUENZA FOR INJECTION INTO MUSCLE, INACTIVATED",aetna,,O,244.29,56.98,56.98,56.98,146.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",aetna,,O,176.32,30.07,100.50,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27130,cpt,REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS,aetna,,O,78286.44,11309.20,11418.64,11418.64,46971.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",aetna,,O,147.58,21.05,89.17,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",aetna,,O,4.27,1.25,1.88,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",aetna,,O,419.99,46.79,246.57,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,aetna,,O,95.55,14.26,24.23,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77001,cpt,"FLUOROSCOPIC GUIDANCE FOR INSERTION, REPLACEMENT OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",aetna,,O,847.87,227.86,512.28,847.87,508.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",aetna,,O,266.35,64.70,160.93,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,aetna,,O,183.82,19.97,84.56,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,aetna,,O,647.78,92.97,391.38,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,aetna,,O,113.25,11.78,64.55,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,aetna,,O,80.09,1.66,45.65,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43247,cpt,"REMOVAL OF FOREIGN BODIES OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",aetna,,O,5841.02,1094.58,2654.02,2654.02,3504.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71101,cpt,"X-RAY OF RIBS ON ONE SIDE OF BODY INCLUDING THE CHEST, MINIMUM OF 3 VIEWS",aetna,,O,377.65,61.44,228.17,228.17,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64718,cpt,RELEASE AND/OR RELOCATION OF ULNAR NERVE AT ELBOW,aetna,,O,18467.33,1563.58,1573.05,14075.51,11080.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,aetna,,O,502.71,78.63,286.54,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,aetna,,O,80.09,5.66,45.65,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,aetna,,O,231.34,36.98,135.82,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,aetna,,O,1952.12,144.93,1179.47,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",aetna,,O,54.32,13.67,14.15,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,aetna,,O,190.07,28.97,108.34,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",aetna,,O,221.79,37.73,134.00,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",aetna,,O,650.28,61.44,370.66,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52332,cpt,INSERTION OF STENT IN URINARY DUCT (URETER) USING AN ENDOSCOPE,aetna,,O,20654.85,2781.70,17672.06,17672.06,12392.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,aetna,,O,252.59,55.19,58.75,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,aetna,,O,306.38,103.42,116.72,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",aetna,,O,377.65,43.63,209.17,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",aetna,,O,285.11,61.44,167.39,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54830,cpt,REMOVAL OF GROWTH OF SPERM DUCT,aetna,,O,17845.38,158.54,10053.87,10053.87,10707.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",aetna,,O,348.89,46.07,198.87,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,aetna,,O,31.88,2.63,17.66,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",aetna,,I,944.41,228.70,570.97,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77372,cpt,"RADIATION THERAPY DELIVERY, STEREOTACTIC RADIOSURGERY (SRS) FOR CRANIAL GROWTHS, PER SESSION, USING A LINEAR ACCELERATOR",aetna,,O,23204.58,6663.20,6726.58,10102.14,13922.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",aetna,,O,90.84,3.51,51.78,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94729,cpt,TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,aetna,,O,231.34,43.74,131.86,238.28,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",aetna,,O,345.14,36.70,36.70,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66991,cpt,EXTRACAPSULAR REMOVAL OF CATARACT WITH INSERTION OF ARTIFICIAL LENS AND INSERTION OF DRAINAGE DEVICE IN FRONT CHAMBER OF EYE,aetna,,O,9278.04,2229.79,3682.12,3757.14,5566.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,aetna,,O,101.33,21.90,57.76,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,aetna,,I,1386.23,364.58,790.15,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,aetna,,O,123.87,5.34,72.73,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",aetna,,O,1858.47,98.50,765.92,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,aetna,,I,4152.82,995.38,2438.12,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9045,cpt,"INJECTION, CARBOPLATIN, 50 MG",aetna,,O,17.50,2.78,2.78,45.93,10.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27327,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF THIGH OR KNEE,aetna,,O,23319.30,13216.61,13216.61,13216.61,13991.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",aetna,,O,266.35,51.50,151.82,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",aetna,,O,101.45,14.76,57.83,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",aetna,,O,8.17,0.89,7.22,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74420,cpt,IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST AGENT,aetna,,O,1067.98,275.21,608.75,1067.98,243.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78707,cpt,"NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT OF BLOOD FLOW AND FUNCTION, WITHOUT DRUGS, SINGLE STUDY",aetna,,O,1360.60,775.54,775.54,775.54,816.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,aetna,,O,67.58,8.51,23.56,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",aetna,,O,2526.13,486.47,496.07,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",aetna,,O,734.07,19.80,418.42,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80156,cpt,"CARBAMAZEPINE LEVEL, TOTAL",aetna,,O,108.53,14.42,14.42,19.65,65.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11044,cpt,REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS,aetna,,O,6092.03,1247.54,1247.54,23397.56,3655.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,aetna,,O,3008.85,207.30,1817.95,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,aetna,,O,10678.57,58.46,4635.47,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",aetna,,O,203.82,32.52,53.46,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",aetna,,O,127.54,21.16,72.70,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,51600,cpt,INJECTION PROCEDURE FOR X-RAY IMAGING OF THE BLADDER OR DURING VOIDING,aetna,,O,2968.32,207.30,1456.17,1456.17,1780.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0881,cpt,"INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)",aetna,,O,10.64,2.75,7.88,7.96,6.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",aetna,,O,85.05,7.99,43.71,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",aetna,,O,348.89,53.55,210.80,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",aetna,,O,140.38,11.21,63.17,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,aetna,,O,383.02,34.82,289.41,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,aetna,,I,14560.83,3337.55,10044.87,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",aetna,,O,62.51,14.38,37.24,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",aetna,,O,318.54,72.28,86.28,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,aetna,,O,348.63,85.16,85.16,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",aetna,,O,151.64,21.05,91.62,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",aetna,,O,147.58,21.05,89.17,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,aetna,,O,36.32,3.85,20.70,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9047,cpt,"INFUSION, ALBUMIN (HUMAN), 25%, 50 ML",aetna,,O,105.55,1.06,47.50,204.13,63.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),aetna,,O,53.08,5.52,32.07,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",aetna,,O,82.88,8.42,36.86,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",aetna,,O,36.32,3.59,12.55,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11047,cpt,"REMOVAL OF BONE, EACH ADDITIONAL 20.0 SQ CM OR LESS",aetna,,O,6907.74,1247.54,1247.54,1247.54,4144.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,aetna,,O,1753.28,94.47,942.80,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,aetna,,E,2880.28,490.23,1768.50,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),aetna,,O,132.12,15.79,75.31,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",aetna,,O,112.55,10.48,51.40,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",aetna,,E,5953.08,743.91,2119.67,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,aetna,,O,93.19,5.27,53.12,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,aetna,,O,69.59,9.12,9.12,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",aetna,,O,7.49,1.49,3.18,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9267,cpt,"INJECTION, PACLITAXEL, 1 MG",aetna,,O,4.99,0.12,0.12,189.00,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11401,cpt,"REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",aetna,,O,1956.76,309.74,309.74,2169.65,1174.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",aetna,,O,120.33,16.46,68.59,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",aetna,,O,377.65,61.44,221.72,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),aetna,,O,283.14,16.69,171.07,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",aetna,,O,93.77,21.35,36.70,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,aetna,,O,287.62,77.37,163.94,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",aetna,,O,220.61,25.26,125.75,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,aetna,,O,38.92,4.65,23.51,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,aetna,,O,203.82,49.80,50.08,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,aetna - medicare advantage,,O,188.17,66.99,113.69,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,aetna - medicare advantage,,O,188.17,19.53,113.69,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",aetna - medicare advantage,,O,300.00,109.46,126.00,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,aetna - medicare advantage,,E,2880.28,490.23,782.08,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,aetna - medicare advantage,,E,880.03,214.07,459.41,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",aetna - medicare advantage,,O,290.00,66.00,111.87,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0521,revCode,FREESTANDING CLINIC CLINIC VISIT BY MEMBER TORHC/FQHC,aetna - medicare advantage,,O,290.00,111.87,111.87,255.96,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,aetna medicare adv,,O,76.68,5.83,9.55,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",aetna medicare adv,,O,231.34,36.97,49.86,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5103,cpt,"INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG",aetna medicare adv,,O,109.30,19.12,19.12,109.12,65.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,aetna medicare adv,,O,694.00,180.07,349.72,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,aetna medicare adv,,O,647.78,92.64,92.64,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,aetna medicare adv,,O,2687.44,201.24,204.36,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",aetna medicare adv,,O,45.06,8.66,17.76,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,aetna medicare adv,,O,7543.40,1294.20,1295.47,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",aetna medicare adv,,O,47.53,8.48,8.48,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,aetna medicare adv,,O,76.04,10.15,10.22,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,aetna medicare adv,,O,50.00,8.06,12.76,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,aetna medicare adv,,O,148.64,17.37,18.43,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,aetna medicare adv,,O,50.01,3.11,5.13,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",aetna medicare adv,,O,281.36,90.50,95.22,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",aetna medicare adv,,O,411.42,47.57,93.54,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,aetna medicare adv,,I,18651.11,4387.85,6011.07,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",aetna medicare adv,,O,183.82,20.70,20.70,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",aetna medicare adv,,O,734.07,114.82,443.53,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),aetna medicare adv,,O,132.12,15.79,22.12,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82530,cpt,"CORTISOL (HORMONE) MEASUREMENT, FREE",aetna medicare adv,,O,184.03,14.59,16.55,24.76,110.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,aetna medicare adv,,O,138.03,20.16,20.81,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",aetna medicare adv,,O,331.50,12.98,13.11,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",aetna medicare adv,,O,315.99,85.00,194.77,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,aetna medicare adv,,O,237.59,106.92,178.95,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",aetna medicare adv,,O,83.33,15.97,26.34,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,aetna medicare adv,,I,78211.42,12813.14,12813.14,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93281,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT MULTIPLE LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",aetna medicare adv,,O,257.60,30.44,30.44,136.53,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",aetna medicare adv,,O,91.30,6.24,10.38,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",aetna medicare adv,,O,422.68,79.92,242.61,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",aetna medicare adv,,O,635.27,137.73,311.00,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,aetna medicare adv,,O,101.45,12.63,14.45,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,aetna medicare adv,,O,345.14,124.25,183.24,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",aetna medicare adv,,O,238.84,35.53,75.38,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,aetna medicare adv,,O,123.87,5.34,8.81,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",aetna medicare adv,,O,93.19,13.33,13.43,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,229,ms-drg,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,aetna medicare adv,,I,87009.82,20597.74,20597.74,22664.85,52205.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",aetna medicare adv,,O,100.04,20.74,59.04,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",aetna medicare adv,,O,203.82,32.52,53.71,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",aetna medicare adv,,O,107.59,3.13,19.65,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",aetna medicare adv,,O,345.14,36.70,36.70,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",aetna medicare adv,,O,502.71,78.63,303.74,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,aetna medicare adv,,O,138.03,9.70,25.20,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,aetna medicare adv,,O,83.78,3.34,3.34,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",aetna medicare adv,,O,50.01,4.43,4.43,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",aetna medicare adv,,O,377.65,43.63,92.59,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,aetna medicare adv,,O,187.57,14.84,100.59,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,aetna medicare adv,,O,71.96,15.59,15.59,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",aetna medicare adv,,O,100.03,11.76,36.90,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",aetna medicare adv,,O,1680.75,111.66,906.33,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80299,cpt,QUANTITATION OF THERAPEUTIC DRUG,aetna medicare adv,,O,46.60,5.86,18.45,18.72,27.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",aetna medicare adv,,O,2073.43,311.07,311.07,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,aetna medicare adv,,O,152.18,14.75,14.90,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",aetna medicare adv,,O,267.61,48.10,73.63,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",aetna medicare adv,,O,5902.67,335.59,1290.20,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,aetna medicare adv,,I,19710.37,4922.26,6867.42,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,aetna medicare adv,,O,256.35,58.45,58.45,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,aetna medicare adv,,O,188.17,66.99,105.55,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),aetna medicare adv,,O,91.30,14.31,19.04,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,aetna medicare adv,,O,290.12,59.69,115.60,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",aetna medicare adv,,O,94.14,7.61,7.62,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",aetna medicare adv,,O,140.38,11.21,16.46,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,aetna medicare adv,,O,2289.17,554.60,592.46,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",aetna medicare adv,,O,267.61,58.94,72.45,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",aetna medicare adv,,O,90.84,9.28,9.28,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,aetna medicare adv,,O,323.88,75.26,75.26,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,aetna medicare adv,,O,1753.28,94.47,96.53,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,aetna medicare adv,,I,36086.42,12423.48,12513.39,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,aetna medicare adv,,I,62688.63,11498.14,13091.42,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,aetna medicare adv,,O,412.67,92.59,92.59,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,aetna medicare adv,,O,94.38,2.18,10.60,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86709,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),aetna medicare adv,,O,106.28,11.04,11.15,19.42,63.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,aetna medicare adv,,O,30.49,2.32,2.32,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",aetna medicare adv,,O,108.49,21.05,34.74,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",aetna medicare adv,,O,377.65,61.44,92.97,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,aetna medicare adv,,O,53.76,5.92,5.93,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,aetna medicare adv,,I,65131.57,7666.11,15760.94,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",aetna medicare adv,,O,1997.14,430.17,436.05,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",aetna medicare adv,,O,318.54,72.28,87.37,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",aetna medicare adv,,O,66.26,9.83,9.83,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",aetna medicare adv,,O,183.82,24.23,24.23,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,aetna medicare adv,,O,4852.19,224.32,326.13,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,aetna medicare adv,,I,20034.03,4988.82,5203.50,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,aetna medicare adv,,O,67.58,5.08,5.08,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",aetna medicare adv,,O,238.30,71.54,93.98,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",aetna medicare adv,,O,369.82,61.44,84.70,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,aetna medicare adv,,O,2149.71,310.75,310.75,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",aetna medicare adv,,O,350.39,39.08,61.24,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",aetna medicare adv,,O,826.60,239.39,241.07,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,aetna medicare adv,,O,1880.84,106.44,156.22,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",aetna medicare adv,,O,4.12,1.10,1.85,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",aetna medicare adv,,O,120.33,16.46,16.51,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,aetna medicare adv,,O,3055.12,320.47,320.47,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,aetna medicare adv,,O,3055.12,202.81,202.81,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,aetna medicare adv,,O,143.17,18.59,18.60,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,aetna medicare adv,,O,195.07,21.19,21.19,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,aetna medicare adv,,O,87.53,4.18,4.18,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",aetna medicare adv,,O,50.72,7.45,11.88,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",aetna medicare adv,,O,1406.87,198.35,322.42,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,aetna medicare adv,,O,108.53,13.66,14.42,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,521,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,aetna medicare adv,,I,91075.32,18634.25,18634.25,21775.75,54645.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,aetna medicare adv,,O,567.74,115.42,288.14,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,aetna medicare adv,,O,183.82,19.97,19.97,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",aetna medicare adv,,O,60.16,6.38,6.44,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",aetna medicare adv,,O,212.36,14.48,14.48,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,aetna medicare adv,,O,1479.41,92.59,93.54,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",aetna medicare adv,,O,85.05,7.99,8.84,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",aetna medicare adv,,O,348.89,61.44,75.46,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",aetna medicare adv,,O,101.45,25.33,25.55,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,aetna medicare adv,,O,60.03,7.19,11.86,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,aetna medicare adv,,O,73.83,11.51,14.84,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,aetna medicare adv,,O,65.11,6.57,6.65,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",aetna medicare adv,,O,348.89,46.07,75.52,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,aetna medicare adv,,O,130.11,30.48,38.47,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,aetna medicare adv,,O,792.84,92.74,92.74,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9228,cpt,"INJECTION, IPILIMUMAB, 1 MG",aetna medicare adv,,O,624.02,124.58,159.84,827.27,374.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,aetna medicare adv,,O,90.02,12.05,13.37,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,aetna medicare adv,,O,3055.12,204.95,204.95,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",aetna medicare adv,,O,151.46,8.03,13.26,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",aetna medicare adv,,O,93.77,21.35,36.70,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",aetna medicare adv,,O,2069.24,93.35,93.35,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",aetna medicare adv,,O,113.79,13.73,29.31,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",aetna medicare adv,,O,373.90,92.59,93.54,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,aetna medicare adv,,O,73.83,12.70,14.30,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,aetna medicare adv,,O,383.02,34.82,232.20,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",aetna medicare adv,,O,345.14,75.82,183.24,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,aetna medicare adv,,O,440.18,84.89,204.22,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",aetna medicare adv,,O,1893.35,485.97,495.92,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,aetna medicare adv,,O,84.93,8.43,12.46,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",aetna medicare adv,,O,135.66,14.84,18.02,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,aetna medicare adv,,O,4630.63,693.07,1537.76,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",aetna medicare adv,,O,285.11,61.44,75.46,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",aetna medicare adv,,O,56.26,6.34,6.36,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1335,cpt,"INJECTION, ERTAPENEM SODIUM, 500 MG",aetna medicare adv,,O,93.92,25.89,187.83,187.83,56.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",aetna medicare adv,,O,65.06,17.18,29.15,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,aetna medicare adv,,O,71.96,9.99,13.04,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0481,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",aetna medicare adv,,O,315.99,155.02,155.02,155.02,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,aetna medicare adv,,O,899.10,136.27,336.23,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",aetna medicare adv,,O,35.39,4.06,6.41,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0696,cpt,"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG",aetna medicare adv,,O,32.72,0.60,14.73,14.73,19.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",aetna medicare adv,,O,650.28,61.44,92.69,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",aetna medicare adv,,O,365.14,61.44,75.34,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,aetna medicare adv,,O,69.59,9.12,9.15,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,aetna medicare adv,,O,203.82,49.80,49.82,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",aetna medicare adv,,O,4116.84,594.86,1247.54,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78816,cpt,NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY,aetna medicare adv,,O,8009.86,1290.20,1290.20,2705.32,4805.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,aetna medicare adv,,O,93.19,11.22,11.94,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,aetna medicare adv,,O,42.51,2.00,2.20,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,aetna medicare adv,,O,266.35,64.70,100.74,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,aetna medicare adv,,O,2707.46,156.22,156.22,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,aetna medicare adv,,O,67.58,3.47,5.72,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",aetna medicare adv,,O,246.35,17.59,17.59,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,312,ms-drg,SYNCOPE AND COLLAPSE,aetna medicare adv,,I,19356.82,5264.37,5840.65,7437.32,11614.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,aetna medicare adv,,O,106.28,8.57,8.57,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,aetna medicare adv,,O,419.99,136.22,239.40,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,aetna medicare adv,,I,26926.14,6286.85,6638.14,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",aetna medicare adv,,O,90.84,3.51,20.41,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",aetna medicare adv,,O,70.01,13.01,23.14,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9144,cpt,"INJECTION, DARATUMUMAB, 10 MG AND HYALURONIDASE-FIHJ",aetna medicare adv,,O,148.31,44.88,48.33,48.33,88.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",aetna medicare adv,,O,52.60,8.84,8.85,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",aetna medicare adv,,O,116.79,7.81,10.63,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",aetna medicare adv,,O,117.54,25.46,58.45,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72220,cpt,"X-RAY OF SACRUM AND TAILBONE, MINIMUM OF 2 VIEWS",aetna medicare adv,,O,240.10,33.96,71.72,75.57,88.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,aetna medicare adv,,O,252.59,54.84,58.45,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",aetna medicare adv,,O,127.54,21.16,21.16,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",aetna medicare adv,,O,36.32,6.91,13.60,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",aetna medicare adv,,O,223.91,73.72,94.18,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",aetna medicare adv,,O,1099.23,114.80,115.66,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",aetna medicare adv,,O,1997.14,273.93,435.95,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),aetna medicare adv,,O,60.03,6.83,11.86,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",aetna medicare adv,,O,2042.16,944.83,1162.58,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",aetna medicare adv,,O,212.59,22.86,22.86,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",aetna medicare adv,,O,65.11,8.45,8.45,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,aetna medicare adv,,O,9.11,0.50,28.72,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,aetna medicare adv,,O,754.07,203.12,203.12,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",aetna medicare adv,,O,238.30,63.70,93.98,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,aetna medicare adv,,I,4152.82,995.38,2486.53,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",aetna medicare adv,,O,252.47,43.75,79.20,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,aetna medicare adv,,O,188.17,19.53,58.45,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",aetna medicare adv,,O,107.59,3.13,19.65,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,aetna medicare adv,,I,22023.98,6812.39,8548.88,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,aetna medicare adv,,O,298.87,98.24,98.24,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",aetna medicare adv,,O,622.77,61.44,92.87,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,aetna medicare adv,,O,4054.33,319.17,319.17,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,aetna medicare adv,,O,80.09,5.66,9.35,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,aetna medicare adv,,O,351.40,81.48,81.48,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,aetna medicare adv,,O,70.06,8.01,8.05,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82175,cpt,ARSENIC LEVEL,aetna medicare adv,,O,93.19,18.59,18.78,19.17,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",aetna medicare adv,,O,2526.13,486.47,496.12,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",aetna medicare adv,,O,105.03,12.96,36.70,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77075,cpt,X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY,aetna medicare adv,,O,735.32,61.44,95.27,97.23,441.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,aetna medicare adv,,O,306.38,103.42,115.66,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,aetna medicare adv,,O,560.24,92.59,92.59,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,aetna medicare adv,,I,1386.23,364.58,975.34,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,aetna medicare adv,,O,521.47,92.78,92.78,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9305,cpt,"INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG",aetna medicare adv,,O,280.11,3.19,76.83,76.83,168.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",aetna medicare adv,,O,252.47,44.06,148.23,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",aetna medicare adv,,O,1252.50,103.81,129.87,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",aetna medicare adv,,O,419.99,46.79,246.58,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90653,cpt,"VACCINE FOR INFLUENZA FOR INJECTION INTO MUSCLE, INACTIVATED",aetna medicare adv,,O,244.29,56.98,56.98,56.98,146.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",aetna medicare adv,,O,1.42,0.39,0.64,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,aetna medicare adv,,O,56.62,7.92,7.92,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",aetna medicare adv,,O,38.92,3.91,3.91,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,aetna medicare adv,,O,287.62,21.62,50.12,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73552,cpt,"X-RAY OF THIGH BONE, MINIMUM 2 VIEWS",aetna medicare adv,,O,327.63,38.17,76.03,173.76,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),aetna medicare adv,,O,283.14,16.69,16.86,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90694,cpt,"INFLUENZA VIRUS VACCINE, QUADRIVALENT (AIIV4), INACTIVATED, ADJUVANTED, PRESERVATIVE FREE, FOR INJECTION INTO MUSCLE, 0.5 ML DOSAGE",aetna medicare adv,,O,205.61,31.23,31.23,31.24,123.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",aetna medicare adv,,O,365.14,48.65,75.34,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",aetna medicare adv,,O,54.32,13.67,14.14,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,aetna medicare adv,,O,811.59,92.97,92.97,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",aetna medicare adv,,O,547.73,117.10,288.14,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,aetna medicare adv,,O,69.59,8.01,19.50,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,aetna medicare adv,,O,41.26,8.55,38.79,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,aetna medicare adv,,O,84.93,8.09,20.67,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,aetna medicare adv,,O,252.59,55.19,58.45,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",aetna medicare adv,,O,13.80,2.61,3.14,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",aetna medicare adv,,O,35.00,2.32,2.32,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,aetna medicare adv,,O,989.19,218.69,228.00,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",aetna medicare adv,,O,513.19,16.80,16.97,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,aetna medicare adv,,O,2152.21,335.59,338.53,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",aetna medicare adv,,O,50.72,5.89,5.92,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,aetna medicare adv,,O,3238.42,206.67,206.67,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,aetna medicare adv,,O,1753.28,94.47,94.66,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",aetna medicare adv,,O,3595.37,208.18,326.84,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",aetna medicare adv,,O,338.89,30.54,31.84,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74220,cpt,X-RAY OF ESOPHAGUS WITH SINGLE CONTRAST,aetna medicare adv,,O,585.25,65.33,156.22,360.68,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,aetna medicare adv,,O,113.25,11.78,14.09,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72202,cpt,"X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE, 3 OR MORE VIEWS",aetna medicare adv,,O,267.61,36.00,94.76,212.75,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",aetna medicare adv,,O,1029.19,93.54,93.54,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",aetna medicare adv,,O,1858.47,98.50,126.87,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,aetna medicare adv,,O,60.16,9.91,11.97,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,aetna medicare adv,,O,105.03,8.42,36.70,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93279,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT SINGLE LEAD PACEMAKER SYSTEM IN ONE CHAMBER OF HEART WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",aetna medicare adv,,O,191.31,30.35,30.35,33.02,114.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,aetna medicare adv,,O,3055.12,204.02,204.02,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,aetna medicare adv,,O,351.40,51.44,51.44,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,aetna medicare adv,,O,752.83,92.79,92.79,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,aetna medicare adv,,O,502.71,78.63,303.74,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,aetna medicare adv,,O,3595.37,280.86,351.47,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,aetna medicare adv,,O,10678.57,58.46,976.85,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,289,ms-drg,ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,aetna medicare adv,,I,25181.10,6178.75,6178.75,6178.75,15108.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,aetna medicare adv,,O,31.24,2.94,8.40,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,aetna medicare adv,,O,547.73,91.89,288.14,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,aetna medicare adv,,O,101.33,21.90,29.13,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",aetna medicare adv,,O,36.32,3.59,4.39,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,aetna medicare adv,,O,3055.12,205.61,205.61,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",aetna medicare adv,,O,65.11,10.15,14.42,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",aetna medicare adv,,O,422.68,79.93,242.61,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",aetna medicare adv,,O,19.52,4.40,8.77,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",aetna medicare adv,,O,221.79,37.73,37.73,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,aetna medicare adv,,O,67.58,8.51,8.55,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,aetna medicare adv,,O,3055.12,203.12,203.12,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",aetna medicare adv,,O,112.07,9.78,16.14,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",aetna medicare adv,,O,40.11,3.87,3.87,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",aetna medicare adv,,O,91.30,18.02,18.08,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83825,cpt,MERCURY LEVEL,aetna medicare adv,,O,132.12,15.93,16.10,27.18,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,aetna medicare adv,,O,116.31,18.99,19.19,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,aetna medicare adv,,O,1893.35,157.27,265.66,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",aetna medicare adv,,O,734.07,19.80,443.53,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,aetna medicare adv,,O,101.33,11.74,23.84,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",aetna medicare adv,,O,267.61,46.08,75.46,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",aetna medicare adv,,O,754.07,158.88,202.49,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",aetna medicare adv,,O,226.34,61.44,76.03,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,aetna medicare adv,,I,14826.55,4677.51,6000.52,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",aetna medicare adv,,O,52.60,5.67,9.35,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,570,ms-drg,SKIN DEBRIDEMENT WITH MCC,aetna medicare adv,,I,75025.56,18584.20,18584.20,22387.93,45015.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,aetna medicare adv,,O,303.87,29.81,59.05,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",aetna medicare adv,,O,82.61,19.42,37.17,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,aetna medicare adv,,O,3055.12,204.02,204.02,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",aetna medicare adv,,O,266.35,64.70,100.74,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,aetna medicare adv,,O,213.87,28.75,47.15,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,aetna medicare adv,,I,74793.54,13792.29,13809.99,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9022,cpt,"INJECTION, ATEZOLIZUMAB, 10 MG",aetna medicare adv,,O,156.30,38.92,80.42,82.27,93.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",aetna medicare adv,,O,241.34,30.35,30.35,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,aetna medicare adv,,I,32181.45,11429.58,11429.58,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",aetna medicare adv,,O,494.32,41.98,42.41,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9173,cpt,"INJECTION, DURVALUMAB, 10 MG",aetna medicare adv,,O,267.80,77.11,78.17,87.07,160.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,aetna medicare adv,,O,183.82,20.77,21.01,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",aetna medicare adv,,O,71.96,7.91,7.94,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,aetna medicare adv,,O,95.55,14.26,14.33,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",aetna medicare adv,,O,650.28,61.44,96.92,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,aetna medicare adv,,O,178.08,50.28,50.28,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,aetna medicare adv,,O,80.09,1.66,10.23,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",aetna medicare adv,,O,44.82,3.29,9.48,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",aetna medicare adv,,O,240.10,61.44,76.03,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,aetna medicare adv,,O,122.03,31.49,72.86,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",aetna medicare adv,,O,41.28,4.92,4.97,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,aetna medicare adv,,O,287.62,77.37,79.04,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",aetna medicare adv,,O,41.28,3.01,4.92,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,aetna medicare adv,,O,41.28,5.78,6.36,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",aetna medicare adv,,O,192.85,42.50,112.14,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,aetna medicare adv,,O,8198.69,1161.40,1161.70,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,aetna medicare adv,,O,221.79,37.03,38.23,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",aetna medicare adv,,O,826.60,242.61,245.08,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,aetna medicare adv,,O,42.58,4.32,7.17,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",aetna medicare adv,,O,3191.43,324.07,324.37,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,aetna medicare adv,,O,4318.19,810.94,817.69,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",aetna medicare adv,,O,199.37,74.90,94.08,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",aetna medicare adv,,O,41.06,11.36,18.57,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",aetna medicare adv,,O,70.06,8.29,8.32,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,aetna medicare adv,,O,42.58,6.02,6.08,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,aetna medicare adv,,O,60.16,11.87,11.99,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,aetna medicare adv,,O,330.33,24.94,25.20,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",aetna medicare adv,,O,281.00,8.75,92.97,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",aetna medicare adv,,O,125.04,27.28,58.45,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,aetna medicare adv,,O,89.65,6.58,17.80,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",aetna medicare adv,,O,114.43,3.13,19.65,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,aetna medicare adv,,O,231.34,36.98,49.86,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,aetna medicare adv,,O,5902.67,923.22,1154.48,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93930,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH ARMS,aetna medicare adv,,O,770.33,202.29,202.29,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,aetna medicare adv,,O,1159.26,202.49,202.49,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0878,cpt,"INJECTION, DAPTOMYCIN, 1 MG",aetna medicare adv,,O,1.16,0.05,0.14,0.14,0.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",aetna medicare adv,,O,148.64,16.43,16.60,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",aetna medicare adv,,O,31.24,4.67,5.25,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",aetna medicare adv,,O,7.91,1.68,3.57,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,aetna medicare adv,,O,203.82,49.80,49.84,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5116,cpt,"INJECTION, TRASTUZUMAB-QYYP, BIOSIMILAR, (TRAZIMERA), 10 MG",aetna medicare adv,,O,249.43,27.71,32.53,187.07,149.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70480,cpt,CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,aetna medicare adv,,O,1343.10,93.35,93.35,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",aetna medicare adv,,O,38.92,2.65,2.65,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,aetna medicare adv,,O,24173.14,2776.54,2776.54,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",aetna medicare adv,,O,176.32,30.07,30.18,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73525,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF HIP JOINT,aetna medicare adv,,O,1211.78,322.42,322.42,327.84,727.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,aetna medicare adv,,O,176.37,11.81,11.86,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,aetna medicare adv,,O,3055.12,202.94,202.94,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,aetna medicare adv,,O,41.19,1.80,50.20,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,aetna medicare adv,,I,5986.20,1090.17,5203.50,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93931,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE ARM OR LIMITED,aetna medicare adv,,O,646.53,92.68,92.68,216.32,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",aetna medicare adv,,O,680.29,236.16,458.67,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",aetna medicare adv,,O,36.32,4.04,4.25,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9354,cpt,"INJECTION, ADO-TRASTUZUMAB EMTANSINE, 1 MG",aetna medicare adv,,O,131.30,30.33,37.56,43.44,78.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",aetna medicare adv,,O,10827.72,2513.53,2513.53,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,aetna medicare adv,,O,3683.73,275.00,2541.19,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,ambertter (centene),,O,76.68,5.83,9.71,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",ambertter (centene),,O,52.60,8.84,9.02,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,ambertter (centene),,O,265.10,8.75,265.10,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,ambertter (centene),,O,1893.35,157.27,651.54,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",ambertter (centene),,O,132.12,25.53,132.12,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",ambertter (centene),,O,468.95,93.59,804.09,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",ambertter (centene),,O,266.35,64.70,266.35,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,ambertter (centene),,O,647.78,92.64,804.09,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",ambertter (centene),,O,281.00,8.75,265.10,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",ambertter (centene),,O,369.82,61.44,170.40,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",ambertter (centene),,O,36.32,4.04,36.32,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",ambertter (centene),,O,91.30,18.02,91.30,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,ambertter (centene),,O,266.35,64.70,266.35,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",ambertter (centene),,O,10827.72,2513.53,3991.68,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,ambertter (centene),,O,231.34,36.98,218.25,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,ambertter (centene),,O,9.11,0.50,0.50,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",ambertter (centene),,O,365.14,61.44,344.48,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77387,cpt,GUIDANCE FOR LOCALIZATION OF TARGET DELIVERY OF RADIATION TREATMENT,ambertter (centene),,O,256.94,157.33,313.88,313.88,58.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,ambertter (centene),,O,5902.67,923.22,5568.56,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",ambertter (centene),,O,231.34,36.97,218.25,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",ambertter (centene),,O,13.80,2.61,40.11,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",ambertter (centene),,O,1997.14,273.93,1997.14,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,ambertter (centene),,O,41.26,8.55,14.44,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",ambertter (centene),,O,94.14,7.61,88.82,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,ambertter (centene),,O,306.38,103.42,306.38,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",ambertter (centene),,O,5902.67,335.59,5568.56,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",ambertter (centene),,O,154.76,24.25,154.76,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",ambertter (centene),,O,502.71,78.63,474.26,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",ambertter (centene),,O,266.35,64.70,266.35,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,ambertter (centene),,O,989.19,218.69,989.19,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",ambertter (centene),,O,285.11,61.44,73.18,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",ambertter (centene),,O,50.72,5.89,50.72,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",ambertter (centene),,O,91.30,6.24,10.56,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,ambertter (centene),,O,41.19,1.80,151.16,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,ambertter (centene),,O,41.28,5.78,41.28,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,ambertter (centene),,O,502.71,78.63,474.26,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",ambertter (centene),,O,365.14,48.65,344.48,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",ambertter (centene),,O,96.29,17.55,90.84,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,ambertter (centene),,O,383.02,34.82,283.86,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",ambertter (centene),,O,1997.14,430.17,1997.14,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",ambertter (centene),,O,267.61,46.08,267.61,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",ambertter (centene),,O,85.05,7.99,50.72,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",ambertter (centene),,O,120.33,16.46,16.80,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,ambertter (centene),,O,31.24,2.94,17.12,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",blue cross blue shield,,O,36.32,4.04,6.42,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",ambertter (centene),,O,70.06,8.29,70.06,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,ambertter (centene),,O,178.08,50.28,51.31,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",ambertter (centene),,O,151.46,8.03,13.39,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,ambertter (centene),,O,116.31,18.99,19.38,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,ambertter (centene) medicare advantage,,I,36086.42,12423.48,12530.79,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,blue cross blue shield,,O,1893.35,157.27,681.17,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17262,cpt,"DESTRUCTION OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,507.74,161.17,493.37,493.37,304.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63048,cpt,"PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF SPINAL CORD AND/OR NERVES, EACH ADDITIONAL SEGMENT",blue cross blue shield,,O,44366.77,5559.58,13162.95,13162.95,26620.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86747,cpt,ANALYSIS FOR ANTIBODY TO PARVOVIRUS,blue cross blue shield,,O,70.78,12.91,12.91,18.79,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1776,cpt,JOINT DEVICE (IMPLANTABLE),blue cross blue shield,,O,3788.11,198.44,1384.51,18412.83,2272.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",blue cross blue shield,,O,4.27,1.25,1.50,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,blue cross blue shield,,O,752.83,92.79,216.32,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73650,cpt,"X-RAY OF HEEL, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,254.50,44.02,93.47,149.69,152.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74270,cpt,SINGLE CONTRAST X-RAY OF LARGE INTESTINE,blue cross blue shield,,O,725.32,158.70,290.82,360.68,435.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,blue cross blue shield,,O,502.71,78.63,99.27,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70470,cpt,CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,2708.71,159.41,228.66,450.85,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11401,cpt,"REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,1956.76,309.74,2169.65,2169.65,1174.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,blue cross blue shield,,O,28.83,5.59,5.59,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64493,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SINGLE LEVEL",blue cross blue shield,,O,4480.53,1107.35,2566.99,2566.99,2688.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1757,cpt,"CATHETER, THROMBECTOMY/EMBOLECTOMY",blue cross blue shield,,O,4350.70,969.29,969.29,969.29,2610.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28010,cpt,"REPAIR OF TOE TENDON, ACCESSED THROUGH THE SKIN",blue cross blue shield,,O,6565.31,6631.24,6631.24,6631.24,3939.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99281,cpt,"EMERGENCY DEPARTMENT VISIT, SELF LIMITED OR MINOR PROBLEM",blue cross blue shield,,E,206.32,65.63,218.69,531.77,123.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86708,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY,blue cross blue shield,,O,30.98,30.98,30.98,30.98,18.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",blue cross blue shield,,O,281.00,8.75,162.07,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9360,cpt,"INJECTION, VINBLASTINE SULFATE, 1 MG",blue cross blue shield,,O,16.98,3.23,3.23,3.23,10.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1763,cpt,"CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)",blue cross blue shield,,O,5191.09,570.72,570.72,4126.91,3114.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42830,cpt,"REMOVAL OF ADENOIDS PATIENT YOUNGER THAN AGE 12, INITIAL PROCEDURE",blue cross blue shield,,O,16836.71,2475.13,5993.73,5993.73,10102.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,776,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,blue cross blue shield,,I,14024.63,2935.28,9541.48,9541.48,8414.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,693,ms-drg,URINARY STONES WITH MCC,blue cross blue shield,,I,10768.65,9928.25,9928.25,9928.25,6461.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11406,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF BODY, ARMS, OR LEGS, MORE THAN 4.0 CM",blue cross blue shield,,O,17469.26,1304.93,5506.99,5506.99,10481.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88312,cpt,SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,blue cross blue shield,,O,63.70,17.04,23.46,63.70,38.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,blue cross blue shield,,O,567.74,115.42,115.42,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13101,cpt,REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF TRUNK,blue cross blue shield,,O,17422.96,473.85,5652.50,5652.50,10453.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,blue cross blue shield,,O,1952.12,344.86,370.43,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,blue cross blue shield,,O,256.35,58.45,64.02,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,348.89,61.44,61.44,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84112,cpt,CERVICOVAGINAL SECRETION OF PLACENTA PROTEIN,blue cross blue shield,,O,257.65,98.11,257.65,257.65,49.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81241,cpt,GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIANT,blue cross blue shield,,O,331.51,68.48,68.48,331.51,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",blue cross blue shield,,O,52.60,5.67,6.52,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,287,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",blue cross blue shield,,I,42121.79,7205.02,13887.33,13887.33,25273.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,698,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,blue cross blue shield,,I,27219.24,6918.41,13797.24,18262.00,16331.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,348.89,46.07,61.44,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,blue cross blue shield,,O,10678.57,95.85,2155.84,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",blue cross blue shield,,O,89.65,10.18,10.18,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",blue cross blue shield,,O,19.52,4.40,6.69,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,792,ms-drg,PREMATURITY WITHOUT MAJOR PROBLEMS,blue cross blue shield,,I,26570.93,4433.28,4433.28,19606.71,15942.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,894,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",blue cross blue shield,,I,15236.57,4413.56,4413.56,4480.15,9141.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,blue cross blue shield,,O,414.89,93.99,216.32,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88311,cpt,PREPARATION OF TISSUE FOR EXAMINATION BY REMOVING ANY CALCIUM PRESENT,blue cross blue shield,,O,46.00,18.36,19.74,34.50,27.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",blue cross blue shield,,O,826.60,239.39,849.89,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97164,cpt,"RE-EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",blue cross blue shield,,O,133.30,44.40,44.40,75.98,79.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1930,cpt,"INJECTION, LANREOTIDE, 1 MG",blue cross blue shield,,O,216.33,32.32,32.32,62.62,129.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1819,cpt,SURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (IMPLANTABLE),blue cross blue shield,,O,656.94,40.85,183.05,183.05,394.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",blue cross blue shield,,O,88.24,14.05,26.60,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",blue cross blue shield,,O,176.32,30.07,65.93,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",blue cross blue shield,,O,650.28,61.44,61.44,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,206,ms-drg,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,blue cross blue shield,,I,26545.25,6727.00,8568.68,10067.42,15927.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,blue cross blue shield,,O,116.31,18.99,22.22,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81325,cpt,"GENE ANALYSIS (PERIPHERAL MYELIN PROTEIN 22), FULL SEQUENCE ANALYSIS",blue cross blue shield,,O,1923.95,255.51,255.51,255.51,1154.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,312.63,61.44,61.44,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82575,cpt,CREATININE CLEARANCE MEASUREMENT TO TEST FOR KIDNEY FUNCTION,blue cross blue shield,,O,80.22,9.31,17.63,20.42,11.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,blue cross blue shield,,O,792.84,92.74,216.32,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,blue cross blue shield,,O,330.33,24.94,48.01,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,314,ms-drg,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,blue cross blue shield,,I,33150.59,4847.80,22580.00,22580.00,19890.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",blue cross blue shield,,O,218.83,30.93,76.59,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84479,cpt,THYROID HORMONE EVALUATION,blue cross blue shield,,O,69.59,19.98,19.98,19.98,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",blue cross blue shield,,O,45.06,8.39,8.39,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",blue cross blue shield,,E,1724.51,232.62,422.10,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,blue cross blue shield,,O,106.28,8.57,14.64,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27654,cpt,SECONDARY REPAIR OF RUPTURED ACHILLES TENDON,blue cross blue shield,,O,32249.15,5736.03,16282.30,16282.30,19349.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0440,revCode,OCCUPATIONAL THERAPY GENERAL,blue cross blue shield,,O,264.26,74.09,97.63,97.63,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",blue cross blue shield,,O,162.48,33.29,52.47,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,blue cross blue shield,,O,694.00,180.07,224.91,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82390,cpt,CERULOPLASMIN (PROTEIN) LEVEL,blue cross blue shield,,O,71.96,2.18,17.27,26.69,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80184,cpt,PHENOBARBITAL LEVEL,blue cross blue shield,,O,101.33,12.53,24.37,24.37,60.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9100,cpt,PATHOGEN(S) TEST FOR PLATELETS,blue cross blue shield,,O,142.13,30.02,97.18,97.18,85.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74240,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST,blue cross blue shield,,O,513.01,159.41,263.33,543.79,307.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17261,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,1535.94,159.87,761.92,761.92,921.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",blue cross blue shield,,O,66.26,9.83,11.87,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9539,cpt,"TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES",blue cross blue shield,,O,225.10,85.93,86.11,231.85,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1815,cpt,"INJECTION, INSULIN, PER 5 UNITS",blue cross blue shield,,O,29.26,4.48,5.50,14.09,17.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45499,cpt,OTHER PROCEDURE ON RECTUM USING AN ENDOSCOPE,blue cross blue shield,,O,39540.59,8733.32,8733.32,8733.32,23724.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9263,cpt,"INJECTION, OXALIPLATIN, 0.5 MG",blue cross blue shield,,O,8.74,0.07,1.50,24.00,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,blue cross blue shield,,O,35679.28,5647.61,11215.03,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,blue cross blue shield,,O,3683.73,275.00,1042.86,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,202.50,1017.53,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,674,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,blue cross blue shield,,I,60019.19,15090.19,23273.88,23273.88,36011.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,blue cross blue shield,,O,2149.71,310.75,499.40,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45350,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (SIGMOIDOSCOPE),blue cross blue shield,,O,3810.64,935.38,3292.25,3292.25,2286.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),blue cross blue shield,,O,41.28,5.08,10.96,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69436,cpt,INCISION OF EARDRUM WITH PLACEMENT OF EARDRUM TUBE UNDER GENERAL ANESTHESIA,blue cross blue shield,,O,13970.08,1227.06,4781.16,9077.44,8382.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10060,cpt,SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS,blue cross blue shield,,O,1091.80,417.40,845.87,1495.21,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,245.09,61.44,61.44,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3420,cpt,"INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG",blue cross blue shield,,O,14.29,1.32,1.32,3.18,8.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",blue cross blue shield,,O,345.14,75.82,114.32,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,201,ms-drg,PNEUMOTHORAX WITHOUT CC/MCC,blue cross blue shield,,I,23260.48,2891.35,8982.44,8982.44,13956.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,blue cross blue shield,,I,36086.42,12423.48,18071.66,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43233,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, 3.0 CM OR MORE",blue cross blue shield,,O,5214.04,1514.61,3018.61,3018.61,3128.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",blue cross blue shield,,O,223.91,73.72,92.39,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,blue cross blue shield,,O,1952.12,144.93,404.68,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,blue cross blue shield,,E,880.03,214.07,608.30,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81256,cpt,GENE ANALYSIS (HEMOCHROMATOSIS) COMMON VARIANTS,blue cross blue shield,,O,355.11,121.73,121.73,355.11,213.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",blue cross blue shield,,O,691.54,93.84,216.32,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84597,cpt,VITAMIN K LEVEL,blue cross blue shield,,O,34.30,3.21,3.21,3.21,20.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,440,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,blue cross blue shield,,I,12850.05,3815.31,5589.85,12183.21,7710.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82375,cpt,CARBOXYHEMOGLOBIN (PROTEIN) LEVEL,blue cross blue shield,,O,116.29,15.40,18.75,119.78,14.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86593,cpt,SYPHILIS TEST,blue cross blue shield,,O,50.01,2.27,6.51,6.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",blue cross blue shield,,O,513.19,16.80,51.97,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0694,cpt,"INJECTION, CEFOXITIN SODIUM, 1 GM",blue cross blue shield,,O,70.94,24.30,24.30,24.30,42.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26055,cpt,INCISION OF TENDON COVERING OF FINGER,blue cross blue shield,,O,17730.63,1248.60,4980.73,4980.73,10638.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,blue cross blue shield,,O,351.40,92.60,228.66,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,blue cross blue shield,,O,3055.12,203.12,517.17,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,281,ms-drg,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC",blue cross blue shield,,I,43961.79,11639.35,11639.35,11639.35,26377.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,328,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",blue cross blue shield,,I,48722.60,11664.12,17780.50,45539.96,29233.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,blue cross blue shield,,O,31.24,2.94,5.24,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",blue cross blue shield,,O,233.84,30.94,76.59,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72220,cpt,"X-RAY OF SACRUM AND TAILBONE, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,240.10,33.96,43.58,75.57,88.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,857,ms-drg,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,blue cross blue shield,,I,58450.53,13402.18,19974.44,19974.44,35070.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82085,cpt,ALDOLASE (ENZYME) LEVEL,blue cross blue shield,,O,50.72,6.25,6.25,28.91,30.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9354,cpt,"INJECTION, ADO-TRASTUZUMAB EMTANSINE, 1 MG",blue cross blue shield,,O,131.30,30.33,43.44,43.44,78.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3380,cpt,"INJECTION, VEDOLIZUMAB, 1 MG",blue cross blue shield,,O,68.13,21.84,64.28,3747.37,40.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,blue cross blue shield,,O,41.28,5.78,5.90,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,blue cross blue shield,,O,113.25,11.78,14.15,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86644,cpt,ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV),blue cross blue shield,,O,79.04,14.45,20.61,20.61,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11721,cpt,REMOVAL OF TISSUE FROM 6 OR MORE FINGER OR TOE NAILS,blue cross blue shield,,O,303.44,50.80,3502.06,3502.06,182.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,blue cross blue shield,,O,9.11,0.50,3.64,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19081,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, FIRST GROWTH",blue cross blue shield,,O,6548.62,1273.00,3399.79,5582.75,3929.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,561,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",blue cross blue shield,,I,28538.09,6566.77,8995.44,13087.98,17122.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80050,cpt,GENERAL HEALTH PANEL,blue cross blue shield,,O,300.45,40.45,40.45,300.45,57.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1940,cpt,"INJECTION, FUROSEMIDE, UP TO 20 MG",blue cross blue shield,,O,39.41,0.66,15.08,16.00,23.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43280,cpt,STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE,blue cross blue shield,,O,36571.06,7902.70,17729.21,26906.78,21942.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",blue cross blue shield,,O,35.00,2.32,12.19,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,832,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,blue cross blue shield,,I,13166.47,3172.81,7858.64,9094.35,7899.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82787,cpt,"GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT, IMMUNOGLOBULIN SUBCLASSES",blue cross blue shield,,O,20.05,8.05,13.19,13.19,12.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87529,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,54.75,15.34,23.25,35.23,32.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,blue cross blue shield,,O,30.49,2.32,10.59,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",blue cross blue shield,,O,267.61,61.44,67.18,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",blue cross blue shield,,O,290.00,66.00,77.82,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",blue cross blue shield,,O,252.47,43.75,95.71,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9267,cpt,"INJECTION, PACLITAXEL, 1 MG",blue cross blue shield,,O,4.99,0.12,1.08,189.00,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93281,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT MULTIPLE LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",blue cross blue shield,,O,257.60,30.44,76.59,136.53,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49465,cpt,"CONTRAST INJECTIONS FOR X-RAY IMAGING THROUGH EXISTING TUBE IN STOMACH, SMALL BOWEL OR LARGE BOWEL, ACCESSED THROUGH SKIN",blue cross blue shield,,O,1017.00,206.42,510.59,510.59,610.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",blue cross blue shield,,O,315.99,85.00,85.00,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84450,cpt,"LIVER ENZYME (SGOT), LEVEL",blue cross blue shield,,O,40.11,5.08,8.75,8.75,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",blue cross blue shield,,O,25.94,5.08,6.95,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,blue cross blue shield,,O,842.86,94.39,216.32,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37766,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, GREATER THAN 20 INCISIONS",blue cross blue shield,,O,24542.50,3410.10,4474.51,5064.25,14725.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,blue cross blue shield,,O,95.55,14.26,18.76,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,blue cross blue shield,,O,70.06,8.01,20.66,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0430,revCode,"OCCUPATIONAL THERAPY, GENERAL",blue cross blue shield,,O,212.21,71.36,71.36,1618.35,127.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70110,cpt,"X-RAY OF LOWER JAW, MINIMUM OF 4 VIEWS",blue cross blue shield,,O,436.43,61.44,268.03,268.03,261.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52214,cpt,"DESTRUCTION OF TISSUE IN THE BLADDER, BLADDER CANAL (URETHRA) OR SURROUNDING GLANDS USING AN ENDOSCOPE",blue cross blue shield,,O,13756.80,5210.41,5210.41,5210.41,8254.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52332,cpt,INSERTION OF STENT IN URINARY DUCT (URETER) USING AN ENDOSCOPE,blue cross blue shield,,O,20654.85,2781.70,8432.36,17672.06,12392.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70150,cpt,"X-RAY OF BONES OF FACE, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,495.21,61.44,61.44,371.41,297.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,blue cross blue shield,,O,1952.12,159.41,542.51,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",blue cross blue shield,,O,50.02,5.00,5.92,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",blue cross blue shield,,O,3191.43,324.07,928.19,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86671,cpt,ANALYSIS FOR ANTIBODY TO FUNGUS,blue cross blue shield,,O,30.63,5.89,7.44,30.62,18.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,blue cross blue shield,,O,531.48,100.50,100.50,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80156,cpt,"CARBAMAZEPINE LEVEL, TOTAL",blue cross blue shield,,O,108.53,14.42,19.65,19.65,65.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93668,cpt,PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION PER SESSION,blue cross blue shield,,O,148.80,49.55,64.11,64.11,89.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84590,cpt,VITAMIN A LEVEL,blue cross blue shield,,O,29.03,11.66,15.88,15.88,17.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,908,ms-drg,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,blue cross blue shield,,I,61086.11,11576.87,20349.19,20349.19,36651.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",blue cross blue shield,,O,373.90,92.59,101.54,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64445,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO SCIATIC NERVE OF LOWER BACK AND LEG,blue cross blue shield,,O,42861.08,5736.03,10198.40,10198.40,25716.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",blue cross blue shield,,O,238.84,35.53,56.05,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,103,ms-drg,HEADACHES WITHOUT MCC,blue cross blue shield,,I,23496.03,6310.95,8860.70,8860.70,14097.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36569,cpt,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER FOR INFUSION (PICC), PATIENT 5 YEARS OR OLDER",blue cross blue shield,,O,2853.53,1292.67,1820.82,2529.35,1712.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0770,revCode,"PREVENTIVE CARE SERVICES, GENERAL",blue cross blue shield,,O,175.06,23.49,60.60,166.01,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,blue cross blue shield,,O,76.68,5.83,14.42,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,blue cross blue shield,,O,862.88,61.44,61.44,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",blue cross blue shield,,O,2042.16,944.83,944.83,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80178,cpt,LITHIUM LEVEL,blue cross blue shield,,O,56.26,6.48,30.27,42.20,7.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45330,cpt,DIAGNOSTIC EXAMINATION OF THE LOWER PORTION OF THE LARGE BOWEL USING AN ENDOSCOPE,blue cross blue shield,,O,3245.25,719.92,2521.54,2991.30,1947.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,blue cross blue shield,,O,323.88,75.26,225.57,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84166,cpt,"PROTEIN MEASUREMENT, BODY FLUID",blue cross blue shield,,O,61.34,6.87,6.87,30.15,20.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62321,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK USING IMAGING GUIDANCE,blue cross blue shield,,O,2267.14,558.18,1596.44,1776.12,1360.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,331,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,blue cross blue shield,,I,49456.93,5489.60,18703.61,19473.00,29674.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L1830,cpt,"KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, OFF-THE-SHELF",blue cross blue shield,,O,405.73,68.25,135.84,232.04,243.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,blue cross blue shield,,O,56.62,7.92,10.88,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,blue cross blue shield,,O,237.59,106.92,106.92,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78709,cpt,"NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT OF BLOOD FLOW AND FUNCTION, WITH OR WITHOUT DRUGS, MULTIPLE STUDIES",blue cross blue shield,,O,1411.87,444.24,540.13,1009.00,847.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,blue cross blue shield,,O,102.63,10.90,18.44,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77001,cpt,"FLUOROSCOPIC GUIDANCE FOR INSERTION, REPLACEMENT OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",blue cross blue shield,,O,847.87,227.86,263.61,847.87,508.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62320,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK,blue cross blue shield,,O,1594.50,564.08,1436.46,1436.46,956.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",blue cross blue shield,,O,1015.48,95.84,507.74,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,246,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,blue cross blue shield,,I,112798.01,18912.25,32253.88,59595.14,67678.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,blue cross blue shield,,O,348.63,85.16,105.98,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29879,cpt,REPAIR OF KNEE JOINT WITH DRILLING AND OR SCRAPING OF JOINT USING AN ENDOSCOPE,blue cross blue shield,,O,37483.30,11194.23,11194.23,11194.23,22489.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9040,cpt,"INJECTION, BLEOMYCIN SULFATE, 15 UNITS",blue cross blue shield,,O,448.39,51.36,51.36,51.36,269.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4649,cpt,SURGICAL SUPPLIES; MEDICAL AND SURGICAL SUPPLIES - OTHER SUPPLIES,blue cross blue shield,,O,8912.36,6246.56,6246.56,6246.56,5347.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9312,cpt,"INJECTION, RITUXIMAB, 10 MG",blue cross blue shield,,O,338.23,76.93,76.93,6015.75,202.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64480,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",blue cross blue shield,,O,6973.44,739.73,2920.54,2920.54,4184.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29888,cpt,REPAIR OF ANTERIOR CRUCIATE LIGAMENT OF KNEE WITH ASSISTANCE OF AN ENDOSCOPE,blue cross blue shield,,O,54316.68,5757.05,14778.63,14778.63,32590.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",blue cross blue shield,,O,754.07,158.88,282.54,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,blue cross blue shield,,O,41.19,1.80,6.76,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4616,cpt,TUBING (OXYGEN) PER FOOT; MEDICAL AND SURGICAL SUPPLIES - RESPIRATORY SUPPLIES AND EQUIPMENT,blue cross blue shield,,O,1580.92,500.52,500.52,1675.77,948.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83625,cpt,LACTATE DEHYDROGENASE (ENZYME) MEASUREMENT,blue cross blue shield,,O,69.59,10.69,10.69,10.69,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",blue cross blue shield,,O,635.27,137.73,290.79,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2210,cpt,"INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG",blue cross blue shield,,O,126.15,25.92,25.92,38.74,75.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0985,revCode,PROFESSIONAL FEES (EXTENSION OF 096X AND 097X) EKG,blue cross blue shield,,O,38.76,7.83,7.83,7.83,23.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73521,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 2 VIEWS",blue cross blue shield,,O,307.42,50.25,50.25,50.25,184.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",blue cross blue shield,,O,647.78,98.50,204.94,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86361,cpt,T CELL COUNT AND RATIO,blue cross blue shield,,O,66.95,7.62,7.62,7.62,40.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,blue cross blue shield,,O,123.87,5.34,15.35,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3489,cpt,"INJECTION, ZOLEDRONIC ACID, 1 MG",blue cross blue shield,,O,147.55,10.36,48.39,110.66,88.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9206,cpt,"INJECTION, IRINOTECAN, 20 MG",blue cross blue shield,,O,16.23,4.11,4.11,36.90,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15271,cpt,"APPLICATION OF SKIN SUBSTITUTE GRAFT TO WOUND OF TRUNK, ARMS, OR LEGS, 25.0 SQ CM OR LESS OF WOUND 100.0 SQ CM OR LESS",blue cross blue shield,,O,8160.85,5348.55,5348.55,5348.55,4896.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",blue cross blue shield,,O,107.59,3.13,29.52,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J8501,cpt,"APREPITANT, ORAL, 5 MG",blue cross blue shield,,O,78.57,18.19,21.34,21.34,47.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,blue cross blue shield,,O,190.07,28.97,28.97,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,149.83,34.39,79.34,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",blue cross blue shield,,O,31.88,3.63,6.09,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,blue cross blue shield,,O,79.04,16.60,22.19,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19302,cpt,PARTIAL REMOVAL OF BREAST AND UNDERARM LYMPH NODES,blue cross blue shield,,O,41081.22,9270.58,9270.58,9270.58,24648.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,blue cross blue shield,,O,148.64,17.37,17.37,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",blue cross blue shield,,O,3583.92,323.18,695.52,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",blue cross blue shield,,O,238.30,63.70,87.28,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,205.61,811.86,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64484,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",blue cross blue shield,,O,7561.13,743.72,2728.97,2728.97,4536.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,240,ms-drg,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,blue cross blue shield,,I,48148.78,17032.79,31073.16,31073.16,28889.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88300,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, LIMITED EXAMINATION",blue cross blue shield,,O,93.19,26.27,31.14,93.19,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1750,cpt,"CATHETER, HEMODIALYSIS/PERITONEAL, LONG-TERM",blue cross blue shield,,O,1377.27,508.51,508.51,508.51,826.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5116,cpt,"INJECTION, TRASTUZUMAB-QYYP, BIOSIMILAR, (TRAZIMERA), 10 MG",blue cross blue shield,,O,249.43,27.71,73.01,187.07,149.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",blue cross blue shield,,O,154.76,24.25,24.25,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86769,cpt,MEASURE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIBODY,blue cross blue shield,,O,94.60,13.14,20.29,70.95,49.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",blue cross blue shield,,O,184.32,70.33,146.52,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",blue cross blue shield,,O,175.06,87.53,185.56,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47000,cpt,"NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN",blue cross blue shield,,O,11195.22,1299.27,6518.37,6518.37,6717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0091,cpt,"SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARING AND CONVEYANCE OF CERVICAL OR VAGINAL SMEAR TO LABORATORY",blue cross blue shield,,O,83.47,18.99,18.99,18.99,50.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,300,ms-drg,PERIPHERAL VASCULAR DISORDERS WITH CC,blue cross blue shield,,I,16027.98,6756.27,12036.47,12036.47,9616.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85384,cpt,FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,blue cross blue shield,,O,56.26,7.19,7.19,75.59,11.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",blue cross blue shield,,O,494.32,41.98,64.23,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,blue cross blue shield,,O,19028.38,1098.56,8077.01,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80185,cpt,"PHENYTOIN LEVEL, TOTAL",blue cross blue shield,,O,108.53,12.98,17.58,17.58,15.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,blue cross blue shield,,O,188.17,66.99,66.99,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82945,cpt,GLUCOSE (SUGAR) LEVEL ON BODY FLUID,blue cross blue shield,,O,37.41,9.76,9.76,9.76,22.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9358,cpt,"INJECTION, FAM-TRASTUZUMAB DERUXTECAN-NXKI, 1 MG",blue cross blue shield,,O,97.75,19.27,19.27,25.93,58.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52276,cpt,INCISION OF THE BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,blue cross blue shield,,O,16599.82,5527.77,5527.77,5527.77,9959.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,299,ms-drg,PERIPHERAL VASCULAR DISORDERS WITH MCC,blue cross blue shield,,I,27935.28,7317.62,16225.76,16225.76,16761.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49651,cpt,REPOSITIONING OF RECURRENT GROIN HERNIA USING AN ENDOSCOPE,blue cross blue shield,,O,26236.25,7878.05,10770.56,21444.53,15741.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1950,cpt,"INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG",blue cross blue shield,,O,4121.85,885.75,1184.25,1474.18,2473.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,blue cross blue shield,,O,38.92,4.65,5.08,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3260,cpt,AMBULATORY SURGICAL BOOT EAC,blue cross blue shield,,O,340.14,93.68,134.53,134.53,204.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,blue cross blue shield,,I,16493.28,2797.28,9159.54,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,768,ms-drg,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,blue cross blue shield,,I,15836.34,3774.13,14739.23,17446.29,9501.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",blue cross blue shield,,O,377.65,43.63,43.63,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",blue cross blue shield,,O,157.91,56.85,70.75,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,blue cross blue shield,,O,1446.95,312.71,761.92,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,blue cross blue shield,,O,252.59,54.84,54.84,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19281,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MAMMOGRAPHIC GUIDANCE, FIRST LESION",blue cross blue shield,,O,21298.80,131.53,131.53,5148.44,12779.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49321,cpt,BIOPSY OF ABDOMEN USING AN ENDOSCOPE,blue cross blue shield,,O,21980.24,4607.33,9249.88,9249.88,13188.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,blue cross blue shield,,O,231.34,36.98,37.15,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,blue cross blue shield,,O,351.40,81.48,301.25,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,657,ms-drg,KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,blue cross blue shield,,I,88711.58,22809.47,22809.47,22809.47,53226.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2150,cpt,"INJECTION, MANNITOL, 25% IN 50 ML",blue cross blue shield,,O,8.74,2.44,2.44,2.44,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,30117,cpt,"REMOVAL OR DESTRUCTION OF GROWTH IN NOSE, INTERNAL APPROACH",blue cross blue shield,,O,28345.01,8146.08,8146.08,8146.08,17007.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0171,cpt,"INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG",blue cross blue shield,,O,5.83,0.81,1.75,3.70,3.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",blue cross blue shield,,O,15729.98,1862.99,5232.21,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,blue cross blue shield,,O,547.73,91.89,112.51,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70490,cpt,CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST,blue cross blue shield,,O,1343.10,94.48,482.16,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,441,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",blue cross blue shield,,I,27183.75,11619.11,20379.28,20379.28,16310.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",blue cross blue shield,,O,4116.84,594.86,864.34,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0276,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES INTRACULAR LENS,blue cross blue shield,,O,845.37,203.20,276.42,276.42,507.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,blue cross blue shield,,O,69.59,8.01,8.01,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75635,cpt,CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES WITH CONTRAST,blue cross blue shield,,O,1952.12,159.41,528.47,528.47,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,blue cross blue shield,,O,560.24,92.59,216.32,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42808,cpt,REMOVAL OR DESTRUCTION OF GROWTH OF THROAT,blue cross blue shield,,O,20752.25,4497.84,4497.84,4497.84,12451.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,blue cross blue shield,,O,10678.57,58.46,1327.32,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),blue cross blue shield,,O,8588.52,489.94,2159.84,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85347,cpt,"COAGULATION TIME MEASUREMENT, ACTIVATED",blue cross blue shield,,O,116.31,1.48,62.61,62.61,22.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,blue cross blue shield,,O,287.62,21.62,183.56,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9034,cpt,"PLATELETS, PHERESIS, EACH UNIT",blue cross blue shield,,O,3040.29,2187.70,2187.70,2187.70,1824.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",blue cross blue shield,,O,36.32,3.59,6.85,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88302,cpt,PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE,blue cross blue shield,,O,148.64,44.04,61.28,89.81,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82040,cpt,ALBUMIN (PROTEIN) LEVEL,blue cross blue shield,,O,37.50,4.85,33.12,33.12,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83916,cpt,MEASUREMENT OF IMMUNE SUBSTANCE (OLIGOCLONAL BANDS),blue cross blue shield,,O,428.92,54.26,54.26,54.26,257.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11402,cpt,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS",blue cross blue shield,,O,6260.36,1304.93,2628.67,2628.67,3756.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",blue cross blue shield,,O,130.95,13.50,13.50,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80361,cpt,OPIATES LEVELS,blue cross blue shield,,O,75.50,12.87,12.87,12.87,45.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0290,cpt,"INJECTION, AMPICILLIN SODIUM, 500 MG",blue cross blue shield,,O,39.91,4.91,4.91,4.91,23.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77077,cpt,"IMAGING OF 2 OR MORE JOINTS, SINGLE VIEW",blue cross blue shield,,O,263.86,41.91,41.91,41.91,158.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,blue cross blue shield,,O,145.10,29.21,29.25,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,472,ms-drg,CERVICAL SPINAL FUSION WITH CC,blue cross blue shield,,I,76071.55,19386.21,33724.33,38213.93,45642.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,236,ms-drg,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,blue cross blue shield,,I,167790.54,25758.09,39020.54,46477.00,100674.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,blue cross blue shield,,O,101.45,12.63,12.63,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9173,cpt,"INJECTION, DURVALUMAB, 10 MG",blue cross blue shield,,O,267.80,77.11,87.07,87.07,160.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,blue cross blue shield,,O,65.11,6.57,13.56,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",blue cross blue shield,,O,101.45,14.76,34.07,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12051,cpt,"REPAIR OF WOUND (2.5 CENTIMETERS OR LESS) OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MOUTH",blue cross blue shield,,O,17191.55,1273.00,1903.39,12893.66,10314.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,blue cross blue shield,,O,647.78,92.97,177.01,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2353,cpt,"INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG",blue cross blue shield,,O,714.06,172.18,172.18,205.65,428.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9045,cpt,"INJECTION, CARBOPLATIN, 50 MG",blue cross blue shield,,O,17.50,2.78,5.79,45.93,10.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72193,cpt,CT SCAN PELVIS WITH CONTRAST,blue cross blue shield,,O,1481.91,468.88,555.25,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5106,cpt,"INJECTION, EPOETIN ALFA-EPBX, BIOSIMILAR, (RETACRIT) (FOR NON-ESRD USE), 1000 UNITS",blue cross blue shield,,O,34.20,7.63,16.35,16.35,20.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",blue cross blue shield,,O,3919.67,159.22,4103.70,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,blue cross blue shield,,O,203.82,49.80,130.59,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73010,cpt,X-RAY OF SHOULDER BLADE,blue cross blue shield,,O,267.61,46.08,46.08,120.42,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5101,cpt,"INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MICROGRAM",blue cross blue shield,,O,1.96,0.20,0.53,0.53,1.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2357,cpt,"INJECTION, OMALIZUMAB, 5 MG",blue cross blue shield,,O,107.50,10.11,10.11,10.11,64.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,blue cross blue shield,,O,80.09,1.66,8.66,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,blue cross blue shield,,O,73.83,12.70,13.62,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",blue cross blue shield,,O,734.07,19.80,123.81,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99202,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 20 MINUTES",blue cross blue shield,,O,303.87,102.69,178.28,178.28,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29581,cpt,APPLICATION OF VEIN WOUND COMPRESSION SYSTEM LOWER LEG BELOW KNEE INCLUDING ANKLE AND FOOT,blue cross blue shield,,O,1305.86,230.97,799.93,926.72,783.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,390,ms-drg,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,blue cross blue shield,,I,12721.53,4148.74,6879.39,6879.39,7632.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86141,cpt,"MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION, HIGH SENSITIVITY",blue cross blue shield,,O,83.78,12.69,17.55,17.55,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,blue cross blue shield,,O,213.87,28.75,28.75,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,blue cross blue shield,,O,3055.12,204.95,458.10,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0829,revCode,HEMODIALYSIS - OUTPATIENT OR HOME OTHER,blue cross blue shield,,O,1915.10,269.56,269.56,269.56,1149.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L1833,cpt,"KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED, OFF-THE SHELF",blue cross blue shield,,O,922.91,282.22,282.22,922.91,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86870,cpt,IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,blue cross blue shield,,O,303.20,21.62,24.80,263.51,181.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",blue cross blue shield,,O,350.39,39.08,47.30,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",blue cross blue shield,,O,62.51,14.38,24.15,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21013,cpt,REMOVAL OF (LESS THAN 2 CENTIMETERS) MUSCLE GROWTH OF FACE AND SCALP,blue cross blue shield,,O,23765.46,4751.76,4751.76,4751.76,14259.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",blue cross blue shield,,O,52.60,8.84,9.97,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58563,cpt,EXAMINATION OF UTERUS WITH DESTRUCTION OF UTERINE LINING USING AN ENDOSCOPE,blue cross blue shield,,O,30147.26,4351.66,12495.98,12495.98,18088.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49083,cpt,DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE,blue cross blue shield,,O,3277.05,723.30,2260.51,2260.51,1966.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73600,cpt,"X-RAY OF ANKLE, 2 VIEWS",blue cross blue shield,,O,267.61,61.44,61.44,173.76,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36581,cpt,"REPLACEMENT OF CENTRAL VENOUS CATHETER, TUNNELED WITHOUT PORT OR PUMP",blue cross blue shield,,O,20102.84,2586.52,5848.59,5848.59,12061.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,195,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,blue cross blue shield,,I,12306.54,4159.34,8390.31,8390.31,7383.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12031,cpt,"REPAIR OF WOUND (2.5 CENTIMETERS OR LESS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",blue cross blue shield,,O,1990.66,2387.99,2387.99,2387.99,1194.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",blue cross blue shield,,O,4.22,1.00,1.00,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82805,cpt,"BLOOD GASES MEASUREMENT, WITH O2 SATURATION",blue cross blue shield,,O,77.52,9.38,9.38,9.38,46.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,blue cross blue shield,,O,90.02,12.05,12.05,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L4386,cpt,"WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PA",blue cross blue shield,,O,646.53,179.87,222.75,222.75,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1725,cpt,"CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE, INFUSION/PERFUSION CAPABILITY)",blue cross blue shield,,O,2861.88,440.55,977.57,2459.23,1717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2629,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, LASER",blue cross blue shield,,O,666.53,193.31,193.31,666.53,399.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71101,cpt,"X-RAY OF RIBS ON ONE SIDE OF BODY INCLUDING THE CHEST, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,377.65,61.44,61.44,228.17,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76098,cpt,IMAGING OF SURGICAL SPECIMEN,blue cross blue shield,,O,1318.08,258.94,488.63,557.24,790.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,202,ms-drg,BRONCHITIS AND ASTHMA WITH CC/MCC,blue cross blue shield,,I,17576.07,7140.60,10944.39,10944.39,10545.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27524,cpt,TREATMENT OF BROKEN KNEECAP WITH PLACEMENT OF STABILIZING DEVICE AND/OR REMOVAL OF KNEECAP,blue cross blue shield,,O,32549.38,5845.48,11062.10,11062.10,19529.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80307,cpt,"TESTING FOR PRESENCE OF DRUG, BY CHEMISTRY ANALYZERS",blue cross blue shield,,O,197.60,49.05,49.05,77.68,118.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11606,cpt,"REMOVAL OF MALIGNANT GROWTH (OVER 4.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,19392.87,4577.95,5620.25,5620.25,11635.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,blue cross blue shield,,O,89.65,6.58,13.67,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80051,cpt,"BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM, CHLORIDE, CARBON DIOXIDE)",blue cross blue shield,,O,65.11,6.87,30.33,48.83,39.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,blue cross blue shield,,O,50.01,5.20,5.44,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,558,ms-drg,"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",blue cross blue shield,,I,9766.23,3665.63,9877.45,9877.45,5859.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5107,cpt,"INJECTION, BEVACIZUMAB-AWWB, BIOSIMILAR, (MVASI), 10 MG",blue cross blue shield,,O,251.18,28.11,86.57,474.05,150.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17260,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS OR LESS) OF TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,1985.48,273.66,761.92,761.92,1191.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52281,cpt,DILATION OF BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,blue cross blue shield,,O,15500.95,1609.63,5605.90,5605.90,9300.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70220,cpt,"X-RAY OF PARANASAL SINUS, COMPLETE, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,362.65,72.01,209.05,271.99,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",blue cross blue shield,,O,56.26,6.34,10.82,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,blue cross blue shield,,O,236.36,11.30,35.18,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52234,cpt,DESTRUCTION AND/OR REMOVAL OF (0.5 TO 2.0 CENTIMETERS) SMALL GROWTHS OF THE BLADDER USING AN ENDOSCOPE,blue cross blue shield,,O,16688.36,2781.70,5224.45,5224.45,10013.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76802,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (LESS THAN 14 WEEKS), EACH ADDITIONAL FETUS",blue cross blue shield,,O,396.33,196.23,196.23,196.23,237.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24075,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF UPPER ARM OR ELBOW,blue cross blue shield,,O,20908.57,1325.18,6095.44,6095.44,12545.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",blue cross blue shield,,O,327.67,47.93,49.43,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76937,cpt,ULTRASOUND GUIDANCE FOR ACCESSING INTO BLOOD VESSEL,blue cross blue shield,,O,690.62,300.63,300.63,359.99,157.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73723,cpt,MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,3471.56,325.59,560.82,3471.56,2082.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,blue cross blue shield,,I,22023.98,6812.39,13045.90,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,349,ms-drg,ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,blue cross blue shield,,I,48784.23,11874.17,11874.17,11874.17,29270.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94010,cpt,MEASUREMENT AND GRAPHIC RECORDING OF TOTAL AND TIMED EXHALED AIR CAPACITY,blue cross blue shield,,O,222.58,50.61,50.61,126.32,133.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49324,cpt,INSERTION OF ABDOMINAL CAVITY CATHETER USING AN ENDOSCOPE,blue cross blue shield,,O,22261.75,4488.40,8563.22,8563.22,13357.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,blue cross blue shield,,I,65131.57,7666.11,27910.92,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,blue cross blue shield,,O,138.03,9.70,9.70,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,896,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",blue cross blue shield,,I,34188.85,7909.34,19332.34,19332.34,20513.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64635,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, SINGLE FACET JOINT",blue cross blue shield,,O,7687.98,1563.06,2564.80,2892.60,4612.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,44388,cpt,DIAGNOSTIC EXAMINATION OF LARGE BOWEL USING AN ENDOSCOPE INSERTED THROUGH SURGICALLY CREATED OPENING INTO LARGE BOWEL FROM BODY WALL (COLOSTOMY),blue cross blue shield,,O,3212.71,710.83,1994.96,1994.96,1927.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,blue cross blue shield,,O,36.32,5.40,17.67,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49659,cpt,HERNIA REPAIR PROCEDURE USING AN ENDOSCOPE,blue cross blue shield,,O,26058.62,8032.81,8673.29,8673.29,15635.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,blue cross blue shield,,O,87.53,4.18,14.40,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77072,cpt,IMAGING FOR BONE AGE ASSESSMENT,blue cross blue shield,,O,240.10,52.12,52.12,213.76,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28740,cpt,FUSION OF FOOT IN THE MIDFOOT REGION,blue cross blue shield,,O,45471.26,5845.48,7707.22,20996.90,27282.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11603,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,2584.00,719.34,2673.34,2673.34,1550.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,68816,cpt,PROBING OF NASAL-TEAR DUCT WITH BALLOON CATHETER DILATION,blue cross blue shield,,O,12410.70,2462.07,2462.07,2462.07,7446.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,987,ms-drg,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,blue cross blue shield,,I,95039.41,20706.36,27921.93,27921.93,57023.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,blue cross blue shield,,I,78211.42,12813.14,17688.26,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,897,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",blue cross blue shield,,I,20249.18,5831.92,8570.70,9701.00,12149.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28112,cpt,"REMOVAL OF BONES AT SECOND, THIRD, OR FOURTH TOE JOINTS",blue cross blue shield,,O,17438.28,2562.21,5466.53,5466.53,10462.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,482,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,blue cross blue shield,,I,55990.08,11135.77,19728.27,19728.27,33594.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86920,cpt,"BLOOD UNIT COMPATIBILITY TEST, IMMEDIATE SPIN TECHNIQUE",blue cross blue shield,,O,378.98,183.76,183.76,291.33,81.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64636,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, EACH ADDITIONAL FACET JOINT",blue cross blue shield,,O,7684.84,1563.06,2564.80,4212.43,4610.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,2112.19,159.37,407.07,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,607,ms-drg,MINOR SKIN DISORDERS WITHOUT MCC,blue cross blue shield,,I,12334.17,7936.13,7936.13,7936.13,7400.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21555,cpt,REMOVAL OF (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF NECK OR FRONT OF CHEST,blue cross blue shield,,O,20108.46,2214.35,5132.49,5132.49,12065.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,254,ms-drg,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,blue cross blue shield,,I,43574.21,11908.23,22388.66,22388.66,26144.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",blue cross blue shield,,O,441.23,35.97,38.85,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70540,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK WITHOUT CONTRAST",blue cross blue shield,,O,1869.58,208.18,639.63,639.63,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,blue cross blue shield,,O,43.18,10.79,13.48,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42820,cpt,REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS),blue cross blue shield,,O,18532.26,4720.05,6406.81,13899.20,3780.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,41010,cpt,INCISION OF TISSUE CONNECTING TONGUE AND FLOOR OF MOUTH,blue cross blue shield,,O,19005.45,3597.59,4791.91,4791.91,11403.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55250,cpt,REMOVAL OF SPERM DUCT,blue cross blue shield,,O,18031.55,1639.64,5663.50,5663.50,10818.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28750,cpt,FUSION OF GREAT TOE AT THE JOINT WITH THE FOOT,blue cross blue shield,,O,33226.41,5666.83,7795.33,11244.87,19935.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73000,cpt,X-RAY OF COLLAR BONE,blue cross blue shield,,O,267.61,51.43,54.55,152.54,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",blue cross blue shield,,O,376.41,61.44,61.44,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0260,cpt,"INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY",blue cross blue shield,,O,2193.04,562.74,1001.39,1003.01,1315.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,147.58,21.05,38.70,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0791,cpt,"INJECTION, CRIZANLIZUMAB-TMCA, 5 MG",blue cross blue shield,,O,441.53,125.13,441.53,441.53,264.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,blue cross blue shield,,O,122.03,31.49,31.96,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74420,cpt,IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST AGENT,blue cross blue shield,,O,1067.98,275.21,395.00,1067.98,243.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23350,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOINT,blue cross blue shield,,O,5340.22,795.73,795.73,4000.22,3204.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0456,cpt,"INJECTION, AZITHROMYCIN, 500 MG",blue cross blue shield,,O,132.56,130.01,130.01,130.01,79.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86316,cpt,ANALYSIS FOR DETECTION OF TUMOR MARKER,blue cross blue shield,,O,123.87,17.16,17.16,17.16,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,blue cross blue shield,,O,83.76,6.73,9.12,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,blue cross blue shield,,O,89.65,18.15,19.64,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,348,ms-drg,ANAL AND STOMAL PROCEDURES WITH CC,blue cross blue shield,,I,45281.59,9162.68,16691.97,16691.97,27168.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",blue cross blue shield,,O,4184.57,938.10,1619.95,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69424,cpt,REMOVAL OF IMPLANTED EARDRUM TUBE UNDER ANESTHESIA,blue cross blue shield,,O,15581.76,7312.05,7312.05,7312.05,9349.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73070,cpt,"X-RAY OF ELBOW, 2 VIEWS",blue cross blue shield,,O,252.59,40.91,43.39,143.98,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86664,cpt,"ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), NUCLEAR ANTIGEN",blue cross blue shield,,O,266.62,15.35,24.87,24.87,159.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1887,cpt,"CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)",blue cross blue shield,,O,357.97,72.03,182.87,218.49,214.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",blue cross blue shield,,O,230.63,78.33,104.15,159.67,138.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,blue cross blue shield,,I,19597.90,4492.16,10060.33,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",blue cross blue shield,,O,200.00,27.06,44.02,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,blue cross blue shield,,O,28365.62,4521.08,10973.13,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",blue cross blue shield,,O,16.70,0.37,1.36,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9047,cpt,"INJECTION, CARFILZOMIB, 1 MG",blue cross blue shield,,O,141.29,44.27,44.27,44.27,84.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28041,cpt,REMOVAL (1.5 CENTIMETERS OR GREATER) MUSCLE GROWTH OF FOOT OR TOE,blue cross blue shield,,O,17491.18,5603.73,5603.73,5603.73,10494.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3660,cpt,"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, OFF-THE-SHELF",blue cross blue shield,,O,100.04,19.56,39.83,99.21,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45381,cpt,"INJECTIONS BENEATH LINING OF LARGE BOWEL, USING A FLEXIBLE ENDOSCOPE",blue cross blue shield,,O,6984.17,1407.16,3276.29,3276.29,4190.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,267.61,46.08,61.44,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,243,ms-drg,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,blue cross blue shield,,I,93249.08,26210.61,26210.61,26210.61,55949.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23120,cpt,PARTIAL REMOVAL OF COLLAR BONE,blue cross blue shield,,O,44226.23,5846.87,11569.09,11569.09,26535.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",blue cross blue shield,,O,801.60,189.21,802.81,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,blue cross blue shield,,O,3238.42,206.67,811.86,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73040,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF SHOULDER JOINT,blue cross blue shield,,O,1406.87,212.42,212.42,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46221,cpt,REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING,blue cross blue shield,,O,3889.72,1284.30,3535.17,8613.19,2333.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80348,cpt,BUPRENORPHINE LEVEL,blue cross blue shield,,O,265.30,9.54,9.54,9.54,159.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,blue cross blue shield,,O,119.15,21.42,21.42,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28805,cpt,AMPUTATION OF FOOT ACROSS INSTEP,blue cross blue shield,,O,18362.44,9082.17,9082.17,9082.17,11017.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88333,cpt,"PATHOLOGY CYTOLOGIC EXAMINATION OF SPECIMEN DURING SURGERY, INITIAL SITE",blue cross blue shield,,O,166.34,24.04,33.11,56.55,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,blue cross blue shield,,O,203.82,49.80,75.83,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,132.12,25.53,31.30,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,blue cross blue shield,,O,1753.28,94.47,482.16,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,438,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,blue cross blue shield,,I,24738.47,19133.39,19133.39,19133.39,14843.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99215,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 40 MINUTES",blue cross blue shield,,O,569.98,60.00,60.00,427.48,341.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72020,cpt,"X-RAY OF SPINE, 1 VIEW",blue cross blue shield,,O,240.10,72.01,111.91,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,92.99,21.05,21.84,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",blue cross blue shield,,O,38.92,3.91,5.09,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,blue cross blue shield,,I,16808.50,4145.69,10124.96,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,blue cross blue shield,,O,908.09,156.44,685.61,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,blue cross blue shield,,O,184.32,70.33,146.52,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7121,cpt,"5% DEXTROSE IN LACTATED RINGERS INFUSION, UP TO 1000 CC",blue cross blue shield,,O,167.99,51.83,51.83,51.83,100.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,blue cross blue shield,,O,1590.91,567.62,1557.52,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0696,cpt,"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG",blue cross blue shield,,O,32.72,0.60,12.98,14.73,19.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,520,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,blue cross blue shield,,I,40151.49,11585.32,15324.52,31059.69,24090.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",blue cross blue shield,,O,108.49,21.05,37.51,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83497,cpt,HYDROXYINDOLACETIC ACID (PRODUCT OF METABOLISM) LEVEL,blue cross blue shield,,O,212.36,12.64,31.86,31.86,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36225,cpt,INSERTION OF CATHETER INTO ARTERY ON ONE SIDE OF CHEST FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,blue cross blue shield,,O,31498.85,2852.00,2852.00,2852.00,18899.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82308,cpt,CALCITONIN (HORMONE) LEVEL,blue cross blue shield,,O,405.84,26.25,70.36,70.36,243.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73222,cpt,MRI SCAN OF ARM JOINT WITH CONTRAST,blue cross blue shield,,O,3055.12,461.27,461.27,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,blue cross blue shield,,O,402.67,93.28,216.32,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17271,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF SCALP, NECK, HANDS, FEET, OR GENITALS",blue cross blue shield,,O,1881.00,241.28,1015.48,1015.48,1128.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",blue cross blue shield,,O,151.46,8.03,23.14,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1439,cpt,"INJECTION, FERRIC CARBOXYMALTOSE, 1 MG",blue cross blue shield,,O,4.71,0.79,1.61,4.99,2.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),blue cross blue shield,,O,126.23,10.13,13.73,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",blue cross blue shield,,O,3595.37,208.18,535.25,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1040,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG",blue cross blue shield,,O,105.67,41.27,69.62,103.80,63.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36838,cpt,REPAIR OF HEMODIALYSIS ACCESS IN ARM,blue cross blue shield,,O,19456.81,7711.31,7711.31,8737.59,11674.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36556,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, NOT TUNNELED",blue cross blue shield,,O,18017.97,2538.20,6938.89,9233.37,10810.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",blue cross blue shield,,O,101.45,11.20,18.17,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76942,cpt,ULTRASONIC GUIDANCE IMAGING SUPERVISION AND INTERPRETATION FOR INSERTION OF NEEDLE,blue cross blue shield,,O,252.59,96.03,122.45,200.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,863,ms-drg,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,blue cross blue shield,,I,11597.19,6882.46,10082.73,10082.73,6958.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,blue cross blue shield,,O,188.17,19.53,91.95,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,blue cross blue shield,,O,298.87,98.24,208.16,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,149,ms-drg,DYSEQUILIBRIUM,blue cross blue shield,,I,22335.15,6075.84,6075.84,6075.84,13401.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64417,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO AXILLARY NERVE OF UPPER ARM AND SHOULDER,blue cross blue shield,,O,38520.39,5845.48,13548.85,13548.85,23112.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,blue cross blue shield,,O,316.37,49.55,94.82,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,4054.33,322.67,1107.49,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58100,cpt,BIOPSY OF LINING OF UTERUS,blue cross blue shield,,O,847.31,506.44,506.44,506.44,508.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52351,cpt,"DIAGNOSTIC EXAMINATION OF THE BLADDER, BLADDER CANAL (URETHRA), AND URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE",blue cross blue shield,,O,17224.91,2833.20,8244.96,9916.07,10334.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",blue cross blue shield,,O,90.84,9.28,12.94,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9503,cpt,"TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES",blue cross blue shield,,O,225.10,13.65,130.89,168.82,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,blue cross blue shield,,O,42.58,6.02,7.73,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",blue cross blue shield,,O,240.10,27.64,61.44,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,blue cross blue shield,,O,50.72,6.35,7.27,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",blue cross blue shield,,E,5953.08,743.91,1394.84,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",blue cross blue shield,,O,757.37,185.43,609.05,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,blue cross blue shield,,O,36.32,3.85,9.19,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,blue cross blue shield,,O,1880.84,106.44,314.01,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",blue cross blue shield,,O,8992.46,1299.03,4302.59,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",blue cross blue shield,,O,270.00,64.89,83.31,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78816,cpt,NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY,blue cross blue shield,,O,8009.86,1290.20,2705.32,2705.32,4805.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,blue cross blue shield,,O,101.45,3.58,23.49,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28119,cpt,REMOVAL OF HEEL BONE SPUR,blue cross blue shield,,O,21577.62,7259.15,7259.15,7259.15,12946.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,blue cross blue shield,,O,3580.43,810.94,1467.86,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,309,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,blue cross blue shield,,I,17858.14,5166.37,8901.93,8901.93,10714.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",blue cross blue shield,,O,2237.24,324.67,912.20,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9311,cpt,"INJECTION, RITUXIMAB 10 MG AND HYALURONIDASE",blue cross blue shield,,O,175.06,36.40,36.40,5983.60,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0881,cpt,"INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)",blue cross blue shield,,O,10.64,2.75,7.18,7.96,6.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,253,ms-drg,OTHER VASCULAR PROCEDURES WITH CC,blue cross blue shield,,I,71874.05,17117.07,31459.36,31459.36,43124.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0101,cpt,CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION,blue cross blue shield,,O,313.23,66.78,66.78,166.01,187.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21552,cpt,REMOVAL OF (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF NECK OR FRONT OF CHEST,blue cross blue shield,,O,19339.12,2214.35,2671.52,2671.52,11603.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45100,cpt,BIOPSY OF ANAL AND/OR RECTAL WALL THROUGH ANUS,blue cross blue shield,,O,16235.20,5203.74,5203.74,5203.74,9741.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",blue cross blue shield,,O,125.04,27.28,30.92,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,blue cross blue shield,,O,290.12,59.69,67.40,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,blue cross blue shield,,O,1630.73,338.97,1039.60,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,blue cross blue shield,,O,78.05,7.37,30.00,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",blue cross blue shield,,O,16.51,4.75,5.19,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43453,cpt,DILATION OF ESOPHAGUS WITH A GUIDED WIRE,blue cross blue shield,,O,4092.51,1539.44,4141.35,4141.35,2455.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,30310,cpt,REMOVAL OF FOREIGN BODY IN NOSE UNDER ANESTHESIA,blue cross blue shield,,O,14264.12,5900.00,5900.00,5900.00,8558.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71111,cpt,"X-RAY OF BOTH SIDES OF THE RIBS INCLUDING THE CHEST, MINIMUM OF 4 VIEWS",blue cross blue shield,,O,377.65,61.44,61.44,188.83,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",blue cross blue shield,,O,199.37,74.90,77.30,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22552,cpt,"FUSION OF SPINE BONES WITH REMOVAL OF DISC IN UPPER SPINAL COLUMN BELOW SECOND VERTEBRA OF NECK , ANTERIOR APPROACH",blue cross blue shield,,O,83429.70,11349.44,13479.82,22181.74,50057.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,blue cross blue shield,,O,31160.78,7903.69,10419.21,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0481,revCode,"CARDIOLOGY, CARDIAC CATHETERIZATION LABORATORY",blue cross blue shield,,O,14660.03,2905.54,2905.54,2905.54,8796.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,blue cross blue shield,,O,96.77,32.33,87.99,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27792,cpt,OPEN TREATMENT OF THE OUTSIDE PROMINENCE OF BONE OF THE LEG (FIBULA) IN THE REGION OF THE ANKLE,blue cross blue shield,,O,32639.18,5674.67,9712.30,9712.30,19583.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,blue cross blue shield,,O,187.57,14.84,16.09,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,759,ms-drg,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",blue cross blue shield,,I,7547.33,2818.29,8457.68,8457.68,4528.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9516,cpt,"IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 MICROCURIES, UP TO 999 MICROCURIES",blue cross blue shield,,O,153.80,97.81,99.99,104.16,92.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",blue cross blue shield,,O,126.23,16.29,16.48,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,blue cross blue shield,,O,176.37,11.81,19.34,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",blue cross blue shield,,O,246.35,17.59,94.41,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,864,ms-drg,FEVER AND INFLAMMATORY CONDITIONS,blue cross blue shield,,I,42549.23,8388.57,8388.57,8388.57,25529.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,blue cross blue shield,,O,195.07,21.19,167.23,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",blue cross blue shield,,O,39.88,13.23,14.61,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9040,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",blue cross blue shield,,O,756.23,259.12,756.23,756.23,453.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9228,cpt,"INJECTION, IPILIMUMAB, 1 MG",blue cross blue shield,,O,624.02,124.58,124.58,827.27,374.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,blue cross blue shield,,O,71.96,9.99,22.46,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",blue cross blue shield,,O,63.63,6.74,17.26,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3490,cpt,DRUGS UNCLASSIFIED INJECTION,blue cross blue shield,,O,22.69,0.62,0.62,12.62,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",blue cross blue shield,,O,60.03,13.90,14.45,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross blue shield,,O,93.77,21.35,23.41,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20220,cpt,BIOPSY OF BONE USING NEEDLE OR TROCAR,blue cross blue shield,,O,9567.06,1325.54,2273.50,2273.50,5740.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70360,cpt,X-RAY OF SOFT TISSUE OF NECK,blue cross blue shield,,O,240.10,61.44,61.44,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82330,cpt,"CALCIUM LEVEL, IONIZED",blue cross blue shield,,O,89.65,13.41,17.77,21.16,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70160,cpt,"X-RAY OF BONES OF NOSE, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,327.63,61.44,61.44,245.72,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27687,cpt,LENGTHENING OF CALF MUSCLE,blue cross blue shield,,O,18786.36,2631.16,13419.43,13419.43,11271.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,blue cross blue shield,,O,138.03,20.16,20.16,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75716,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMAGING OF ARTERIES OF BOTH ARMS OR LEGS,blue cross blue shield,,O,7596.99,64.33,1446.90,5697.74,4558.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,808,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,blue cross blue shield,,I,33019.93,13774.56,18365.56,18365.56,19811.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87076,cpt,BACTERIAL CULTURE FOR ANAEROBIC ISOLATES,blue cross blue shield,,O,96.38,8.00,8.16,72.29,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86645,cpt,ANALYSIS FOR ANTIBODY (IGM) TO CYTOMEGALOVIRUS (CMV),blue cross blue shield,,O,71.96,16.92,19.96,19.96,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49320,cpt,DIAGNOSTIC EXAMINATION OF THE ABDOMEN USING AN ENDOSCOPE,blue cross blue shield,,O,23341.31,9084.82,9084.82,9084.82,14004.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",blue cross blue shield,,O,192.85,42.50,42.50,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9041,cpt,"INJECTION, BORTEZOMIB (VELCADE), 0.1 MG",blue cross blue shield,,O,20.57,3.00,9.47,39.05,12.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,blue cross blue shield,,O,31.88,2.63,6.07,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27570,cpt,MANIPULATION OF KNEE JOINT UNDER ANESTHESIA,blue cross blue shield,,O,13902.50,1248.60,2658.81,10424.46,8341.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85060,cpt,BLOOD SMEAR INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT,blue cross blue shield,,O,69.59,7.63,7.63,7.63,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58570,cpt,"REMOVAL OF UTERUS THROUGH ABDOMEN USING AN ENDOSCOPE, 250.0 G OR LESS",blue cross blue shield,,O,32349.41,8032.54,10429.05,10429.05,19409.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,blue cross blue shield,,O,109.71,43.44,76.85,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,175,ms-drg,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,blue cross blue shield,,I,23982.29,5734.35,14746.99,14746.99,14389.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72126,cpt,CT SCAN OF UPPER SPINE WITH CONTRAST,blue cross blue shield,,O,1992.35,304.63,304.63,304.63,1195.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55876,cpt,INSERTION OF RADIATION THERAPY DEVICES IN PROSTATE GLAND FOR RADIATION THERAPY GUIDANCE,blue cross blue shield,,O,27054.40,2670.10,16970.47,16970.47,16232.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",blue cross blue shield,,O,70.78,13.97,15.79,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",blue cross blue shield,,O,238.30,71.54,80.44,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",blue cross blue shield,,O,91.43,5.96,40.01,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20680,cpt,REMOVAL OF DEEP IMPLANT FROM BONE,blue cross blue shield,,O,22681.09,2246.95,5109.20,12436.52,13608.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,blue cross blue shield,,O,2289.17,554.60,999.85,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70260,cpt,"X-RAY OF SKULL, COMPLETE, MINIMUM OF 4 VIEWS",blue cross blue shield,,O,538.98,61.44,61.44,94.48,323.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,blue cross blue shield,,I,14759.59,3312.91,7395.15,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87149,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, DIRECT PROBE TECHNIQUE",blue cross blue shield,,O,115.61,26.23,26.23,26.23,69.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",blue cross blue shield,,O,650.28,61.44,61.44,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20612,cpt,ASPIRATION AND/OR INJECTION OF CYST OF TENDON,blue cross blue shield,,O,667.01,697.00,697.00,697.00,400.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",blue cross blue shield,,O,1.42,0.39,0.49,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,blue cross blue shield,,O,93.19,5.27,10.45,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31624,cpt,IRRIGATION AND SUCTION OF LUNG AIRWAYS TO OBTAIN CELLS USING AN ENDOSCOPE,blue cross blue shield,,O,17901.60,2941.10,3763.71,3763.71,10740.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,645,ms-drg,ENDOCRINE DISORDERS WITHOUT CC/MCC,blue cross blue shield,,I,16355.76,4514.30,8513.93,8513.93,9813.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,blue cross blue shield,,O,83.76,14.03,20.71,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80202,cpt,VANCOMYCIN (ANTIBIOTIC) LEVEL,blue cross blue shield,,O,92.78,13.27,27.34,27.34,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",blue cross blue shield,,O,85.94,24.92,24.92,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36902,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT AND BALLOON DILATION OF DIALYSIS SEGMENT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",blue cross blue shield,,O,17042.54,4518.00,17456.98,17456.98,10225.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",blue cross blue shield,,O,365.24,8.63,26.52,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,blue cross blue shield,,O,108.53,13.66,14.48,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",blue cross blue shield,,O,0.59,0.15,0.19,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0519,revCode,"CLINIC, OTHER",blue cross blue shield,,O,1236.79,2026.80,2026.80,2026.80,742.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",blue cross blue shield,,O,47.53,8.48,9.08,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74455,cpt,REVIEW BY RADIOLOGIST OF URINARY BLADDER AND URETHRA IMAGES WITH CONTRAST AND AFTER PASSING URINE,blue cross blue shield,,O,1067.98,182.43,182.43,608.75,640.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23472,cpt,"PROSTHETIC REPAIR OF SHOULDER JOINT, TOTAL SHOULDER",blue cross blue shield,,O,76075.73,11006.86,25947.42,25947.42,45645.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86617,cpt,CONFIRMATION TEST FOR ANTIBODY TO BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),blue cross blue shield,,O,35.39,15.26,19.18,29.04,21.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0780,cpt,"INJECTION, PROCHLORPERAZINE, UP TO 10 MG",blue cross blue shield,,O,84.30,3.36,32.90,62.66,50.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",blue cross blue shield,,O,51.68,6.81,8.21,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92920,cpt,"BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORONARY ARTERY OR BRANCH (ACCESSED THROUGH THE SKIN), EACH ADDITIONAL ARTERY OR BRANCH",blue cross blue shield,,O,56646.63,4554.88,22653.36,22653.36,33987.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,blue cross blue shield,,O,3055.12,204.02,458.10,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,blue cross blue shield,,O,50.02,4.84,10.72,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,blue cross blue shield,,O,646.53,93.49,359.62,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45384,cpt,"REMOVAL OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL BY HOT BIOPSY FORCEPS, USING A FLEXIBLE ENDOSCOPE",blue cross blue shield,,O,4528.30,938.20,2788.87,4749.21,2716.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,blue cross blue shield,,O,183.82,19.97,77.30,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,blue cross blue shield,,O,30.08,5.04,5.65,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64624,cpt,DESTRUCTION OF GENICULAR NERVE BRANCHES OF KNEE BY INJECTION USING IMAGING GUIDANCE,blue cross blue shield,,O,5206.83,1562.39,1846.20,2589.93,3124.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",blue cross blue shield,,O,190.94,53.23,56.92,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28118,cpt,REMOVAL OF HEEL BONE,blue cross blue shield,,O,31022.88,2578.63,13749.13,15484.76,18613.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",blue cross blue shield,,O,88.56,20.43,31.69,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,2707.46,156.22,437.38,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,393,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,blue cross blue shield,,I,34228.75,11585.36,16485.12,16485.12,20537.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,387,ms-drg,INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,blue cross blue shield,,I,21152.75,7292.53,7292.53,7292.53,12691.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84207,cpt,VITAMIN B-6 LEVEL,blue cross blue shield,,O,134.49,18.96,18.96,142.55,80.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52356,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) WITH STENT USING AN ENDOSCOPE,blue cross blue shield,,O,26186.13,3916.85,10931.90,10931.90,15711.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,blue cross blue shield,,O,60.16,11.87,22.64,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,389,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH CC,blue cross blue shield,,I,17143.70,5530.39,8576.12,18965.92,10286.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29826,cpt,SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE,blue cross blue shield,,O,33765.02,2631.25,16721.96,16721.96,6904.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,200,ms-drg,PNEUMOTHORAX WITH CC,blue cross blue shield,,I,20169.50,7259.72,12541.14,12541.14,12101.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,197,ms-drg,INTERSTITIAL LUNG DISEASE WITH CC,blue cross blue shield,,I,12136.23,7534.12,10498.11,10498.11,7281.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27652,cpt,"REPAIR OF RUPTURED ACHILLES TENDON WITH GRAFT, OPEN OR THROUGH SKIN PROCEDURE",blue cross blue shield,,O,49471.05,12998.96,12998.96,12998.96,29682.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36416,cpt,PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,blue cross blue shield,,O,11.79,2.31,2.31,11.79,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49082,cpt,DRAINAGE OF FLUID FROM ABDOMINAL CAVITY,blue cross blue shield,,O,21980.24,9880.52,9880.52,9880.52,13188.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",blue cross blue shield,,O,345.14,36.70,130.83,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11044,cpt,REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS,blue cross blue shield,,O,6092.03,1247.54,2058.19,23397.56,3655.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",blue cross blue shield,,O,240.10,61.44,61.44,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),blue cross blue shield,,O,60.03,6.83,7.33,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,blue cross blue shield,,O,52.60,6.75,9.32,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1745,cpt,"INJECTION, INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG",blue cross blue shield,,O,282.56,34.04,75.44,75.44,169.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,blue cross blue shield,,O,55.44,9.79,9.79,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80299,cpt,QUANTITATION OF THERAPEUTIC DRUG,blue cross blue shield,,O,46.60,5.86,13.05,18.72,27.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",blue cross blue shield,,O,183.82,63.60,63.60,79.74,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3032,cpt,"INJECTION, EPTINEZUMAB-JJMR, 1 MG",blue cross blue shield,,O,40.76,17.01,18.08,18.08,24.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1758,cpt,"CATHETER, URETERAL",blue cross blue shield,,O,112.55,32.52,35.46,37.04,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,blue cross blue shield,,O,42.58,3.22,15.10,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",blue cross blue shield,,O,41.06,11.36,13.03,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74220,cpt,X-RAY OF ESOPHAGUS WITH SINGLE CONTRAST,blue cross blue shield,,O,585.25,65.33,65.33,360.68,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",blue cross blue shield,,O,8.17,0.89,2.47,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0378,cpt,"HOSPITAL OBSERVATION SERVICE, PER HOUR",blue cross blue shield,,O,16.99,2.44,22.26,22.26,10.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58350,cpt,INJECTION OF SALINE OR X-RAY CONTRAST MATERIAL INTO TUBES,blue cross blue shield,,O,25793.70,15033.09,15033.09,15033.09,15476.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84446,cpt,VITAMIN E LEVEL,blue cross blue shield,,O,83.76,7.84,7.84,66.59,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,blue cross blue shield,,O,76.04,10.15,20.30,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93990,cpt,ULTRASOUND OF HEMODIALYSIS ACCESS,blue cross blue shield,,O,254.87,124.44,124.44,181.70,152.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",blue cross blue shield,,O,90.84,3.51,28.93,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28485,cpt,OPEN TREATMENT OF FRACTURE OF THE MID PORTION OF THE FOOT,blue cross blue shield,,O,27378.71,5847.07,11179.03,11179.03,16427.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,blue cross blue shield,,O,16.28,2.44,4.36,4798.21,9.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",blue cross blue shield,,O,365.14,48.65,61.44,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0311,revCode,LABORATORY PATHOLOGY CYTOLOGY,blue cross blue shield,,O,83.47,16.15,16.15,16.15,50.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82731,cpt,FETAL FIBRONECTIN (PROTEIN) ANALYSIS,blue cross blue shield,,O,565.34,62.32,98.44,424.01,108.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",blue cross blue shield,,O,116.79,7.81,16.48,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87625,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), TYPES 16 AND 18 ONLY",blue cross blue shield,,O,119.58,50.69,93.91,93.91,71.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64479,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",blue cross blue shield,,O,7223.75,739.73,2764.46,2764.46,4334.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7070,cpt,"INFUSION, D5W, 1000 CC",blue cross blue shield,,O,157.80,23.30,23.30,56.81,94.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80189,cpt,MEASUREMENT OF ITRACONAZOLE,blue cross blue shield,,O,67.78,40.41,40.41,40.41,40.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,blue cross blue shield,,O,42.58,4.32,6.14,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26160,cpt,REMOVAL OF GROWTH OF TENDON FINGER OR HAND,blue cross blue shield,,O,19482.74,1247.77,5351.19,5351.19,11689.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,blue cross blue shield,,I,14826.55,4677.51,9219.13,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,blue cross blue shield,,O,45.06,3.98,21.84,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,blue cross blue shield,,O,520.22,353.23,362.52,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,4054.33,319.17,740.91,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19301,cpt,PARTIAL REMOVAL OF BREAST,blue cross blue shield,,O,31896.98,2805.32,12984.24,12984.24,19138.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1874,cpt,"STENT, COATED/COVERED, WITH DELIVERY SYSTEM",blue cross blue shield,,O,3791.70,2041.15,2041.15,2843.78,2275.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,286,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",blue cross blue shield,,I,55760.94,13702.32,26072.17,26072.17,33456.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,206.42,1324.98,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),blue cross blue shield,,O,50.01,5.20,5.51,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",blue cross blue shield,,O,50.72,5.89,7.88,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80145,cpt,MEASUREMENT OF ADALIMUMAB,blue cross blue shield,,O,96.43,23.48,23.48,96.43,57.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,699,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,blue cross blue shield,,I,19519.09,6879.34,9803.04,9803.04,11711.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross blue shield,,O,318.12,56.64,56.64,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87425,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ROTAVIRUS,blue cross blue shield,,O,84.93,10.39,10.39,51.31,50.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52260,cpt,DILATION OF THE BLADDER USING AN ENDOSCOPE UNDER GENERAL OR SPINAL ANESTHESIA,blue cross blue shield,,O,14534.61,1612.75,7644.43,7644.43,8720.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,4852.19,224.32,549.94,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,794,ms-drg,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,blue cross blue shield,,I,5174.39,2904.57,4817.76,30750.68,3104.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82552,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, ISOENZYMES",blue cross blue shield,,O,66.05,9.38,9.38,25.20,39.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,blue cross blue shield,,O,24173.14,2776.54,9281.40,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,580,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",blue cross blue shield,,I,52656.26,7319.59,18388.00,18388.00,31593.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21012,cpt,REMOVAL OF (2 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF FACE AND SCALP,blue cross blue shield,,O,17016.95,1262.82,4330.56,4330.56,10210.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11403,cpt,"REMOVAL OF GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,12550.24,933.20,2673.34,9600.53,7530.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,blue cross blue shield,,O,345.14,124.25,156.74,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94729,cpt,TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,blue cross blue shield,,O,231.34,43.74,43.74,238.28,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,348.89,53.55,59.81,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",blue cross blue shield,,O,16.23,1.83,3.60,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1730,cpt,"CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (19 OR FEWER ELECTRODES)",blue cross blue shield,,O,482.50,51.38,51.38,51.38,289.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1876,cpt,"STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM",blue cross blue shield,,O,922.91,270.48,409.89,733.71,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71120,cpt,"X-RAY OF BREAST BONE, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,252.44,21.72,21.72,173.76,151.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,797,ms-drg,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,blue cross blue shield,,I,38868.65,8508.80,8508.80,8508.80,23321.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",blue cross blue shield,,O,44.82,3.29,6.83,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76080,cpt,IMAGING FOR ABSCESS OR ABNORMAL DRAINAGE TRACT PROCEDURE,blue cross blue shield,,O,1318.08,176.36,661.02,661.02,790.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31231,cpt,DIAGNOSTIC EXAMINATION OF NASAL PASSAGES USING AN ENDOSCOPE,blue cross blue shield,,O,282.74,249.40,249.40,2514.21,169.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86665,cpt,"ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), VIRAL CAPSID",blue cross blue shield,,O,266.62,18.21,24.87,24.87,159.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,blue cross blue shield,,I,18651.11,4387.85,8542.96,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),blue cross blue shield,,O,53.08,5.52,5.77,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",blue cross blue shield,,O,231.34,36.97,37.89,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72157,cpt,MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,4054.33,330.07,421.46,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",blue cross blue shield,,O,221.79,37.73,37.88,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31625,cpt,BIOPSY OF LUNG AIRWAYS USING AN ENDOSCOPE,blue cross blue shield,,O,19596.48,1331.96,3763.71,3763.71,11757.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,blue cross blue shield,,O,396.41,290.00,290.00,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",blue cross blue shield,,O,680.29,236.16,700.70,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63030,cpt,PARTIAL REMOVAL OF BONE WITH RELEASE OF SPINAL CORD OR SPINAL NERVES OF 1 INTERSPACE IN LOWER SPINE,blue cross blue shield,,O,29485.64,5732.13,12241.77,22114.23,17691.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9190,cpt,"INJECTION, FLUOROURACIL, 500 MG",blue cross blue shield,,O,9.25,1.74,1.78,20.90,5.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",blue cross blue shield,,O,632.77,59.44,101.00,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29880,cpt,REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE,blue cross blue shield,,O,21409.78,2586.84,7284.82,7284.82,12845.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2916,cpt,"INJECTION, SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION, 12.5 MG",blue cross blue shield,,O,11.24,11.24,11.24,11.24,6.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",blue cross blue shield,,O,7.49,1.49,1.62,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73060,cpt,"X-RAY OF UPPER ARM, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,245.09,22.66,33.36,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,blue cross blue shield,,O,94.38,2.18,14.44,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,blue cross blue shield,,I,16915.97,4140.71,7982.34,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36821,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, ANY SITE AS SEPARATE PROCEDURE",blue cross blue shield,,O,21470.01,2569.92,10309.61,10309.61,12882.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45171,cpt,REMOVAL OF RECTAL GROWTH THROUGH THE ANUS,blue cross blue shield,,O,20209.15,6477.03,6477.03,6477.03,12125.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86161,cpt,MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM PROTEINS),blue cross blue shield,,O,30.00,9.98,9.98,15.00,18.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",blue cross blue shield,,O,91.30,18.02,20.86,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21931,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF BACK OR FLANK,blue cross blue shield,,O,19815.20,1325.34,5743.86,5743.86,11889.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",blue cross blue shield,,O,85.05,7.99,14.35,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77075,cpt,X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY,blue cross blue shield,,O,735.32,61.44,67.08,97.23,441.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58662,cpt,DESTRUCTION OR REMOVAL OF OVARY OR GROWTH OF PELVIS USING AN ENDOSCOPE,blue cross blue shield,,O,30175.18,4607.33,11655.80,22301.14,18105.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64494,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SECOND LEVEL",blue cross blue shield,,O,4519.81,1107.35,2566.99,2566.99,2711.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",blue cross blue shield,,O,411.42,47.57,61.44,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",blue cross blue shield,,O,47.53,3.60,11.66,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11423,cpt,"REMOVAL OF GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",blue cross blue shield,,O,16719.52,1325.50,1908.34,1908.34,10031.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,blue cross blue shield,,O,1343.10,94.48,482.16,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,blue cross blue shield,,O,831.61,156.22,252.80,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,blue cross blue shield,,O,93.19,15.38,17.32,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64520,cpt,INJECTION OF ANESTHETIC AGENT INTO MIDDLE OR LOWER SPINE SYMPATHETIC NERVE,blue cross blue shield,,O,4485.85,1113.24,9603.36,9603.36,2691.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27814,cpt,OPEN TREATMENT OF PROMINENCES OF BOTH BONES OF THE LEG (TIBIA AND FIBULA) IN THE REGION OF THE ANKLE WITHOUT HARDWARE FIXATION,blue cross blue shield,,O,35327.03,5736.33,10489.40,10489.40,21196.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76820,cpt,ULTRASOUND SCAN OF FETAL UMBILICAL ARTERY BLOOD FLOW RATE,blue cross blue shield,,O,274.39,58.47,58.47,58.47,164.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3480,cpt,"INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ",blue cross blue shield,,O,2.49,0.19,0.82,1.30,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84305,cpt,SOMATOMEDIN (GROWTH FACTOR) LEVEL,blue cross blue shield,,O,256.01,20.83,34.48,34.48,153.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72128,cpt,CT SCAN OF MIDDLE SPINE WITHOUT CONTRAST,blue cross blue shield,,O,1753.28,199.66,400.81,400.81,1051.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,blue cross blue shield,,O,67.58,5.08,12.42,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70480,cpt,CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,blue cross blue shield,,O,1343.10,93.35,482.16,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,blue cross blue shield,,O,811.59,92.97,359.62,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",blue cross blue shield,,O,1858.47,98.50,404.52,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93931,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE ARM OR LIMITED,blue cross blue shield,,O,646.53,92.68,216.32,216.32,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0640,cpt,"INJECTION, LEUCOVORIN CALCIUM, PER 50 MG",blue cross blue shield,,O,24.48,4.06,4.06,38.80,14.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1030,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG",blue cross blue shield,,O,87.39,9.18,52.33,65.54,52.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86774,cpt,ANALYSIS FOR ANTIBODY TO TETANUS BACTERIA (CLOSTRIDIUM TETANUS),blue cross blue shield,,O,92.01,5.21,10.10,14.86,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73220,cpt,MRI SCAN OF ARM BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,3055.12,320.47,923.08,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",blue cross blue shield,,O,4.99,0.54,1.94,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,blue cross blue shield,,O,69.59,7.80,9.76,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",blue cross blue shield,,O,220.61,25.26,25.26,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,blue cross blue shield,,O,84.93,8.43,10.53,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9520,cpt,"TECHNETIUM TC-99M TILMANOCEPT, DIAGNOSTIC, UP TO 0.5 MILLICURIES",blue cross blue shield,,O,1862.08,641.93,778.92,1862.08,1117.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",blue cross blue shield,,O,357.64,32.78,35.90,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",blue cross blue shield,,O,519.10,54.18,54.18,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,blue cross blue shield,,O,7543.40,1294.20,2675.88,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11444,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH, 3.1-4.0 CM",blue cross blue shield,,O,17594.26,1325.54,5499.42,5499.42,10556.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84432,cpt,THYROGLOBULIN (THYROID RELATED HORMONE) LEVEL,blue cross blue shield,,O,93.19,15.90,21.22,24.00,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",blue cross blue shield,,O,65.11,8.45,11.32,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82626,cpt,DEHYDROEPIANDROSTERONE (DHEA) HORMONE LEVEL,blue cross blue shield,,O,156.90,25.37,27.08,27.08,94.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19287,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MRI GUIDANCE, FIRST LESION",blue cross blue shield,,O,12888.62,6117.24,6117.24,6117.24,7733.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58558,cpt,BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE,blue cross blue shield,,O,24068.17,2373.69,7465.56,19315.13,14440.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0878,cpt,"INJECTION, DAPTOMYCIN, 1 MG",blue cross blue shield,,O,1.16,0.05,0.05,0.14,0.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72202,cpt,"X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE, 3 OR MORE VIEWS",blue cross blue shield,,O,267.61,36.00,36.32,212.75,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",blue cross blue shield,,O,1997.14,273.93,514.25,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96409,cpt,ADMINISTRATION OF CHEMOTHERAPY INTO VEIN USING PUSH TECHNIQUE,blue cross blue shield,,O,448.94,102.13,102.13,361.50,269.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",blue cross blue shield,,O,1040.92,159.87,596.78,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,blue cross blue shield,,O,69.59,9.12,10.78,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54840,cpt,REMOVAL OF FLUID ACCUMULATION IN SPERM RESERVOIR,blue cross blue shield,,O,20218.00,2833.10,5719.05,5719.05,12130.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",blue cross blue shield,,O,212.59,22.86,94.65,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross blue shield,,O,100.04,20.74,24.79,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1769,cpt,GUIDE WIRE,blue cross blue shield,,O,338.79,40.02,40.02,304.82,203.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74248,cpt,FOLLOW-THROUGH X-RAY OF UPPER DIGESTIVE TRACT WITH MULTIPLE SERIAL FILMS,blue cross blue shield,,O,225.66,98.48,98.48,98.48,135.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",blue cross blue shield,,O,3457.28,1078.00,2031.10,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59812,cpt,TREATMENT OF INCOMPLETE ABORTION,blue cross blue shield,,O,19183.63,2499.34,4101.22,4101.22,11510.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,blue cross blue shield,,O,101.33,11.74,11.75,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",blue cross blue shield,,O,50.01,4.43,10.05,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54830,cpt,REMOVAL OF GROWTH OF SPERM DUCT,blue cross blue shield,,O,17845.38,158.54,158.54,10053.87,10707.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,231,ms-drg,CORONARY BYPASS WITH PTCA WITH MCC,blue cross blue shield,,I,281339.82,82084.31,82084.31,82084.31,168803.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",blue cross blue shield,,O,502.71,78.63,84.80,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",blue cross blue shield,,O,3395.81,1103.79,2242.95,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,blue cross blue shield,,O,143.17,18.59,18.86,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,blue cross blue shield,,O,112.55,9.00,164.50,1270.41,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",blue cross blue shield,,O,245.09,44.06,44.06,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1442,cpt,"INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM",blue cross blue shield,,O,4.99,0.72,1.51,269.36,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",blue cross blue shield,,O,19538.26,2569.95,6266.42,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2350,cpt,"INJECTION, OCRELIZUMAB, 1 MG",blue cross blue shield,,O,156.72,36.34,36.34,117.73,94.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",blue cross blue shield,,O,2526.13,486.47,825.82,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29999,cpt,OTHER PROCEDURE ON JOINT USING AN ENDOSCOPE,blue cross blue shield,,O,23277.71,8021.63,8021.63,8021.63,13966.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,blue cross blue shield,,O,1479.41,92.59,482.16,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,blue cross blue shield,,O,401.42,94.39,229.19,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49329,cpt,OTHER PROCEDURE ON ABDOMEN USING AN ENDOSCOPE,blue cross blue shield,,O,30927.63,7890.38,10749.62,28017.68,18556.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",blue cross blue shield,,O,117.54,58.77,117.54,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",blue cross blue shield,,O,1007.94,158.30,173.37,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28735,cpt,FUSION OF MULTIPLE FOOT JOINTS WITH BONE INCISION TO CORRECT A FOOT DEFORMITY,blue cross blue shield,,O,58269.00,9856.95,9856.95,9856.95,34961.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",blue cross blue shield,,O,94.14,7.61,15.47,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9967,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML",blue cross blue shield,,O,2.49,0.45,0.45,2.49,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89321,cpt,SEMEN ANALYSIS FOR SPERM PRESENCE,blue cross blue shield,,O,70.78,12.05,72.90,72.90,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70482,cpt,CT SCAN OF CRANIAL CAVITY BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,2175.56,360.68,417.97,417.97,1305.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,blue cross blue shield,,O,440.18,84.89,440.18,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,795,ms-drg,NORMAL NEWBORN,blue cross blue shield,,I,4390.63,2140.83,2149.88,4272.65,2634.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,blue cross blue shield,,O,4630.63,693.07,921.77,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,blue cross blue shield,,O,3008.85,207.30,978.48,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,251,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,blue cross blue shield,,I,66765.78,10498.59,16705.15,16705.15,40059.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",blue cross blue shield,,O,331.50,12.98,38.03,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,471,ms-drg,CERVICAL SPINAL FUSION WITH MCC,blue cross blue shield,,I,96806.06,58134.12,58134.12,58134.12,58083.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87210,cpt,SMEAR FOR INFECTIOUS AGENTS,blue cross blue shield,,O,101.45,7.28,26.72,76.09,19.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",blue cross blue shield,,O,1645.73,583.80,583.80,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",blue cross blue shield,,O,267.61,48.10,61.44,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",blue cross blue shield,,O,1138.00,159.38,685.82,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73223,cpt,MRI SCAN OF ARM JOINT BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,3679.85,324.07,464.03,464.03,2207.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85240,cpt,CLOTTING FACTOR VIII (AHG) MEASUREMENT,blue cross blue shield,,O,195.83,17.55,28.62,28.62,117.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5114,cpt,"INJECTION, TRASTUZUMAB-DKST, BIOSIMILAR, (OGIVRI), 10 MG",blue cross blue shield,,O,246.06,84.57,84.57,84.57,147.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,blue cross blue shield,,O,5444.73,938.10,3276.29,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",blue cross blue shield,,O,140.04,24.64,62.33,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",blue cross blue shield,,O,13.78,1.69,1.80,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,blue cross blue shield,,O,419.99,136.22,157.94,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74170,cpt,CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,2708.71,159.22,612.94,612.94,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17250,cpt,APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,blue cross blue shield,,O,703.02,157.08,383.04,777.14,421.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,100.03,11.76,12.95,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,blue cross blue shield,,O,60.16,9.91,9.91,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86148,cpt,PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUREMENT,blue cross blue shield,,O,87.30,12.69,12.69,46.36,52.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29827,cpt,REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE,blue cross blue shield,,O,38417.80,5736.03,17014.63,17014.63,23050.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,blue cross blue shield,,O,107.35,17.69,23.70,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,blue cross blue shield,,O,83.78,3.34,38.08,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,811,ms-drg,RED BLOOD CELL DISORDERS WITH MCC,blue cross blue shield,,I,26952.43,9206.49,16010.05,16010.05,16171.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",blue cross blue shield,,O,41.28,3.01,9.59,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",blue cross blue shield,,O,252.47,44.06,108.92,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",blue cross blue shield,,O,65.06,17.18,19.73,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,blue cross blue shield,,O,45.13,4.38,45.13,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58661,cpt,REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE,blue cross blue shield,,O,27191.57,4592.49,12091.58,23996.68,16314.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87511,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,47.70,23.24,23.24,35.23,28.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",blue cross blue shield,,O,82.61,19.42,24.66,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0834,cpt,"INJECTION, COSYNTROPIN, 0.25 MG",blue cross blue shield,,O,138.82,20.13,20.13,113.47,83.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9171,cpt,"INJECTION, DOCETAXEL, 1 MG",blue cross blue shield,,O,54.77,0.66,12.96,12.96,32.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,812,ms-drg,RED BLOOD CELL DISORDERS WITHOUT MCC,blue cross blue shield,,I,17513.39,3290.25,10433.81,22466.97,10508.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1630,cpt,"INJECTION, HALOPERIDOL, UP TO 5 MG",blue cross blue shield,,O,78.96,21.20,23.83,59.22,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0461,cpt,"INJECTION, ATROPINE SULFATE, 0.01 MG",blue cross blue shield,,O,1.15,0.19,0.28,11.00,0.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11900,cpt,"INJECTION INTO SKIN GROWTH, 1-7 GROWTHS",blue cross blue shield,,O,1269.35,159.63,1489.62,1489.62,761.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",blue cross blue shield,,O,377.65,61.44,61.44,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1884,cpt,EMBOLIZATION PROTECTIVE SYSTEM,blue cross blue shield,,O,32.49,0.64,15.48,15.48,19.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,blue cross blue shield,,O,16541.64,1561.79,4608.09,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28730,cpt,FUSION OF MULTIPLE FOOT JOINTS WITHOUT A BONE INCISION,blue cross blue shield,,O,48954.48,10198.40,10198.40,22181.74,29372.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,blue cross blue shield,,O,8198.69,1161.40,1904.63,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",blue cross blue shield,,O,158.29,56.98,69.17,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",blue cross blue shield,,O,266.35,64.70,64.70,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,381,ms-drg,COMPLICATED PEPTIC ULCER WITH CC,blue cross blue shield,,I,26479.34,7578.10,12742.06,12742.06,15887.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72070,cpt,"X-RAY OF MIDDLE SPINE, 2 VIEWS",blue cross blue shield,,O,322.63,39.71,39.71,256.49,193.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29877,cpt,REMOVAL OR SHAVING OF KNEE JOINT CARTILAGE USING AN ENDOSCOPE,blue cross blue shield,,O,20747.46,2550.50,7792.87,7792.87,12448.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,673,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,blue cross blue shield,,I,69347.05,21366.97,30406.80,39818.00,41608.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20600,cpt,ASPIRATION AND/OR INJECTION OF SMALL JOINT OR JOINT CAPSULE,blue cross blue shield,,O,720.58,867.89,5970.31,5970.31,432.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",blue cross blue shield,,O,362.65,61.08,61.44,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",blue cross blue shield,,O,91.30,6.24,17.18,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,blue cross blue shield,,O,6833.06,1646.56,1646.56,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,239,ms-drg,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,blue cross blue shield,,I,102484.87,46674.34,46674.34,46674.34,61490.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",blue cross blue shield,,O,240.10,61.44,61.44,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24076,cpt,REMOVAL (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF UPPER ARM OR ELBOW,blue cross blue shield,,O,19365.36,246.67,246.67,2283.41,11619.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62284,cpt,INJECTION OF DYE FOR X-RAY IMAGING AND/OR CT OF LOWER SPINAL CANAL,blue cross blue shield,,O,8406.93,1321.61,1321.61,1321.61,5044.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",blue cross blue shield,,O,183.82,20.70,71.64,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",blue cross blue shield,,O,38.92,2.65,7.19,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2270,cpt,"INJECTION, MORPHINE SULFATE, UP TO 10 MG",blue cross blue shield,,O,84.59,0.76,25.35,82.91,50.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92978,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL OR GRAFT WITH REVIEW BY RADIOLOGIST, INITIAL VESSEL",blue cross blue shield,,O,81139.05,9201.74,27750.61,27750.61,48683.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,193,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,blue cross blue shield,,I,28507.68,8334.78,13795.54,17274.09,17104.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2765,cpt,"INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG",blue cross blue shield,,O,79.57,14.40,29.34,59.62,47.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",blue cross blue shield,,O,117.61,12.87,21.01,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,blue cross blue shield,,O,1620.71,439.39,1038.75,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,310,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,blue cross blue shield,,I,15215.00,3354.50,6648.19,6648.19,9129.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,blue cross blue shield,,I,17457.81,5769.18,9375.86,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11404,cpt,"REMOVAL OF GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,18281.83,1325.18,2707.98,2707.98,10969.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9022,cpt,"INJECTION, ATEZOLIZUMAB, 10 MG",blue cross blue shield,,O,156.30,38.92,54.17,82.27,93.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9060,cpt,"INJECTION, CISPLATIN, POWDER OR SOLUTION, 10 MG",blue cross blue shield,,O,20.12,5.00,5.00,57.69,12.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1762,cpt,"CONNECTIVE TISSUE, HUMAN (INCLUDES FASCIA LATA)",blue cross blue shield,,O,11791.19,3835.60,3835.60,3835.60,7074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11300,cpt,"SHAVING OF 0.5 CENTIMETERS OR LESS SKIN GROWTH OF THE TRUNK, ARMS, OR LEGS",blue cross blue shield,,O,978.38,743.55,743.55,743.55,587.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",blue cross blue shield,,O,60.16,6.38,11.20,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0256,cpt,"INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG",blue cross blue shield,,O,7.94,5.85,5.85,5.85,4.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64450,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO OTHER PERIPHERAL NERVE OR BRANCH,blue cross blue shield,,O,1637.53,6489.10,6489.10,12436.52,982.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",blue cross blue shield,,O,217.58,10.34,230.63,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20501,cpt,INJECTION OF ABNORMAL MUSCLE DRAINAGE TRACT FOR X-RAY STUDY,blue cross blue shield,,O,1806.86,854.86,854.86,854.86,1084.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85301,cpt,ANTITHROMBIN III ANTIGEN (CLOTTING INHIBITOR) LEVEL,blue cross blue shield,,O,56.62,10.81,13.72,56.62,33.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17003,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 2-14 GROWTHS",blue cross blue shield,,O,1040.92,159.38,622.37,1315.38,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45333,cpt,REMOVAL OF POLYPS OR GROWTHS IN UPPER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY) USING ELECTRIC CAUTERY,blue cross blue shield,,O,4413.22,3051.59,3051.59,3051.59,2647.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",blue cross blue shield,,O,1091.80,160.12,596.78,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,203,ms-drg,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,blue cross blue shield,,I,12110.61,3397.96,8338.30,8338.30,7266.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70130,cpt,"X-RAY OF BONE BEHIND THE EAR, MINIMUM OF 3 VIEWS PER SIDE",blue cross blue shield,,O,340.14,32.68,32.68,32.68,204.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",blue cross blue shield,,O,1997.14,430.17,514.25,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85306,cpt,PROTEIN S (CLOTTING INHIBITOR) MEASUREMENT,blue cross blue shield,,O,187.57,15.02,38.74,187.57,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76857,cpt,"ULTRASOUND OF PELVIS, LIMITED, NOT PREGNANCY RELATED",blue cross blue shield,,O,187.57,93.59,198.82,198.82,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38900,cpt,IMAGING OF LYMPH NODES DURING SURGERY,blue cross blue shield,,O,35811.33,5130.30,9713.39,9713.39,21486.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,blue cross blue shield,,O,67.58,8.51,15.58,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",blue cross blue shield,,O,120.33,16.46,24.36,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52005,cpt,INSERTION OF CATHETER INTO URINARY DUCT (URETER) USING AN ENDOSCOPE THROUGH THE BLADDER AREA,blue cross blue shield,,O,15929.97,1594.04,5033.32,8382.60,9557.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93660,cpt,EVALUATION OF HEART FUNCTION USING TILT TABLE,blue cross blue shield,,O,1208.02,288.64,288.64,821.83,724.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42825,cpt,REMOVAL OF TONSILS PATIENT YOUNGER THAN AGE 12,blue cross blue shield,,O,19458.57,4601.50,5017.69,5017.69,11675.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,442,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",blue cross blue shield,,I,23206.50,6521.42,8105.14,8487.22,13923.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28122,cpt,PARTIAL REMOVAL OF FOOT OR HEEL BONE FOR BONE INFECTION IN THE MIDFOOT AREA,blue cross blue shield,,O,20985.21,13419.43,13419.43,13419.43,12591.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10005,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, FIRST GROWTH",blue cross blue shield,,O,2576.47,558.51,1646.56,1932.35,1545.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",blue cross blue shield,,O,13.80,2.61,2.61,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,377,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH MCC,blue cross blue shield,,I,46517.09,11486.77,17220.56,18787.25,27910.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82010,cpt,"KETONE BODIES ANALYSIS, QUANTITATIVE",blue cross blue shield,,O,70.06,11.22,11.22,12.36,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,blue cross blue shield,,O,754.07,203.12,216.32,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",blue cross blue shield,,O,4.12,1.10,1.67,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10180,cpt,COMPLEX DRAINAGE OF WOUND INFECTION AFTER SURGERY,blue cross blue shield,,O,19831.00,324.08,1451.20,11072.05,11898.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66982,cpt,COMPLEX REMOVAL OF CATARACT WITH INSERTION OF PROSTHETIC LENS,blue cross blue shield,,O,16910.08,1876.58,4894.22,4894.22,10146.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,blue cross blue shield,,O,67.58,3.47,10.30,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",blue cross blue shield,,O,2073.43,311.07,1213.17,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q4101,cpt,"APLIGRAF, PER SQUARE CENTIMETER",blue cross blue shield,,O,102.63,76.85,76.85,76.85,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",blue cross blue shield,,O,1680.75,111.66,950.92,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3111,cpt,"INJECTION, ROMOSOZUMAB-AQQG, 1 MG",blue cross blue shield,,O,25.46,6.54,6.54,9.58,15.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,798,ms-drg,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,blue cross blue shield,,I,27090.99,8508.80,8508.80,8508.80,16254.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20900,cpt,HARVEST OF GRAFT FROM SMALL BONE,blue cross blue shield,,O,47977.80,5667.02,9856.95,9856.95,28786.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5117,cpt,"INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG",blue cross blue shield,,O,320.89,24.34,107.23,107.23,192.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55874,cpt,INJECTION OF BIODEGRADABLE MATERIAL NEXT TO PROSTATE,blue cross blue shield,,O,27054.40,4079.31,16970.47,16970.47,16232.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94640,cpt,RESPIRATORY INHALED PRESSURE OR NONPRESSURE TREATMENT TO RELIEVE AIRWAY OBSTRUCTION OR FOR SPUTUM SPECIMEN,blue cross blue shield,,O,223.34,51.35,99.96,99.96,134.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11421,cpt,"REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",blue cross blue shield,,O,21237.03,738.55,2689.89,2689.89,12742.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1788,cpt,"PORT, INDWELLING (IMPLANTABLE)",blue cross blue shield,,O,1737.02,466.81,547.75,1737.02,1042.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",blue cross blue shield,,O,241.34,30.35,76.59,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1303,cpt,"INJECTION, RAVULIZUMAB-CWVZ, 10 MG",blue cross blue shield,,O,762.92,173.77,173.77,221.67,457.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52235,cpt,DESTRUCTION AND/OR REMOVAL OF (2.0 TO 5.0 CENTIMETERS) MEDIUM GROWTHS OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,blue cross blue shield,,O,20734.14,2781.70,4447.47,4447.47,12440.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6207,cpt,CONTACT LAYER >16<= 48 SQ IN; MEDICAL AND SURGICAL SUPPLIES - MISCELLANEOUS DRESSING AND WOUND SUPPLIES,blue cross blue shield,,O,7.98,5.64,5.64,5.64,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4648,cpt,IMPLANTABLE TISSUE MARKER; MEDICAL AND SURGICAL SUPPLIES - OTHER SUPPLIES,blue cross blue shield,,O,4877.20,783.88,1531.26,2061.90,2926.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,blue cross blue shield,,O,306.38,103.42,133.77,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,blue cross blue shield,,O,1343.10,94.47,482.16,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,44620,cpt,CLOSURE OF SURGICALLY CREATED LARGE OR SMALL BOWEL OPENING,blue cross blue shield,,O,1432.32,1432.32,1432.32,1432.32,859.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),blue cross blue shield,,O,65.11,4.25,19.96,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20936,cpt,HARVEST OF BONE FROM SAME SPINE INCISION FOR GRAFT,blue cross blue shield,,O,73036.79,11349.44,13487.02,13487.02,43822.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",blue cross blue shield,,O,281.36,90.50,118.03,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84244,cpt,RENIN (KIDNEY ENZYME) LEVEL,blue cross blue shield,,O,145.10,21.55,25.83,27.49,87.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52204,cpt,BIOPSY OF THE BLADDER USING AN ENDOSCOPE,blue cross blue shield,,O,16937.27,1612.75,8967.03,8967.03,10162.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32554,cpt,ASPIRATION OF FLUID FROM CHEST CAVITY,blue cross blue shield,,O,1140.37,7373.36,7373.36,7373.36,684.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,blue cross blue shield,,O,22.60,4.56,7.07,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27726,cpt,REPAIR OF NONHEALED BROKEN OUTER LOWER LEG BONE WITH PLACEMENT OF STABILIZING DEVICE,blue cross blue shield,,O,58963.84,9291.13,9291.13,9291.13,35378.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10006,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, EACH ADDITIONAL GROWTH",blue cross blue shield,,O,3892.02,563.01,1811.42,1811.42,2335.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",blue cross blue shield,,O,101.45,25.33,32.18,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",blue cross blue shield,,O,65.11,10.15,10.37,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,805,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,blue cross blue shield,,I,14483.73,3890.14,11039.31,11041.35,8690.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",blue cross blue shield,,O,85.39,17.80,19.40,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,788,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,blue cross blue shield,,I,14986.74,7771.24,10290.35,10724.94,8992.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9537,cpt,"TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES",blue cross blue shield,,O,245.09,59.33,157.08,157.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0744,cpt,"INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG",blue cross blue shield,,O,67.52,16.35,23.97,50.64,40.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,560,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",blue cross blue shield,,I,42178.02,11012.76,11012.76,18039.67,25306.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,418,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,blue cross blue shield,,I,55035.81,10049.90,14375.97,14375.97,33021.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1726,cpt,"CATHETER, BALLOON DILATATION, NON-VASCULAR",blue cross blue shield,,O,253.84,91.38,213.13,213.13,152.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,blue cross blue shield,,O,187.57,13.08,13.08,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,blue cross blue shield,,O,521.47,92.78,216.32,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82671,cpt,"ESTROGEN ANALYSIS, FRACTIONATED",blue cross blue shield,,O,436.51,31.65,60.51,65.74,261.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9144,cpt,"INJECTION, DARATUMUMAB, 10 MG AND HYALURONIDASE-FIHJ",blue cross blue shield,,O,148.31,44.88,45.50,48.33,88.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,blue cross blue shield,,O,4318.19,810.94,1528.29,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73020,cpt,"X-RAY OF SHOULDER, 1 VIEW",blue cross blue shield,,O,240.10,40.75,100.71,100.71,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",blue cross blue shield,,O,40.11,3.87,13.52,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64415,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO BRACHIAL NERVE BUNDLE OF ARM,blue cross blue shield,,O,33058.65,2631.25,10313.23,11631.36,19835.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,785,ms-drg,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,blue cross blue shield,,I,14108.83,5205.40,9992.96,10198.00,8465.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57461,cpt,CONE BIOPSY OF CERVIX AND VAGINA USING AN ENDOSCOPE WITH LOOP ELECTRODE,blue cross blue shield,,O,20672.65,1553.11,1553.11,2459.35,12403.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2185,cpt,"INJECTION, MEROPENEM, 100 MG",blue cross blue shield,,O,7.14,0.71,3.32,3.32,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9035,cpt,"PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT",blue cross blue shield,,O,2.35,1.69,1.69,2.35,1.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86060,cpt,MEASUREMENT FOR STREP ANTIBODY (STREP THROAT),blue cross blue shield,,O,18.25,3.28,3.28,3.28,10.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,blue cross blue shield,,O,647.78,92.64,216.32,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",blue cross blue shield,,O,266.35,51.50,61.44,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,blue cross blue shield,,I,19710.37,4922.26,8321.11,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5112,cpt,"INJECTION, TRASTUZUMAB-DTTB, BIOSIMILAR, (ONTRUZANT), 10 MG",blue cross blue shield,,O,297.75,13.43,13.43,2873.58,178.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,blue cross blue shield,,O,3953.80,1077.08,3964.17,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,blue cross blue shield,,O,1753.28,94.47,400.81,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,blue cross blue shield,,O,40.11,4.65,6.69,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,blue cross blue shield,,O,2599.91,94.47,228.66,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,blue cross blue shield,,O,42.51,2.00,6.59,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",blue cross blue shield,,O,70.01,13.01,18.31,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,348.89,56.80,61.44,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,blue cross blue shield,,O,989.19,218.69,738.57,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93986,cpt,ULTRASOUND SCAN OF BLOOD FLOW IN EXTREMITY ON BOTH SIDES OF BODY FOR PREOPERATIVE ASSESSMENT OF BLOOD VESSEL FOR DIALYSIS ACCESS,blue cross blue shield,,O,278.90,129.17,129.17,129.17,167.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78195,cpt,NUCLEAR MEDICINE STUDY OF LYMPHATIC SYSTEM,blue cross blue shield,,O,2847.53,457.66,1055.60,2847.53,1708.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9395,cpt,"INJECTION, FULVESTRANT, 25 MG",blue cross blue shield,,O,421.43,10.87,138.95,316.07,252.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,304,ms-drg,HYPERTENSION WITH MCC,blue cross blue shield,,I,24017.13,7342.26,12391.04,12391.04,14410.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82042,cpt,"CEREBROSPINAL FLUID, OR AMNIOTIC FLUID ALBUMIN (PROTEIN) LEVEL",blue cross blue shield,,O,25.00,3.52,3.52,3.52,15.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71110,cpt,"X-RAY OF RIBS ON BOTH SIDES OF BODY, 3 VIEWS",blue cross blue shield,,O,536.84,63.39,72.72,72.72,322.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",blue cross blue shield,,O,83.33,15.97,33.98,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83090,cpt,HOMOCYSTEINE (AMINO ACID) LEVEL,blue cross blue shield,,O,48.76,14.61,14.61,22.40,29.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,164,ms-drg,MAJOR CHEST PROCEDURES WITH CC,blue cross blue shield,,I,103938.91,16060.55,25897.15,25897.15,62363.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,blue cross blue shield,,O,60.03,7.19,7.35,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,391,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",blue cross blue shield,,I,26671.96,14596.47,14596.47,14596.47,16003.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82672,cpt,"ESTROGEN ANALYSIS, TOTAL",blue cross blue shield,,O,54.25,13.92,13.92,13.92,32.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,blue cross blue shield,,O,784.37,233.55,1926.49,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1335,cpt,"INJECTION, ERTAPENEM SODIUM, 500 MG",blue cross blue shield,,O,93.92,25.89,30.23,187.83,56.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,blue cross blue shield,,O,513.11,156.86,263.33,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86709,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),blue cross blue shield,,O,106.28,11.04,19.42,19.42,63.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,blue cross blue shield,,O,26791.18,4521.08,10726.56,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",blue cross blue shield,,O,71.96,7.91,17.67,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63267,cpt,"REMOVAL OF LOWER SPINE BONE AND GROWTH OTHER THAN A TUMOR, EXTRADURAL",blue cross blue shield,,O,36152.79,5732.13,14769.24,14769.24,21691.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,493,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",blue cross blue shield,,I,69921.76,14158.62,23822.02,24367.50,41953.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,blue cross blue shield,,I,27884.18,6142.25,12253.32,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89051,cpt,BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,blue cross blue shield,,O,42.58,5.49,20.79,30.20,6.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",blue cross blue shield,,O,422.68,79.93,79.93,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,blue cross blue shield,,O,123.87,33.18,79.34,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",blue cross blue shield,,O,36.32,6.91,6.91,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,blue cross blue shield,,O,3055.12,202.94,517.17,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29876,cpt,REMOVAL OF JOINT LINING FROM TWO OR MORE KNEE JOINT COMPARTMENTS USING AN ENDOSCOPE,blue cross blue shield,,O,22731.95,2550.70,8021.63,8021.63,13639.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",blue cross blue shield,,O,113.79,13.73,17.16,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",blue cross blue shield,,O,226.34,61.44,61.44,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,blue cross blue shield,,O,1159.26,202.49,359.62,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",blue cross blue shield,,O,41.28,4.92,9.59,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,blue cross blue shield,,O,899.10,136.27,522.98,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,blue cross blue shield,,O,383.02,34.82,46.48,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74174,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST,blue cross blue shield,,O,1840.81,323.17,1326.08,1326.08,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,446,ms-drg,DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,blue cross blue shield,,I,16827.92,7953.21,7953.21,7953.21,10096.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87481,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,53.88,23.24,23.24,35.23,32.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81401,cpt,MOLECULAR PATHOLOGY PROCEDURE LEVEL 2,blue cross blue shield,,O,342.50,237.96,237.96,237.96,205.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82595,cpt,CRYOGLOBULIN (PROTEIN) MEASUREMENT,blue cross blue shield,,O,40.11,6.89,6.89,30.08,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46260,cpt,REMOVAL OF MULTIPLE INTERNAL AND EXTERNAL HEMORRHOID GROUPS,blue cross blue shield,,O,18904.18,2231.78,4726.84,4726.84,11342.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",blue cross blue shield,,O,2069.24,93.35,395.58,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77002,cpt,FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE,blue cross blue shield,,O,1932.70,187.94,659.82,1101.64,1159.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,blue cross blue shield,,O,30.08,3.63,5.52,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19120,cpt,"REMOVAL OF 1 OR MORE BREAST GROWTH, OPEN PROCEDURE",blue cross blue shield,,O,20656.67,251.77,251.77,2947.92,3480.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9047,cpt,"INFUSION, ALBUMIN (HUMAN), 25%, 50 ML",blue cross blue shield,,O,105.55,1.06,105.55,204.13,63.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,blue cross blue shield,,I,26508.25,6362.98,16227.85,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,605,ms-drg,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",blue cross blue shield,,I,13265.14,6299.63,9754.07,9754.07,7959.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),blue cross blue shield,,O,3857.66,938.20,3478.57,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45388,cpt,"DESTRUCTION OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE",blue cross blue shield,,O,6846.80,2717.41,2717.41,2717.41,4108.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,373,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,blue cross blue shield,,I,28552.84,5080.75,7657.82,7657.82,17131.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",blue cross blue shield,,O,48.36,3.92,8.51,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",blue cross blue shield,,O,31.24,4.67,4.67,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,blue cross blue shield,,O,76.68,7.98,15.20,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82542,cpt,CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE,blue cross blue shield,,O,97.91,11.61,16.41,37.36,58.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,384,ms-drg,UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,blue cross blue shield,,I,25397.63,7562.44,7562.44,7562.44,15238.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",blue cross blue shield,,O,183.82,20.21,65.41,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84478,cpt,TRIGLYCERIDES LEVEL,blue cross blue shield,,O,62.51,9.28,9.28,9.28,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23071,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF SHOULDER AREA,blue cross blue shield,,O,19193.40,2282.87,2291.84,2291.84,11516.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87799,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, QUANTIFICATION",blue cross blue shield,,O,264.26,35.66,39.90,174.31,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25111,cpt,"REMOVAL OF CYST AT WRIST, INITIAL OR PRIMARY",blue cross blue shield,,O,17783.77,1248.37,4924.66,4924.66,10670.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9958,cpt,"HIGH OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION, PER ML",blue cross blue shield,,O,2.49,0.43,0.43,1.12,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23700,cpt,MANIPULATION OF SHOULDER JOINT UNDER ANESTHESIA,blue cross blue shield,,O,29233.76,11569.09,11569.09,11569.09,17540.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22901,cpt,REMOVAL (5 CENTIMETERS OR GREATER) MUSCLE GROWTH IN ABDOMINAL WALL,blue cross blue shield,,O,17549.33,5652.50,5652.50,5652.50,10529.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38525,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, OPEN PROCEDURE",blue cross blue shield,,O,34276.96,4931.97,12984.24,12984.24,20566.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29828,cpt,RELEASE OF TENDON CONNECTING BICEPS MUSCLE AND SHOULDER USING AN ENDOSCOPE,blue cross blue shield,,O,45470.39,5674.87,16913.72,16913.72,27282.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92551,cpt,AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING,blue cross blue shield,,O,217.58,10.34,144.12,217.58,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82365,cpt,INFRARED ANALYSIS OF STONE,blue cross blue shield,,O,73.14,12.65,28.00,38.76,15.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42826,cpt,REMOVAL OF TONSILS PATIENT AGE 12 OR OVER,blue cross blue shield,,O,21996.72,2514.81,5825.05,16497.54,13198.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,blue cross blue shield,,O,71.96,15.59,16.16,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19285,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",blue cross blue shield,,O,31940.44,2805.32,7734.30,7734.30,19164.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,blue cross blue shield,,O,1869.58,206.26,745.39,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64495,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, THIRD AND ANY ADDITIONAL LEVEL(S)",blue cross blue shield,,O,4552.63,1111.87,2202.56,2202.56,2731.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2060,cpt,"INJECTION, LORAZEPAM, 2 MG",blue cross blue shield,,O,78.01,14.44,28.91,77.43,46.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36901,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",blue cross blue shield,,O,15374.12,2544.37,4389.29,4389.29,9224.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29825,cpt,RELEASE OR REMOVAL OF SHOULDER SCAR TISSUE USING AN ENDOSCOPE,blue cross blue shield,,O,29814.55,2596.65,14706.90,14706.90,17888.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,206.42,1017.53,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93985,cpt,ULTRASOUND SCAN OF BLOOD FLOW IN EXTREMITY ON ONE SIDE FOR PREOPERATIVE ASSESSMENT OF BLOOD VESSEL FOR DIALYSIS ACCESS,blue cross blue shield,,O,579.91,163.32,163.32,163.32,347.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36907,cpt,"BALLOON DILATION OF DIALYSIS SEGMENT, ACCESSED THROUGH THE SKIN, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",blue cross blue shield,,O,22996.23,2589.90,10133.54,10133.54,13797.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",blue cross blue shield,,O,183.82,24.23,73.84,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,blue cross blue shield,,O,167.56,25.68,27.11,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9201,cpt,"INJECTION, GEMCITABINE HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 200 MG",blue cross blue shield,,O,32.61,3.97,10.15,24.46,19.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82310,cpt,"CALCIUM LEVEL, TOTAL",blue cross blue shield,,O,38.80,5.06,11.12,11.12,23.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3246,cpt,"INJECTION, TIROFIBAN HCL, 0.25 MG",blue cross blue shield,,O,296.48,9.76,9.76,574.60,177.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86343,cpt,WHITE BLOOD CELL HISTAMINE (IMMUNE SYSTEM CHEMICAL) RELEASE TEST,blue cross blue shield,,O,31.15,12.51,27.07,27.07,18.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",blue cross blue shield,,O,108.88,10.16,25.99,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",blue cross blue shield,,O,67.24,14.75,31.76,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58301,cpt,REMOVAL OF INTRA-UTERINE DEVICE (IUD) FOR PREGNANCY PREVENTION,blue cross blue shield,,O,19235.71,1553.11,1553.11,3553.34,11541.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43249,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, LESS THAN 3.0 CM",blue cross blue shield,,O,5156.78,1469.46,4819.09,4819.09,3094.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17270,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS) OF SCALP, NECK, HANDS, FEET, OR GENITALS",blue cross blue shield,,O,1733.91,160.86,507.74,507.74,1040.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",blue cross blue shield,,O,112.07,9.78,19.99,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,blue cross blue shield,,O,183.82,20.77,73.68,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,blue cross blue shield,,O,6554.34,441.62,2272.57,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9025,cpt,"INJECTION, AZACITIDINE, 1 MG",blue cross blue shield,,O,14.99,0.42,1.43,6.63,8.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",blue cross blue shield,,O,98.78,7.87,101.74,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,blue cross blue shield,,O,135.66,26.63,26.64,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2617,cpt,"STENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY SYSTEM",blue cross blue shield,,O,922.91,235.25,305.79,305.79,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1756,cpt,"INJECTION, IRON SUCROSE, 1 MG",blue cross blue shield,,O,2.08,0.23,0.80,0.94,1.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,501,ms-drg,SOFT TISSUE PROCEDURES WITH CC,blue cross blue shield,,I,78496.87,11464.77,19965.84,19965.84,47098.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",blue cross blue shield,,O,2.49,0.02,1.60,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57282,cpt,REPAIR OF PELVIC LIGAMENTS THROUGH VAGINA,blue cross blue shield,,O,37671.60,13774.78,13774.78,13774.78,22602.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91010,cpt,MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT,blue cross blue shield,,O,3386.38,370.13,645.60,2423.62,2031.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,660,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,blue cross blue shield,,I,37749.06,9520.18,18013.27,18013.27,22649.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1956,cpt,"INJECTION, LEVOFLOXACIN, 250 MG",blue cross blue shield,,O,66.43,22.13,22.13,66.43,39.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,789,ms-drg,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",blue cross blue shield,,I,28579.60,13213.92,13213.92,15837.91,17147.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,blue cross blue shield,,O,100.03,11.53,15.30,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89060,cpt,CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,blue cross blue shield,,O,40.11,7.18,40.11,40.11,8.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",blue cross blue shield,,I,18651.52,4921.84,8974.17,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",blue cross blue shield,,O,45.06,8.66,8.66,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,504,ms-drg,FOOT PROCEDURES WITH CC,blue cross blue shield,,I,31027.08,19880.60,19880.60,19880.60,18616.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,blue cross blue shield,,O,36.32,4.67,10.88,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",blue cross blue shield,,O,647.78,98.50,169.00,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),blue cross blue shield,,O,91.30,14.31,15.53,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73702,cpt,CT SCAN OF LEG BEFORE AND AFTER CONTRAST INJECTION,blue cross blue shield,,O,2362.30,156.43,482.16,482.16,1417.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",blue cross blue shield,,O,226.34,61.44,61.44,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,blue cross blue shield,,I,18716.13,4221.86,9346.88,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,234,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,blue cross blue shield,,I,205358.74,31986.81,50803.66,50803.66,123215.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,206.42,458.10,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,151.64,21.05,42.46,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55700,cpt,BIOPSY OF PROSTATE GLAND,blue cross blue shield,,O,15825.28,1612.35,4133.17,4133.17,1936.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,blue cross blue shield,,O,152.18,14.75,20.48,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76800,cpt,ULTRASOUND SCAN OF SPINAL CANAL,blue cross blue shield,,O,490.46,94.48,256.04,256.04,294.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",blue cross blue shield,,O,54.32,13.67,13.67,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36245,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, EACH FIRST ORDER BRANCH",blue cross blue shield,,O,25437.42,2540.45,4685.12,4685.12,15262.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,blue cross blue shield,,O,265.10,8.75,102.81,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9966,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 200-299 MG/ML IODINE CONCENTRATION, PER ML",blue cross blue shield,,O,3.98,1.26,1.26,1.26,2.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9968,cpt,"INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION ADJUNCT (E.G., METHYLENE BLUE, ISOSULFAN BLUE), 1 MG",blue cross blue shield,,O,50.44,21.10,21.10,50.44,30.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74250,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST AND MULTIPLE SERIAL FILMS,blue cross blue shield,,O,530.23,158.38,262.66,397.67,318.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),blue cross blue shield,,O,29523.82,4577.80,10749.62,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83516,cpt,"ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, MULTIPLE STEP METHOD",blue cross blue shield,,O,55.44,9.63,9.63,41.58,13.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11641,cpt,"REMOVAL OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",blue cross blue shield,,O,3244.66,783.95,1903.39,1903.39,1946.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70330,cpt,X-RAY OF JAW JOINTS ON BOTH SIDES OF THE FACE,blue cross blue shield,,O,362.65,192.20,212.05,212.05,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",blue cross blue shield,,O,85.03,16.92,17.20,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,blue cross blue shield,,O,252.59,4.78,49.28,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1759,cpt,"CATHETER, INTRACARDIAC ECHOCARDIOGRAPHY",blue cross blue shield,,O,3192.67,2455.68,2455.68,2455.68,1915.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",blue cross blue shield,,O,117.54,25.46,29.75,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88108,cpt,"CELL EXAMINATION OF SPECIMEN, CONCENTRATION TECHNIQUE",blue cross blue shield,,O,209.99,47.15,49.28,157.49,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83498,cpt,"HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVEL",blue cross blue shield,,O,126.23,22.15,22.15,94.68,75.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",blue cross blue shield,,O,148.64,16.43,19.44,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9308,cpt,"INJECTION, RAMUCIRUMAB, 5 MG",blue cross blue shield,,O,244.70,36.68,36.68,175.88,146.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",blue cross blue shield,,O,41.28,5.10,5.54,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,blue cross blue shield,,O,105.03,8.42,36.05,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",blue cross blue shield,,O,468.95,93.59,229.19,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57522,cpt,REMOVAL OR DESTRUCTION OF CERVIX WITH ELECTRICAL CAUTERY,blue cross blue shield,,O,19085.48,2436.56,5572.53,5572.53,11451.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23412,cpt,"REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROCEDURE, CHRONIC OR OLD",blue cross blue shield,,O,42342.66,5745.08,16913.72,16913.72,25405.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12042,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF NECK, HANDS, FEET, AND/OR GENITALS",blue cross blue shield,,O,14792.08,1273.00,1908.34,2549.24,8875.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,blue cross blue shield,,I,32181.45,11429.58,19282.44,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,661,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,blue cross blue shield,,I,33148.21,7514.39,12545.11,12545.11,19888.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",blue cross blue shield,,O,1406.87,198.35,198.35,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81025,cpt,URINE PREGNANCY TEST,blue cross blue shield,,O,28.39,1.36,1.36,9.77,17.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5103,cpt,"INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG",blue cross blue shield,,O,109.30,19.12,63.79,109.12,65.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",blue cross blue shield,,O,50.72,7.45,8.52,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,152,ms-drg,OTITIS MEDIA AND URI WITH MCC,blue cross blue shield,,I,13428.45,8057.07,8057.07,8057.07,8057.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",blue cross blue shield,,O,298.47,66.35,102.34,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",blue cross blue shield,,O,96.29,11.40,13.13,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31623,cpt,EXAMINATION OF LUNG AIRWAYS USING AN ENDOSCOPE,blue cross blue shield,,O,19988.36,1331.96,3763.71,3763.71,11993.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19085,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH MRI GUIDANCE, FIRST LESION",blue cross blue shield,,O,11216.07,1273.00,6117.24,6117.24,6729.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9965,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 100-199 MG/ML IODINE CONCENTRATION, PER ML",blue cross blue shield,,O,7.98,1.70,2.26,6.34,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",blue cross blue shield,,O,1029.19,93.54,216.32,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",blue cross blue shield,,O,103.81,18.28,19.03,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88177,cpt,"PAP TEST, EVALUATION OF FINE NEEDLE ASPIRATE, IMMEDIATE, EACH ADDITIONAL EVALUATION EPISODE",blue cross blue shield,,O,49.54,27.92,27.92,81.12,29.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0409,revCode,OTHER IMAGING SERVICES OTHER,blue cross blue shield,,O,1393.12,304.37,304.37,359.99,835.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28008,cpt,INCISION OF TISSUES OF MUSCLE COMPARTMENT OF FOOT AND/OR TOE,blue cross blue shield,,O,19100.45,5060.32,6148.57,15484.76,11460.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0257,cpt,UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL OUTPATIENT DEPARTMENT THAT IS NOT CERTIFIED AS AN ESRD FACILITY,blue cross blue shield,,O,1970.87,277.41,277.41,277.41,614.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93010,cpt,ROUTINE ELECTROCARDIOGRAM (ECG) USING AT LEAST 12 LEADS WITH INTERPRETATION AND REPORT ONLY,blue cross blue shield,,O,38.76,7.83,7.83,7.83,23.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,blue cross blue shield,,O,53.76,5.92,7.54,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,4054.33,324.17,444.64,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",blue cross blue shield,,O,298.47,56.42,98.01,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9264,cpt,"INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG",blue cross blue shield,,O,46.26,10.29,20.93,20.93,27.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,478,ms-drg,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,blue cross blue shield,,I,59227.50,15137.07,22824.33,22824.33,35536.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),blue cross blue shield,,O,166.34,27.39,30.75,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,184,ms-drg,MAJOR CHEST TRAUMA WITH CC,blue cross blue shield,,I,16454.36,7110.38,10197.70,10197.70,9872.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,blue cross blue shield,,I,62688.63,11498.14,28108.42,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9541,cpt,"TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES",blue cross blue shield,,O,245.09,123.76,124.44,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,178,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,blue cross blue shield,,I,19678.73,7277.47,14434.95,14434.95,11807.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84295,cpt,BLOOD SODIUM LEVEL,blue cross blue shield,,O,37.50,9.29,12.33,12.33,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",blue cross blue shield,,O,203.82,32.52,39.37,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36589,cpt,REMOVAL OF CENTRAL VENOUS CATHETER FOR INFUSION,blue cross blue shield,,O,1252.35,2586.12,2834.49,4542.11,751.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",blue cross blue shield,,O,422.68,79.92,79.92,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92960,cpt,EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT,blue cross blue shield,,O,854.12,508.26,562.27,905.36,512.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),blue cross blue shield,,O,132.12,15.79,18.85,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20206,cpt,"NEEDLE BIOPSY OF MUSCLE, ACCESSED THROUGH THE SKIN",blue cross blue shield,,O,8054.03,1503.07,1503.07,1503.07,4832.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,blue cross blue shield,,I,75778.57,12009.61,20706.32,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,769,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,blue cross blue shield,,I,24014.05,6896.44,21393.60,21393.60,14408.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73552,cpt,"X-RAY OF THIGH BONE, MINIMUM 2 VIEWS",blue cross blue shield,,O,327.63,38.17,38.17,173.76,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,blue cross blue shield,,O,287.62,77.37,287.62,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29824,cpt,PARTIAL REMOVAL OF COLLAR BONE AT SHOULDER USING AN ENDOSCOPE,blue cross blue shield,,O,30695.12,2631.25,17497.02,17497.02,18417.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9000,cpt,"INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG",blue cross blue shield,,O,25.20,1.82,4.72,14.05,15.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52601,cpt,REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE,blue cross blue shield,,O,21140.75,3922.58,12709.61,12709.61,12684.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9037,cpt,"PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",blue cross blue shield,,O,3190.10,638.19,2179.70,2179.70,1914.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,blue cross blue shield,,I,30232.58,9248.60,13409.73,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88341,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, EACH ADDITIONAL PROCEDURE",blue cross blue shield,,O,128.79,24.89,24.89,132.54,77.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43251,cpt,"REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE USING A MECHANICAL SNARE",blue cross blue shield,,O,6666.20,1457.56,3664.49,3664.49,3999.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87517,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS B VIRUS, QUANTIFICATION",blue cross blue shield,,O,205.27,42.71,57.99,57.99,123.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87902,cpt,ANALYSIS TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS,blue cross blue shield,,O,824.65,76.19,76.19,437.97,302.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,blue cross blue shield,,O,2687.44,201.24,592.16,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,blue cross blue shield,,O,175.06,87.53,117.54,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",blue cross blue shield,,O,715.30,48.27,48.27,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,blue cross blue shield,,I,26926.14,6286.85,11467.98,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,blue cross blue shield,,O,5902.67,923.22,981.20,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",blue cross blue shield,,O,101.45,14.76,25.21,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3670,cpt,"SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, OFF-THE-SHELF",blue cross blue shield,,O,687.80,335.63,335.63,335.63,412.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86905,cpt,BLOOD TYPING FOR RED BLOOD CELL ANTIGENS,blue cross blue shield,,O,192.29,8.31,8.31,8.31,115.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,blue cross blue shield,,O,647.78,94.48,229.19,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",blue cross blue shield,,O,122.56,1.48,26.29,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,V2632,cpt,"POST CHMBR INTRAOCULAR LENS; PROSTHETICS, ORTHOTICS, AND SUPPLIES",blue cross blue shield,,O,845.37,203.20,268.09,268.09,507.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80197,cpt,TACROLIMUS LEVEL,blue cross blue shield,,O,674.82,13.49,57.77,57.77,16.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72194,cpt,CT SCAN OF PELVIS BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,2207.76,501.08,501.08,501.08,1324.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9260,cpt,"METHOTREXATE SODIUM, 50 MG",blue cross blue shield,,O,11.24,1.79,1.79,1.79,6.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11422,cpt,"REMOVAL OF GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",blue cross blue shield,,O,18352.47,1273.00,2649.40,2649.40,11011.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",blue cross blue shield,,O,68064.84,9197.64,27750.61,27750.61,40838.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36475,cpt,DESTRUCTION OF FIRST INCOMPETENT VEIN OF ARM OR LEG USING RADIOFREQUENCY AND IMAGING GUIDANCE,blue cross blue shield,,O,27732.57,3410.10,7603.74,10128.50,16639.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,blue cross blue shield,,O,19198.81,2406.74,2406.74,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",blue cross blue shield,,O,285.11,61.44,61.44,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43248,cpt,INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,blue cross blue shield,,O,3996.24,1081.46,2241.37,3758.90,2397.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,blue cross blue shield,,I,17945.73,6102.59,13290.63,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,blue cross blue shield,,O,1481.91,158.58,288.25,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,784,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH CC,blue cross blue shield,,I,14784.88,6415.40,12895.67,20022.84,8870.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37799,cpt,OTHER PROCEDURE ON BLOOD VESSEL,blue cross blue shield,,O,25554.94,3410.10,7603.74,13483.00,15332.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",blue cross blue shield,,O,135.66,14.84,20.33,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,blue cross blue shield,,I,74793.54,13792.29,18887.55,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",blue cross blue shield,,O,5902.67,335.59,995.57,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,blue cross blue shield,,O,303.87,29.81,106.78,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1781,cpt,MESH (IMPLANTABLE),blue cross blue shield,,O,2029.44,404.71,599.30,814.49,1217.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,blue cross blue shield,,O,1958.01,473.85,1191.50,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",blue cross blue shield,,O,105.03,12.96,39.90,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91112,cpt,TRANSIT AND PRESSURE MEASUREMENT OF STOMACH THROUGH COLON WITH WIRELESS CAPSULE,blue cross blue shield,,O,1776.38,206.04,206.04,1332.29,1065.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,153,ms-drg,OTITIS MEDIA AND URI WITHOUT MCC,blue cross blue shield,,I,11209.32,3336.34,8451.77,8451.77,6725.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85303,cpt,PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT,blue cross blue shield,,O,264.26,13.57,70.76,264.26,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",blue cross blue shield,,O,107.59,3.13,29.33,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",blue cross blue shield,,O,114.43,3.13,31.40,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80230,cpt,MEASUREMENT OF INFLIXIMAB,blue cross blue shield,,O,96.43,48.71,48.71,48.71,57.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,51600,cpt,INJECTION PROCEDURE FOR X-RAY IMAGING OF THE BLADDER OR DURING VOIDING,blue cross blue shield,,O,2968.32,207.30,830.39,1456.17,1780.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,372,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,blue cross blue shield,,I,21464.09,6956.42,12516.32,12516.32,12878.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",blue cross blue shield,,O,331.51,119.35,136.25,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3301,cpt,"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG",blue cross blue shield,,O,21.30,1.21,7.36,9.59,12.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49657,cpt,"REPAIR OF TRAPPED INCISIONAL HERNIA USING AN ENDOSCOPE, SECONDARY",blue cross blue shield,,O,34209.16,7903.10,10812.66,10812.66,20525.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87497,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS, QUANTIFICATION",blue cross blue shield,,O,232.41,21.19,21.19,53.55,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",blue cross blue shield,,O,4496.04,1078.59,2175.68,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",blue cross blue shield,,O,20.05,1.78,1.78,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23073,cpt,REMOVAL (5 CENTIMETERS OR GREATER) MUSCLE GROWTH OF SHOULDER AREA,blue cross blue shield,,O,17420.22,246.67,246.67,246.67,10452.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",blue cross blue shield,,I,16029.09,4785.97,8818.16,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,176,ms-drg,PULMONARY EMBOLISM WITHOUT MCC,blue cross blue shield,,I,19404.23,4326.04,10580.37,23340.67,11642.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,51999,cpt,OTHER PROCEDURE ON BLADDER USING AN ENDOSCOPE,blue cross blue shield,,O,35246.53,10429.05,10429.05,10429.05,21147.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",blue cross blue shield,,O,82.88,8.42,28.49,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6197,cpt,"ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING",blue cross blue shield,,O,25.00,9.00,14.73,39.75,15.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",blue cross blue shield,,O,267.61,58.94,61.44,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11982,cpt,REMOVAL OF DRUG DELIVERY IMPLANT FROM TISSUE,blue cross blue shield,,O,17499.86,1044.64,1044.64,1044.64,10499.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,blue cross blue shield,,O,178.08,50.28,79.34,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,473,ms-drg,CERVICAL SPINAL FUSION WITHOUT CC/MCC,blue cross blue shield,,I,73180.56,15169.99,27084.42,74397.72,43908.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82955,cpt,G6PD (ENZYME) LEVEL,blue cross blue shield,,O,101.45,8.91,8.91,8.91,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78472,cpt,NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION BY LABELING RED BLOOD CELLS WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER MULTIPLE CYCLES,blue cross blue shield,,O,2436.09,342.21,645.81,777.36,1461.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,blue cross blue shield,,O,2261.82,101.22,1596.44,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9305,cpt,"INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG",blue cross blue shield,,O,280.11,3.19,30.93,76.83,168.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",blue cross blue shield,,O,73.14,3.60,10.62,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",blue cross blue shield,,O,318.54,72.28,72.28,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82088,cpt,ALDOSTERONE HORMONE LEVEL,blue cross blue shield,,O,209.99,28.44,37.38,40.99,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73720,cpt,MRI SCAN OF LEG BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,3055.12,325.59,1041.43,1041.43,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,327,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",blue cross blue shield,,I,49416.36,16344.34,23136.42,23136.42,29649.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,blue cross blue shield,,O,252.59,75.92,216.32,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80164,cpt,"VALPROIC ACID LEVEL, TOTAL",blue cross blue shield,,O,122.56,13.27,22.57,22.57,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87798,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,228.87,16.13,23.24,35.23,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),blue cross blue shield,,O,50.01,5.20,5.45,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92526,cpt,TREATMENT OF SWALLOWING AND/OR ORAL FEEDING FUNCTION,blue cross blue shield,,O,407.71,81.87,134.77,134.77,244.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",blue cross blue shield,,O,410.17,61.80,68.01,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21320,cpt,CLOSED TREATMENT OF BROKEN NOSE BONE WITH PLACEMENT OF STABILIZING DEVICE,blue cross blue shield,,O,17629.16,2495.01,5046.10,5046.10,10577.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74019,cpt,"X-RAY OF ABDOMEN, 2 VIEWS",blue cross blue shield,,O,365.14,61.44,61.44,213.76,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36558,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, TUNNELED",blue cross blue shield,,O,20661.93,2586.12,6323.15,6323.15,12397.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",blue cross blue shield,,O,209.99,16.56,40.90,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20550,cpt,"INJECTIONS OF TENDON SHEATH, LIGAMENT, OR MUSCLE MEMBRANE",blue cross blue shield,,O,708.61,5839.17,5839.17,5839.17,425.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",blue cross blue shield,,O,419.99,46.79,155.82,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89320,cpt,"SEMEN EVALUATION VOLUME, SPERM COUNT, MOTILITY AND ANALYSIS",blue cross blue shield,,O,135.66,12.31,65.59,65.59,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",blue cross blue shield,,O,622.77,61.44,61.44,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,blue cross blue shield,,O,28.83,5.60,5.60,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15275,cpt,"APPLICATION OF SKIN SUBSTITUTE (WOUND SURFACE UP TO 100 SQ CM) TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, EYE REGION, GENITALS, HANDS, FEET, AND/OR MULTIPLE FINGERS OR TOES (FIRST 25 SQ CM OR LESS)",blue cross blue shield,,O,9281.17,3155.16,8146.08,8146.08,5568.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3370,cpt,"INJECTION, VANCOMYCIN HCL, 500 MG",blue cross blue shield,,O,70.84,21.28,21.56,66.54,42.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",blue cross blue shield,,O,250.10,18.15,42.50,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71100,cpt,"X-RAY OF RIBS OF ONE SIDE OF BODY, 2 VIEWS",blue cross blue shield,,O,426.43,49.08,55.55,319.82,255.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,blue cross blue shield,,O,93.19,11.22,14.13,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",blue cross blue shield,,O,826.60,242.61,849.89,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9181,cpt,"INJECTION, ETOPOSIDE, 10 MG",blue cross blue shield,,O,4.37,0.99,0.99,8.01,2.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1580,cpt,"INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG",blue cross blue shield,,O,9.46,3.41,5.64,5.64,5.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,blue cross blue shield,,O,51.39,9.33,9.33,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,329,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,blue cross blue shield,,I,114604.99,18176.89,42391.95,42391.95,68762.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",blue cross blue shield,,O,1893.35,485.97,777.45,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1650,cpt,"INJECTION, ENOXAPARIN SODIUM, 10 MG",blue cross blue shield,,O,21.39,7.39,8.12,64.18,12.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,14060,cpt,"TISSUE TRANSFER REPAIR OF WOUND (10 SQ CENTIMETERS OR LESS) OF EYELIDS, NOSE, EARS, AND/OR LIPS",blue cross blue shield,,O,4854.80,2032.61,4854.80,4854.80,2912.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,blue cross blue shield,,O,71.96,7.48,15.53,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11426,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF SCALP, NECK, HANDS, FEET, OR GENITALS, MORE THAN 4.0 CM",blue cross blue shield,,O,19573.33,2243.72,5406.77,5406.77,11744.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,blue cross blue shield,,O,132.54,29.82,43.99,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,948,ms-drg,SIGNS AND SYMPTOMS WITHOUT MCC,blue cross blue shield,,I,31307.98,7762.31,8408.85,8408.85,18784.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97605,cpt,"NEGATIVE PRESSURE WOUND THERAPY, SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS, PER SESSION",blue cross blue shield,,O,1881.44,329.77,540.81,540.81,1128.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",blue cross blue shield,,O,50.02,5.17,6.73,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87350,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS BE SURFACE ANTIGEN,blue cross blue shield,,O,28.83,6.19,19.42,19.42,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77417,cpt,THERAPEUTIC RADIOLOGY PORT FILMS,blue cross blue shield,,O,42.51,29.20,29.20,29.20,9.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",blue cross blue shield,,O,1099.23,114.80,806.37,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,blue cross blue shield,,O,2152.21,335.59,592.00,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50200,cpt,"NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN",blue cross blue shield,,O,9979.95,1172.33,1172.33,3057.19,5987.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,blue cross blue shield,,O,101.45,15.87,16.76,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28270,cpt,INCISION OF JOINT CAPSULE OF FOOT AND TOE,blue cross blue shield,,O,43492.65,2630.53,8952.81,22181.74,26095.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52318,cpt,"CRUSHING, FRAGMENTING, AND REMOVAL OF BLADDER STONES, COMPLICATED OR LARGER THAN 2.5 CENTIMETERS",blue cross blue shield,,O,20534.02,6595.72,6595.72,6595.72,12320.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,494,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",blue cross blue shield,,I,76484.16,12271.65,20756.53,20756.53,45890.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,blue cross blue shield,,O,266.35,64.70,64.70,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",blue cross blue shield,,O,734.07,114.82,122.24,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,270,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,blue cross blue shield,,I,66302.58,30493.48,58398.86,58398.86,39781.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76604,cpt,ULTRASOUND SCAN OF CHEST,blue cross blue shield,,O,652.17,94.47,216.32,216.32,391.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,blue cross blue shield,,O,221.79,37.03,38.42,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,208,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,blue cross blue shield,,I,75679.94,16342.73,23209.18,23209.18,45407.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58670,cpt,DESTRUCTION OF FALLOPIAN TUBES USING AN ENDOSCOPE,blue cross blue shield,,O,21604.39,4491.89,9350.46,9350.46,12962.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9250,cpt,"METHOTREXATE SODIUM, 5 MG",blue cross blue shield,,O,2.49,0.10,0.10,0.10,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,96.29,17.55,18.82,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36905,cpt,"EXCISION OF BLOOD CLOT AND/OR INFUSION TO DISSOLVE BLOOD CLOT IN DIALYSIS CIRCUIT AND BALLOON DILATION OF DIALYSIS SEGMENT, , ACCESSED THROUGH THE SKIN, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION",blue cross blue shield,,O,37372.90,9050.94,10133.54,10133.54,22423.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74280,cpt,DOUBLE CONTRAST X-RAY OF LARGE INTESTINE,blue cross blue shield,,O,984.18,281.76,281.76,281.76,590.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,blue cross blue shield,,O,348.63,85.16,105.98,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99203,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30-44 MINUTES",blue cross blue shield,,O,280.00,68.79,68.79,378.91,168.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7030,cpt,"INFUSION, NORMAL SALINE SOLUTION , 1000 CC",blue cross blue shield,,O,9.26,2.95,22.51,58.60,5.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,blue cross blue shield,,O,3222.12,719.92,1384.76,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84157,cpt,"TOTAL PROTEIN LEVEL, BODY FLUID",blue cross blue shield,,O,38.63,10.07,10.07,10.07,7.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88720,cpt,MEASUREMENT OF BILIRUBIN,blue cross blue shield,,O,132.12,5.04,8.45,132.12,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,439,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,blue cross blue shield,,I,19744.66,5026.91,10330.99,10330.99,11846.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,blue cross blue shield,,O,50.01,3.11,8.11,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,511,ms-drg,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",blue cross blue shield,,I,63714.38,21108.73,21108.73,21108.73,38228.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",blue cross blue shield,,O,369.82,61.44,61.44,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,blue cross blue shield,,O,770.33,202.50,359.62,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86648,cpt,ANALYSIS FOR ANTIBODY TO DIPHTHERIA (BACTERIA),blue cross blue shield,,O,92.01,5.21,10.28,15.27,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",blue cross blue shield,,O,300.00,109.46,118.96,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99205,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 60-74 MINUTES",blue cross blue shield,,O,664.15,50.63,50.63,50.63,398.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86317,cpt,"DETECTION OF INFECTIOUS AGENT ANTIBODY, QUANTITATIVE",blue cross blue shield,,O,148.64,8.99,29.14,29.14,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,563,ms-drg,"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",blue cross blue shield,,I,15868.22,5516.36,9635.77,9635.77,9520.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,blue cross blue shield,,O,412.67,92.59,216.32,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73120,cpt,"X-RAY OF HAND, 2 VIEWS",blue cross blue shield,,O,240.10,38.01,61.44,96.93,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11623,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",blue cross blue shield,,O,4960.80,1253.04,2217.32,2217.32,2976.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,blue cross blue shield,,I,14560.83,3337.55,8258.90,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,blue cross blue shield,,I,84785.32,12190.37,21255.43,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82530,cpt,"CORTISOL (HORMONE) MEASUREMENT, FREE",blue cross blue shield,,O,184.03,14.59,14.59,24.76,110.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9370,cpt,VINCRISTINE SULFATE 1 MG INJ,blue cross blue shield,,O,58.11,8.53,10.91,49.70,34.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9065,cpt,"INJECTION, CLADRIBINE, PER 1 MG",blue cross blue shield,,O,103.78,28.00,28.00,28.00,62.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74175,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN WITH CONTRAST,blue cross blue shield,,O,1952.12,159.41,547.34,547.34,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11771,cpt,EXTENSIVE REMOVAL OF CYST OF TAILBONE,blue cross blue shield,,O,19648.60,2145.13,5607.96,5607.96,11789.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0330,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION GENERAL,blue cross blue shield,,O,1511.29,404.86,404.86,1511.29,906.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46250,cpt,REMOVAL OF MULTIPLE EXTERNAL HEMORRHOIDS,blue cross blue shield,,O,17632.50,2210.23,5521.37,5521.37,10579.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",blue cross blue shield,,O,10827.72,2513.53,3118.43,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",blue cross blue shield,,O,140.38,11.21,32.59,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85246,cpt,CLOTTING FACTOR VIII (VW FACTOR) ANTIGEN,blue cross blue shield,,O,154.54,22.94,24.33,24.33,92.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1760,cpt,"CLOSURE DEVICE, VASCULAR (IMPLANTABLE/INSERTABLE)",blue cross blue shield,,O,915.75,447.04,447.04,447.04,549.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2628,cpt,"CATHETER, OCCLUSION",blue cross blue shield,,O,405.17,139.86,148.16,303.88,243.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",blue cross blue shield,,O,35.39,4.06,5.40,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",blue cross blue shield,,O,7.91,1.68,2.15,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",blue cross blue shield,,O,365.14,61.44,61.44,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,blue cross blue shield,,E,2880.28,490.23,1119.96,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",blue cross blue shield,,O,112.55,10.48,52.96,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84260,cpt,SEROTONIN (HORMONE) LEVEL,blue cross blue shield,,O,234.76,4.98,33.15,33.15,140.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25607,cpt,"TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST, ABOVE WRIST, WITH PLACEMENT OF STABILIZING DEVICE",blue cross blue shield,,O,35608.49,5736.03,10980.75,11244.87,21365.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93312,cpt,INSERTION OF PROBE IN ESOPHAGUS FOR HEART ULTRASOUND EXAMINATION INCLUDING INTERPRETATION AND REPORT,blue cross blue shield,,O,1858.32,408.83,408.83,1435.55,1114.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",blue cross blue shield,,O,356.40,83.75,120.48,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0360,cpt,"INJECTION, HYDRALAZINE HCL, UP TO 20 MG",blue cross blue shield,,O,85.01,26.37,26.37,85.01,51.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92507,cpt,"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR HEARING PROCESSING DISORDER",blue cross blue shield,,O,264.26,74.09,97.63,97.63,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0875,cpt,"INJECTION, DALBAVANCIN, 5 MG",blue cross blue shield,,O,23.28,14.41,16.28,1722.94,13.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,blue cross blue shield,,O,1205.09,132.64,449.83,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49655,cpt,"REPAIR OF TRAPPED INCISIONAL HERNIA USING AN ENDOSCOPE, PRIMARY",blue cross blue shield,,O,35154.03,10688.17,10688.17,10688.17,21092.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82340,cpt,URINE CALCIUM LEVEL,blue cross blue shield,,O,15.08,6.05,10.08,10.08,9.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19082,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, EACH ADDITIONAL GROWTH",blue cross blue shield,,O,11530.70,2243.72,4516.07,4516.07,6918.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q4130,cpt,"STRATTICE TM, PER SQUARE CENTIMETER",blue cross blue shield,,O,188.22,28.83,28.83,110.81,112.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74022,cpt,COMPLETE X-RAY STUDY OF ABDOMEN WITH SINGLE X-RAY OF CHEST,blue cross blue shield,,O,550.24,73.32,73.32,98.50,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45331,cpt,BIOPSY OF THE LOWER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY),blue cross blue shield,,O,4384.17,710.14,3810.64,3810.64,2630.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),blue cross blue shield,,O,283.14,16.69,55.82,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,949,ms-drg,AFTERCARE WITH CC/MCC,blue cross blue shield,,I,40031.13,15153.97,15153.97,15268.28,24018.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83605,cpt,LACTIC ACID LEVEL,blue cross blue shield,,O,71.96,5.48,5.48,53.97,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25000,cpt,INCISION OR THE TENDON COVERING ON THE TOP SIDE OF THE WRIST,blue cross blue shield,,O,17800.46,1260.13,5839.17,5839.17,10680.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78014,cpt,NUCLEAR MEDICINE STUDY OF THYROID AND THYROID FUNCTION,blue cross blue shield,,O,1304.33,342.21,847.97,883.36,782.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,233,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,blue cross blue shield,,I,285898.27,47239.96,86794.01,86794.01,171538.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,blue cross blue shield,,O,101.33,21.90,22.22,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86039,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, TITER",blue cross blue shield,,O,294.94,10.94,40.26,168.12,176.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",blue cross blue shield,,O,212.36,14.48,64.97,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",blue cross blue shield,,O,147.58,21.05,38.70,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,3055.12,320.47,985.05,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85460,cpt,"FETAL HEMOGLOBIN OR RED BLOOD CELLS MEASUREMENT FOR ASSESSMENT OF FETAL-MATERNAL CIRCULATION, DIFFERENTIAL LYSIS",blue cross blue shield,,O,251.28,7.76,45.83,199.76,150.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,blue cross blue shield,,O,84.93,8.09,10.72,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,blue cross blue shield,,E,292.62,111.66,292.62,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47562,cpt,REMOVAL OF GALLBLADDER USING AN ENDOSCOPE,blue cross blue shield,,O,25184.23,4521.08,9136.32,9136.32,5405.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",blue cross blue shield,,O,135.66,25.29,29.72,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58300,cpt,PLACEMENT OF INTRA-UTERINE DEVICE (IUD) FOR PREGNANCY PREVENTION,blue cross blue shield,,O,17850.39,2499.34,7465.56,7465.56,10710.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,blue cross blue shield,,O,41.26,8.55,11.80,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77021,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF MRI GUIDANCE FOR INSERTION OF NEEDLE,blue cross blue shield,,O,11389.85,1273.00,6117.24,6117.24,6833.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1751,cpt,"CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN HEMODIALYSIS)",blue cross blue shield,,O,1072.97,129.75,129.75,296.86,643.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,959,ms-drg,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,blue cross blue shield,,I,91612.29,49073.63,49073.63,49073.63,54967.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",blue cross blue shield,,O,93.19,13.33,14.59,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,815,ms-drg,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,blue cross blue shield,,I,22126.32,13025.70,13025.70,13025.70,13275.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,blue cross blue shield,,O,351.40,51.44,197.94,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",blue cross blue shield,,O,338.89,30.54,76.59,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",blue cross blue shield,,O,547.73,117.10,126.85,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,16020,cpt,DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5% TOTAL BODY SURFACE),blue cross blue shield,,O,738.64,157.08,318.11,553.98,443.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",blue cross blue shield,,O,266.35,64.70,64.70,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29881,cpt,REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE,blue cross blue shield,,O,21489.40,2516.47,7609.83,7609.83,3025.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",blue cross blue shield,,O,1434.39,436.85,514.25,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,787,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,blue cross blue shield,,I,18030.21,6935.18,12158.05,13885.01,10818.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87106,cpt,"FUNGAL CULTURE, YEAST",blue cross blue shield,,O,112.65,7.28,16.71,16.71,67.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27720,cpt,REPAIR OF NON-HEALED FRACTURE OF SHIN BONE,blue cross blue shield,,O,58963.84,9291.13,9291.13,9291.13,35378.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,blue cross blue shield,,O,3595.37,280.86,528.69,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38531,cpt,OPEN BIOPSY OR EXCISION OF LYMPH NODES IN GROIN,blue cross blue shield,,O,23875.09,8736.17,8736.17,8736.17,14325.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36819,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, UPPER ARM, BASILIC VEIN",blue cross blue shield,,O,28569.86,4455.22,7649.13,8737.59,17141.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,blue cross blue shield,,O,40.11,4.18,5.49,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",blue cross blue shield,,O,437.43,101.00,240.21,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36471,cpt,INJECTION OF CHEMICAL AGENT INTO MULTIPLE INCOMPETENT VEINS OF ONE LEG,blue cross blue shield,,O,2606.20,1345.28,1345.28,4314.46,1563.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81257,cpt,GENE ANALYSIS (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) FOR COMMON DELETIONS OR VARIANT,blue cross blue shield,,O,1006.34,102.26,193.14,193.14,603.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",blue cross blue shield,,O,520.22,353.36,355.71,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,blue cross blue shield,,O,27089.15,2439.68,2439.68,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88313,cpt,SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE INCLUDING INTERPRETATION AND REPORT,blue cross blue shield,,O,119.15,50.94,54.49,94.72,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38505,cpt,NEEDLE BIOPSY OR REMOVAL OF SURFACE LYMPH NODES,blue cross blue shield,,O,13047.69,1305.53,3254.84,3254.84,7828.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88309,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, HIGH COMPLEXITY",blue cross blue shield,,O,696.07,195.29,195.29,296.80,417.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",blue cross blue shield,,O,70.06,8.29,18.36,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,blue cross blue shield,,I,12315.58,3063.82,7256.87,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96376,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION, IN A FACILITY",blue cross blue shield,,O,355.05,16.11,123.19,123.19,213.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,blue cross blue shield,,O,2112.19,159.41,501.90,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,blue cross blue shield,,O,252.59,55.19,71.39,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,blue cross blue shield,,O,130.11,30.48,34.75,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,blue cross blue shield,,O,416.45,133.14,229.85,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27650,cpt,"REPAIR OF RUPTURED ACHILLES TENDON, OPEN OR THROUGH SKIN PROCEDURE",blue cross blue shield,,O,32782.22,11215.95,11215.95,11215.95,19669.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6222,cpt,"GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING",blue cross blue shield,,O,1.25,0.67,0.67,0.99,0.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,202.81,517.17,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,blue cross blue shield,,O,80.09,5.66,10.00,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63047,cpt,"PARTIAL REMOVAL OF MIDDLE SPINE BONE WITH RELEASE OF SPINAL CORD AND/OR NERVES, LOWER BACK (LUMBAR) AREA",blue cross blue shield,,O,38040.40,5647.81,13162.95,13162.95,22824.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28285,cpt,CORRECTION OF TOE JOINT DEFORMITY,blue cross blue shield,,O,17411.66,2596.33,13419.43,13419.43,10447.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,blue cross blue shield,,O,50.00,8.06,10.36,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9959,cpt,"HIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML",blue cross blue shield,,O,2.49,0.64,0.84,1.87,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,blue cross blue shield,,O,4054.33,327.84,376.72,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",blue cross blue shield,,O,127.54,21.16,106.74,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59820,cpt,TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER,blue cross blue shield,,O,18205.61,2373.69,4868.12,13386.01,10923.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86335,cpt,"IMMUNOLOGIC ANALYSIS TECHNIQUE ON BODY FLUID, OTHER FLUIDS WITH CONCENTRATION",blue cross blue shield,,O,212.36,23.13,23.13,29.47,34.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,blue cross blue shield,,O,73.83,11.51,13.25,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,blue cross blue shield,,O,1753.28,96.00,437.62,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45382,cpt,CONTROL OF BLEEDING OF UPPER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,blue cross blue shield,,O,9610.88,1407.16,1714.28,1714.28,5766.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73090,cpt,"X-RAY OF FOREARM, 2 VIEWS",blue cross blue shield,,O,245.09,38.03,38.03,183.82,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49406,cpt,"FLUID COLLECTION DRAINAGE OF THE ABDOMINAL REGION BY CATHETER USING IMAGING GUIDANCE, ACCESSED THROUGH THE SKIN",blue cross blue shield,,O,10801.65,1304.34,2260.51,2260.51,6480.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,blue cross blue shield,,O,3055.12,204.02,377.46,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59151,cpt,REMOVAL OF OVARIAN OR TUBAL PREGNANCY INCLUDING REMOVAL OF THE OVARY AND/OR TUBE USING AN ENDOSCOPE,blue cross blue shield,,O,25793.70,15033.09,15033.09,15033.09,15476.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,blue cross blue shield,,O,3099.12,461.58,920.35,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0702,cpt,"INJECTION, BETAMETHASONE ACETATE 3 MG AND BETAMETHASONE SODIUM PHOSPHATE 3 MG",blue cross blue shield,,O,31.72,5.99,12.02,12.02,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,blue cross blue shield - medicare advantage,,O,348.63,85.16,86.42,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,814,ms-drg,RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,blue cross blue shield - medicare advantage,,I,47176.14,12429.72,12429.72,12429.72,28305.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,blue cross blue shield - medicare advantage,,O,67.58,3.47,5.66,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",blue cross blue shield - medicare advantage,,O,1997.14,273.93,509.22,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",blue cross blue shield - medicare advantage,,O,70.06,8.29,8.29,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,blue cross blue shield - medicare advantage,,O,101.33,21.90,85.00,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",blue cross blue shield - medicare advantage,,O,754.07,158.88,556.85,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",blue cross blue shield - medicare advantage,,O,65.06,17.18,23.06,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",blue cross blue shield - medicare advantage,,O,120.33,16.46,16.46,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64624,cpt,DESTRUCTION OF GENICULAR NERVE BRANCHES OF KNEE BY INJECTION USING IMAGING GUIDANCE,blue cross blue shield - medicare advantage,,O,5206.83,1562.39,2589.93,2589.93,3124.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,blue cross blue shield - medicare advantage,,O,122.03,31.49,37.42,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",blue cross blue shield - medicare advantage,,O,91.30,6.24,10.35,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5101,cpt,"INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MICROGRAM",blue cross blue shield - medicare advantage,,O,1.96,0.20,0.48,0.53,1.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,blue cross blue shield - medicare advantage,,O,53.76,5.92,53.76,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,blue cross blue shield - medicare advantage,,O,143.17,18.59,39.86,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",blue cross blue shield - medicare advantage,,O,231.34,36.97,81.39,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",blue cross blue shield - medicare advantage,,O,230.63,78.33,148.25,159.67,138.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",blue cross blue shield - medicare advantage,,O,331.50,12.98,12.98,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),blue cross blue shield - medicare advantage,,O,132.12,15.79,20.60,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0881,cpt,"INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)",blue cross blue shield - medicare advantage,,O,10.64,2.75,6.98,7.96,6.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,blue cross blue shield - medicare advantage,,O,383.02,34.82,34.82,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,blue cross blue shield - medicare advantage,,O,567.74,115.42,159.02,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",blue cross blue shield - medicare advantage,,O,252.47,43.75,103.28,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",blue cross blue shield - medicare advantage,,O,2.49,0.02,0.68,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,blue cross blue shield - medicare advantage,,O,2149.71,310.75,466.05,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",blue cross blue shield - medicare advantage,,O,13.80,2.61,3.11,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",blue cross blue shield - medicare advantage,,O,38.92,3.91,6.06,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,blue cross blue shield - medicare advantage,,O,188.17,66.99,106.21,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,blue cross blue shield - medicare advantage,,O,84.93,8.43,13.24,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",blue cross blue shield - medicare advantage,,O,5902.67,335.59,1039.60,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",blue cross blue shield - medicare advantage,,O,635.27,137.73,137.73,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,blue cross blue shield - medicare advantage,,O,31.24,2.94,8.80,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,blue cross blue shield - medicare advantage,,O,50.01,3.11,5.08,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",blue cross blue shield - medicare advantage,,O,369.82,61.44,228.65,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,blue cross blue shield - medicare advantage,,O,67.58,8.51,8.51,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,blue cross blue shield - medicare advantage,,O,2687.44,201.24,2687.44,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",blue cross blue shield - medicare advantage,,O,85.05,7.99,22.53,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,blue cross blue shield - medicare advantage,,O,520.22,353.23,430.23,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",blue cross blue shield - medicare advantage,,O,71.96,7.91,18.91,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",blue cross blue shield - medicare advantage,,O,3595.37,208.18,572.76,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",blue cross blue shield - medicare advantage,,O,158.29,56.98,130.11,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",blue cross blue shield - medicare advantage,,O,56.26,6.34,21.63,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",blue cross blue shield - medicare advantage,,O,1858.47,98.50,222.01,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,blue cross blue shield - medicare advantage,,O,1159.26,202.49,359.62,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,blue cross blue shield - medicare advantage,,O,41.28,5.78,6.44,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,blue cross blue shield - medicare advantage,,O,440.18,84.89,395.63,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",blue cross blue shield - medicare advantage,,O,10827.72,2513.53,5882.38,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,blue cross blue shield - medicare advantage,,O,8198.69,1161.40,1777.47,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",blue cross blue shield - medicare advantage,,O,38.92,2.65,21.95,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,blue cross blue shield - medicare advantage,,O,252.59,55.19,65.13,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,blue cross blue shield - medicare advantage,,O,1205.09,132.64,132.64,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,blue cross blue shield - medicare advantage,,O,203.82,49.80,56.21,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",blue cross blue shield - medicare advantage,,O,65.11,10.15,10.15,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,blue cross blue shield - medicare advantage,,O,83.76,6.73,69.27,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,blue cross blue shield - medicare advantage,,O,694.00,180.07,244.15,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",blue cross blue shield - medicare advantage,,O,52.60,8.84,8.84,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",blue cross blue shield - medicare advantage,,O,520.22,353.36,430.23,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,blue cross blue shield - medicare advantage,,O,70.06,8.01,62.97,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,blue cross blue shield - medicare advantage,,O,754.07,203.12,754.07,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,blue cross blue shield - medicare advantage,,E,880.03,214.07,675.54,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",blue cross blue shield - medicare advantage,,O,345.14,75.82,365.84,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,blue cross blue shield - medicare advantage,,O,351.40,51.44,273.24,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,blue cross blue shield - medicare advantage,,O,290.12,59.69,62.90,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",blue cross blue shield - medicare advantage,,O,734.07,19.80,156.24,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",blue cross blue shield - medicare advantage,,E,5953.08,743.91,1397.70,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",blue cross blue shield - medicare advantage,,O,116.79,7.81,18.21,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,blue cross blue shield - medicare advantage,,O,3683.73,275.00,299.93,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,blue cross blue shield - medicare advantage,,O,348.63,85.16,86.42,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,blue cross blue shield - medicare advantage,,O,67.58,5.08,5.08,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",blue cross blue shield - medicare advantage,,O,47.53,8.48,8.48,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",blue cross blue shield - medicare advantage,,O,94.14,7.61,20.60,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,blue cross blue shield - medicare advantage,,O,547.73,91.89,92.94,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,blue cross blue shield - medicare advantage,,O,1893.35,157.27,601.04,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,blue cross blue shield - medicare advantage,,O,90.02,12.05,25.36,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross blue shield - medicare advantage,,O,100.04,20.74,52.50,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),blue cross blue shield - medicare advantage,,O,126.23,10.13,104.40,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,blue cross blue shield - medicare advantage,,O,252.59,54.84,71.17,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,blue cross blue shield - medicare advantage,,O,50.02,4.84,44.00,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,blue cross blue shield - medicare advantage,,E,2880.28,490.23,1491.00,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",blue cross blue shield - medicare advantage,,O,2526.13,486.47,736.05,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",blue cross blue shield - medicare advantage,,O,151.46,8.03,13.12,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",blue cross blue shield - medicare advantage,,O,7.91,1.68,9.37,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,blue cross blue shield - medicare advantage,,O,256.35,58.45,71.81,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,blue cross blue shield - medicare advantage,,O,188.17,19.53,106.70,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,blue cross blue shield - medicare advantage,,O,831.61,156.22,159.02,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",blue cross blue shield - medicare advantage,,O,547.73,117.10,153.42,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,blue cross blue shield - medicare advantage,,O,1630.73,338.97,1039.60,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",blue cross blue shield - medicare advantage,,O,183.82,20.70,20.73,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",blue cross blue shield - medicare advantage,,O,117.54,25.46,32.93,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,blue cross blue shield - medicare advantage,,O,41.19,1.80,3.14,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",blue cross blue shield - medicare advantage,,O,801.60,189.21,626.35,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,blue cross blue shield - medicare advantage,,O,3595.37,280.86,536.10,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,blue cross blue shield - medicare advantage,,O,106.28,8.57,16.56,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,blue cross blue shield - medicare advantage,,O,345.14,124.25,365.84,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,blue cross blue shield - medicare advantage,,O,76.68,5.83,9.52,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",blue cross blue shield - medicare advantage,,O,1997.14,430.17,514.25,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,blue cross blue shield - medicare advantage,,O,183.82,19.97,23.02,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,blue cross blue shield - medicare advantage,,O,73.83,11.51,11.51,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,blue cross blue shield - medicare advantage,,O,2289.17,554.60,973.45,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,blue cross blue shield - medicare advantage,,O,9.11,0.50,1.00,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0801,revCode,INPATIENT RENAL DIALYSIS INPATIENT HEMODIALYSIS,blue cross blue shield - medicare advantage,,O,1970.87,693.35,693.35,693.35,1182.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",blue cross blue shield - medicare advantage,,O,757.37,185.43,626.35,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,blue cross blue shield - medicare advantage,,O,41.26,8.55,21.66,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,blue cross blue shield - medicare advantage,,O,16.28,2.44,4.97,4798.21,9.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),blue cross blue shield - medicare advantage,,O,91.30,14.31,28.00,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9541,cpt,"TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES",blue cross blue shield - medicare advantage,,O,245.09,123.76,156.24,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",blue cross blue shield - medicare advantage,,O,373.90,92.59,92.59,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",blue cross blue shield - medicare advantage,,O,4184.57,938.10,1436.41,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",blue cross blue shield - medicare advantage,,O,105.03,12.96,29.24,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,blue cross blue shield - medicare advantage,,O,56.62,7.92,8.48,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74240,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST,blue cross blue shield - medicare advantage,,O,513.01,159.41,543.79,543.79,307.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",blue cross blue shield - medicare advantage,,O,1252.50,103.81,200.78,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76942,cpt,ULTRASONIC GUIDANCE IMAGING SUPERVISION AND INTERPRETATION FOR INSERTION OF NEEDLE,blue cross/blue shield medicare adv,,O,252.59,96.03,185.81,200.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",blue cross/blue shield medicare adv,,O,71.96,7.91,16.26,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,390,ms-drg,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,12721.53,4148.74,5022.18,6879.39,7632.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,blue cross/blue shield medicare adv,,O,252.59,4.78,40.78,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,blue cross/blue shield medicare adv,,O,414.89,93.99,128.02,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,897,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",blue cross/blue shield medicare adv,,I,20249.18,5831.92,5831.92,9701.00,12149.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,blue cross/blue shield medicare adv,,O,899.10,136.27,136.27,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",blue cross/blue shield medicare adv,,O,1680.75,111.66,696.16,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,blue cross/blue shield medicare adv,,O,1481.91,158.58,381.96,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9130,cpt,DACARBAZINE 100 MG INJ,blue cross/blue shield medicare adv,,O,21.60,7.32,7.32,7.32,12.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,blue cross/blue shield medicare adv,,O,80.09,5.66,9.71,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,673,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,blue cross/blue shield medicare adv,,I,69347.05,21366.97,30406.80,39818.00,41608.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78709,cpt,"NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT OF BLOOD FLOW AND FUNCTION, WITH OR WITHOUT DRUGS, MULTIPLE STUDIES",blue cross/blue shield medicare adv,,O,1411.87,444.24,538.96,1009.00,847.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,blue cross/blue shield medicare adv,,I,26926.14,6286.85,8167.99,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",blue cross/blue shield medicare adv,,O,1997.14,430.17,514.25,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",blue cross/blue shield medicare adv,,O,362.65,61.08,61.08,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9045,cpt,"INJECTION, CARBOPLATIN, 50 MG",blue cross/blue shield medicare adv,,O,17.50,2.78,5.05,45.93,10.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,blue cross/blue shield medicare adv,,O,76.68,7.98,7.98,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,640,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",blue cross/blue shield medicare adv,,I,24682.45,5356.97,10115.47,14419.00,14809.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,blue cross/blue shield medicare adv,,O,1630.73,338.97,957.51,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,786,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,blue cross/blue shield medicare adv,,I,26502.24,8570.18,13414.81,31953.68,15901.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1769,cpt,GUIDE WIRE,blue cross/blue shield medicare adv,,O,338.79,40.02,40.56,304.82,203.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,535,ms-drg,FRACTURES OF HIP AND PELVIS WITH MCC,blue cross/blue shield medicare adv,,I,21743.33,8468.58,10843.67,10843.67,13046.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,blue cross/blue shield medicare adv,,I,14826.55,4677.51,8280.73,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",blue cross/blue shield medicare adv,,O,826.60,239.39,826.60,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,blue cross/blue shield medicare adv,,O,76.68,5.83,13.38,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,206.42,458.10,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",blue cross/blue shield medicare adv,,O,1997.14,273.93,514.25,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,312.63,61.44,61.44,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",blue cross/blue shield medicare adv,,O,1099.23,114.80,873.89,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",blue cross/blue shield medicare adv,,O,240.10,61.44,61.44,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80202,cpt,VANCOMYCIN (ANTIBIOTIC) LEVEL,blue cross/blue shield medicare adv,,O,92.78,13.27,16.42,27.34,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81291,cpt,"GENE ANALYSIS (5, 10-METHYLENETETRAHYDROFOLATE REDUCTASE) COMMON VARIANTS",blue cross/blue shield medicare adv,,O,244.24,81.68,237.13,237.13,146.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72202,cpt,"X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE, 3 OR MORE VIEWS",blue cross/blue shield medicare adv,,O,267.61,36.00,36.00,212.75,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,602,ms-drg,CELLULITIS WITH MCC,blue cross/blue shield medicare adv,,I,27263.26,7119.45,14531.98,14531.98,16357.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73592,cpt,X-RAY OF LEG IN INFANT MINIMUM OF 2 VIEWS,blue cross/blue shield medicare adv,,O,890.38,66.21,66.21,66.21,534.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",blue cross/blue shield medicare adv,,O,356.40,83.75,106.09,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,blue cross/blue shield medicare adv,,O,69.59,8.01,9.13,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,blue cross/blue shield medicare adv,,O,152.18,14.75,31.01,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72220,cpt,"X-RAY OF SACRUM AND TAILBONE, MINIMUM OF 2 VIEWS",blue cross/blue shield medicare adv,,O,240.10,33.96,33.96,75.57,88.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,blue cross/blue shield medicare adv,,O,50.02,4.84,4.84,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",blue cross/blue shield medicare adv,,O,89.65,10.18,11.75,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,blue cross/blue shield medicare adv,,O,1952.12,144.93,424.51,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,149.83,34.39,79.34,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",blue cross/blue shield medicare adv,,O,238.84,35.53,54.64,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,blue cross/blue shield medicare adv,,O,862.88,61.44,61.44,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,blue cross/blue shield medicare adv,,O,7543.40,1294.20,2675.89,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93990,cpt,ULTRASOUND OF HEMODIALYSIS ACCESS,blue cross/blue shield medicare adv,,O,254.87,124.44,124.44,181.70,152.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,blue cross/blue shield medicare adv,,O,83.76,14.03,65.97,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,blue cross/blue shield medicare adv,,O,256.35,58.45,63.99,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,blue cross/blue shield medicare adv,,O,138.03,20.16,26.70,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1758,cpt,"CATHETER, URETERAL",blue cross/blue shield medicare adv,,O,112.55,32.52,37.04,37.04,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,blue cross/blue shield medicare adv,,I,18716.13,4221.86,4221.86,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,14759.59,3312.91,5398.54,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,blue cross/blue shield medicare adv,,O,203.82,49.80,64.75,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1726,cpt,"CATHETER, BALLOON DILATATION, NON-VASCULAR",blue cross/blue shield medicare adv,,O,253.84,91.38,187.09,213.13,152.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1630,cpt,"INJECTION, HALOPERIDOL, UP TO 5 MG",blue cross/blue shield medicare adv,,O,78.96,21.20,21.50,59.22,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",blue cross/blue shield medicare adv,,O,151.46,8.03,21.39,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,blue cross/blue shield medicare adv,,O,67.58,8.51,15.48,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",blue cross/blue shield medicare adv,,O,468.95,93.59,229.19,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,660,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,blue cross/blue shield medicare adv,,I,37749.06,9520.18,15469.14,18013.27,22649.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,healthchoice,,O,73.83,11.51,19.75,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",blue cross/blue shield medicare adv,,O,238.30,63.70,63.70,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",blue cross/blue shield medicare adv,,O,635.27,137.73,245.09,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1882,cpt,"CARDIOVERTER-DEFIBRILLATOR, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)",blue cross/blue shield medicare adv,,O,88422.56,1752.92,1752.92,1752.92,53053.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,blue cross/blue shield medicare adv,,O,41.19,1.80,5.75,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",blue cross/blue shield medicare adv,,O,298.47,66.35,88.30,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",blue cross/blue shield medicare adv,,E,1724.51,232.62,434.98,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",blue cross/blue shield medicare adv,,O,67.24,14.75,31.76,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,blue cross/blue shield medicare adv,,O,38.92,4.65,5.27,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,blue cross/blue shield medicare adv,,O,143.17,18.59,22.98,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,596,ms-drg,MAJOR SKIN DISORDERS WITHOUT MCC,blue cross/blue shield medicare adv,,I,9208.08,9208.08,9208.08,9208.08,5524.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",blue cross/blue shield medicare adv,,O,25.94,5.08,7.79,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6196,cpt,"ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, EACH DRESSING",blue cross/blue shield medicare adv,,O,11.24,2.52,2.52,2.52,6.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77002,cpt,FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE,blue cross/blue shield medicare adv,,O,1932.70,187.94,451.21,1101.64,1159.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,280,ms-drg,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",blue cross/blue shield medicare adv,,I,31302.10,10044.53,14302.64,76220.28,18781.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0378,cpt,"HOSPITAL OBSERVATION SERVICE, PER HOUR",blue cross/blue shield medicare adv,,O,16.99,2.44,3.03,22.26,10.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6197,cpt,"ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING",blue cross/blue shield medicare adv,,O,25.00,9.00,13.10,39.75,15.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",blue cross/blue shield medicare adv,,O,377.65,61.44,61.44,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2060,cpt,"INJECTION, LORAZEPAM, 2 MG",blue cross/blue shield medicare adv,,O,78.01,14.44,25.87,77.43,46.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",blue cross/blue shield medicare adv,,O,31.24,4.67,5.73,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9201,cpt,"INJECTION, GEMCITABINE HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 200 MG",blue cross/blue shield medicare adv,,O,32.61,3.97,8.66,24.46,19.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83825,cpt,MERCURY LEVEL,blue cross/blue shield medicare adv,,O,132.12,15.93,27.18,27.18,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,blue cross/blue shield medicare adv,,O,41.28,5.78,5.78,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,464,ms-drg,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,blue cross/blue shield medicare adv,,I,45913.20,20544.81,22898.76,22898.76,27547.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88302,cpt,PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE,blue cross/blue shield medicare adv,,O,148.64,44.04,56.57,89.81,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,393,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,blue cross/blue shield medicare adv,,I,34228.75,11585.36,13656.82,16485.12,20537.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85303,cpt,PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT,blue cross/blue shield medicare adv,,O,264.26,13.57,264.26,264.26,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",blue cross/blue shield medicare adv,,O,233.84,30.94,76.59,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3490,cpt,DRUGS UNCLASSIFIED INJECTION,blue cross/blue shield medicare adv,,O,22.69,0.62,12.62,12.62,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,114.43,3.13,30.01,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0461,cpt,"INJECTION, ATROPINE SULFATE, 0.01 MG",blue cross/blue shield medicare adv,,O,1.15,0.19,0.19,11.00,0.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",blue cross/blue shield medicare adv,,O,419.99,46.79,191.38,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",blue cross/blue shield medicare adv,,O,1029.19,93.54,216.32,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3660,cpt,"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, OFF-THE-SHELF",blue cross/blue shield medicare adv,,O,100.04,19.56,19.56,99.21,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82330,cpt,"CALCIUM LEVEL, IONIZED",blue cross/blue shield medicare adv,,O,89.65,13.41,21.16,21.16,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1876,cpt,"STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM",blue cross/blue shield medicare adv,,O,922.91,270.48,280.94,733.71,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross/blue shield medicare adv,,O,93.77,21.35,21.35,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,blue cross/blue shield medicare adv,,I,65131.57,7666.11,20783.20,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,blue cross/blue shield medicare adv,,O,71.96,9.99,9.99,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",blue cross/blue shield medicare adv,,O,73.14,3.60,12.67,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",blue cross/blue shield medicare adv,,O,365.14,48.65,61.44,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",blue cross/blue shield medicare adv,,O,50.02,5.17,5.17,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",blue cross/blue shield medicare adv,,O,650.28,61.44,61.44,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,320.47,924.58,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9968,cpt,"INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION ADJUNCT (E.G., METHYLENE BLUE, ISOSULFAN BLUE), 1 MG",blue cross/blue shield medicare adv,,O,50.44,21.10,23.05,50.44,30.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86671,cpt,ANALYSIS FOR ANTIBODY TO FUNGUS,blue cross/blue shield medicare adv,,O,30.63,5.89,5.89,30.62,18.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",blue cross/blue shield medicare adv,,O,85.05,7.99,13.85,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,blue cross/blue shield medicare adv,,O,330.33,24.94,31.95,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,blue cross/blue shield medicare adv,,O,351.40,81.48,301.25,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",blue cross/blue shield medicare adv,,O,108.88,10.16,20.25,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",blue cross/blue shield medicare adv,,O,1434.39,436.85,514.25,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,blue cross/blue shield medicare adv,,O,106.28,8.57,14.46,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1819,cpt,SURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (IMPLANTABLE),blue cross/blue shield medicare adv,,O,656.94,40.85,73.26,183.05,394.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,blue cross/blue shield medicare adv,,I,16493.28,2797.28,8017.14,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1884,cpt,EMBOLIZATION PROTECTIVE SYSTEM,blue cross/blue shield medicare adv,,O,32.49,0.64,0.64,15.48,19.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,348.89,46.07,46.07,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",blue cross/blue shield medicare adv,,O,162.48,33.29,53.00,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",blue cross/blue shield medicare adv,,O,91.43,5.96,17.25,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,805,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,blue cross/blue shield medicare adv,,I,14483.73,3890.14,11041.35,11041.35,8690.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,blue cross/blue shield medicare adv,,O,3055.12,202.94,517.17,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",blue cross/blue shield medicare adv,,O,3595.37,208.18,534.38,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1886,cpt,"CATHETER, EXTRAVASCULAR TISSUE ABLATION, ANY MODALITY (INSERTABLE)",blue cross/blue shield medicare adv,,O,4613.33,902.16,902.16,902.16,2768.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",blue cross/blue shield medicare adv,,O,203.82,32.52,32.52,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",blue cross/blue shield medicare adv,,O,47.53,8.48,9.36,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88313,cpt,SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE INCLUDING INTERPRETATION AND REPORT,blue cross/blue shield medicare adv,,O,119.15,50.94,53.73,94.72,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,785,ms-drg,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,14108.83,5205.40,7294.97,10198.00,8465.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88177,cpt,"PAP TEST, EVALUATION OF FINE NEEDLE ASPIRATE, IMMEDIATE, EACH ADDITIONAL EVALUATION EPISODE",blue cross/blue shield medicare adv,,O,49.54,27.92,36.66,81.12,29.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,blue cross/blue shield medicare adv,,O,646.53,93.49,359.62,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86774,cpt,ANALYSIS FOR ANTIBODY TO TETANUS BACTERIA (CLOSTRIDIUM TETANUS),blue cross/blue shield medicare adv,,O,92.01,5.21,10.85,14.86,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",blue cross/blue shield medicare adv,,O,520.22,353.36,551.76,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,blue cross/blue shield medicare adv,,O,87.53,4.18,14.89,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,4054.33,322.67,1017.55,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73650,cpt,"X-RAY OF HEEL, MINIMUM OF 2 VIEWS",blue cross/blue shield medicare adv,,O,254.50,44.02,44.02,149.69,152.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,blue cross/blue shield medicare adv,,O,36.32,3.85,7.73,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,blue cross/blue shield medicare adv,,O,2149.71,310.75,412.04,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",blue cross/blue shield medicare adv,,O,39.88,13.23,13.23,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0153,cpt,"INJECTION, ADENOSINE, 1 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE COMPOUNDS)",blue cross/blue shield medicare adv,,O,0.73,0.07,0.07,0.07,0.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76098,cpt,IMAGING OF SURGICAL SPECIMEN,blue cross/blue shield medicare adv,,O,1318.08,258.94,557.24,557.24,790.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,blue cross/blue shield medicare adv,,I,26508.25,6362.98,14255.96,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2310,cpt,"INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG",blue cross/blue shield medicare adv,,O,86.61,39.34,39.34,39.34,51.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,blue cross/blue shield medicare adv,,O,252.59,55.19,67.13,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",blue cross/blue shield medicare adv,,O,754.07,158.88,256.04,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",blue cross/blue shield medicare adv,,O,122.56,1.48,23.36,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0640,cpt,"INJECTION, LEUCOVORIN CALCIUM, PER 50 MG",blue cross/blue shield medicare adv,,O,24.48,4.06,5.69,38.80,14.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",blue cross/blue shield medicare adv,,O,41.06,11.36,11.36,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,blue cross/blue shield medicare adv,,O,40.11,4.18,5.57,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0780,cpt,"INJECTION, PROCHLORPERAZINE, UP TO 10 MG",blue cross/blue shield medicare adv,,O,84.30,3.36,9.56,62.66,50.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",blue cross/blue shield medicare adv,,O,154.76,24.25,24.25,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,blue cross/blue shield medicare adv,,O,178.08,50.28,51.54,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",blue cross/blue shield medicare adv,,O,31.88,3.63,17.58,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87529,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,54.75,15.34,15.34,35.23,32.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,blue cross/blue shield medicare adv,,O,28.83,5.59,6.05,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,blue cross/blue shield medicare adv,,O,290.12,59.69,59.69,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",blue cross/blue shield medicare adv,,O,94.14,7.61,15.47,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,blue cross/blue shield medicare adv,,O,4630.63,693.07,693.07,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",blue cross/blue shield medicare adv,,O,245.09,44.06,46.08,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,776,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,blue cross/blue shield medicare adv,,I,14024.63,2935.28,6965.38,9541.48,8414.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,4054.33,324.17,413.13,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,blue cross/blue shield medicare adv,,O,237.59,106.92,132.67,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,blue cross/blue shield medicare adv,,O,348.63,85.16,105.97,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",blue cross/blue shield medicare adv,,O,270.00,64.89,64.89,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",blue cross/blue shield medicare adv,,O,826.60,242.61,826.60,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70110,cpt,"X-RAY OF LOWER JAW, MINIMUM OF 4 VIEWS",blue cross/blue shield medicare adv,,O,436.43,61.44,61.44,268.03,261.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,blue cross/blue shield medicare adv,,O,89.65,6.58,6.58,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,348.89,53.55,61.44,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,blue cross/blue shield medicare adv,,I,18651.11,4387.85,7336.39,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9520,cpt,"TECHNETIUM TC-99M TILMANOCEPT, DIAGNOSTIC, UP TO 0.5 MILLICURIES",blue cross/blue shield medicare adv,,O,1862.08,641.93,641.93,1862.08,1117.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",blue cross/blue shield medicare adv,,O,88.24,14.05,23.92,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",blue cross/blue shield medicare adv,,O,250.10,18.15,41.43,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74250,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST AND MULTIPLE SERIAL FILMS,blue cross/blue shield medicare adv,,O,530.23,158.38,296.40,397.67,318.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77001,cpt,"FLUOROSCOPIC GUIDANCE FOR INSERTION, REPLACEMENT OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",blue cross/blue shield medicare adv,,O,847.87,227.86,245.86,847.87,508.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,blue cross/blue shield medicare adv,,O,42.58,3.22,13.32,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73070,cpt,"X-RAY OF ELBOW, 2 VIEWS",blue cross/blue shield medicare adv,,O,252.59,40.91,40.91,143.98,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),blue cross/blue shield medicare adv,,O,53.08,5.52,5.80,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,blue cross/blue shield medicare adv,,O,440.18,84.89,440.18,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",blue cross/blue shield medicare adv,,O,20.05,1.78,1.94,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86665,cpt,"ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), VIRAL CAPSID",blue cross/blue shield medicare adv,,O,266.62,18.21,20.88,24.87,159.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,661,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,33148.21,7514.39,12545.11,12545.11,19888.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,742,ms-drg,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,blue cross/blue shield medicare adv,,I,58157.58,12241.40,14140.43,14140.43,34894.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86317,cpt,"DETECTION OF INFECTIOUS AGENT ANTIBODY, QUANTITATIVE",blue cross/blue shield medicare adv,,O,148.64,8.99,19.59,29.14,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82088,cpt,ALDOSTERONE HORMONE LEVEL,blue cross/blue shield medicare adv,,O,209.99,28.44,40.99,40.99,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,blue cross/blue shield medicare adv,,O,40.11,4.65,8.25,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",blue cross/blue shield medicare adv,,O,2073.43,311.07,1067.63,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,100.03,11.76,11.76,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",blue cross/blue shield medicare adv,,O,680.29,236.16,680.29,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,blue cross/blue shield medicare adv,,O,287.62,77.37,287.62,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71111,cpt,"X-RAY OF BOTH SIDES OF THE RIBS INCLUDING THE CHEST, MINIMUM OF 4 VIEWS",blue cross/blue shield medicare adv,,O,377.65,61.44,61.44,188.83,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1753.28,94.47,400.81,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",blue cross/blue shield medicare adv,,O,175.06,87.53,180.31,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,blue cross/blue shield medicare adv,,O,43.18,10.79,10.79,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",blue cross/blue shield medicare adv,,O,91.30,6.24,17.26,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,147.58,21.05,38.70,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,blue cross/blue shield medicare adv,,O,521.47,92.78,216.32,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77072,cpt,IMAGING FOR BONE AGE ASSESSMENT,blue cross/blue shield medicare adv,,O,240.10,52.12,61.44,213.76,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",blue cross/blue shield medicare adv,,O,285.11,61.44,61.44,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,253,ms-drg,OTHER VASCULAR PROCEDURES WITH CC,blue cross/blue shield medicare adv,,I,71874.05,17117.07,29961.17,31459.36,43124.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",blue cross/blue shield medicare adv,,O,60.03,13.90,17.72,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,183.82,20.21,53.87,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",blue cross/blue shield medicare adv,,O,4.99,0.54,0.59,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3480,cpt,"INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ",blue cross/blue shield medicare adv,,O,2.49,0.19,0.19,1.30,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5110,cpt,"INJECTION, FILGRASTIM-AAFI, BIOSIMILAR, (NIVESTYM), 1 MICROGRAM",blue cross/blue shield medicare adv,,O,2.63,0.29,0.82,0.82,1.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99215,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 40 MINUTES",blue cross/blue shield medicare adv,,O,569.98,60.00,104.56,427.48,341.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,blue cross/blue shield medicare adv,,O,31.88,2.63,6.43,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,202,ms-drg,BRONCHITIS AND ASTHMA WITH CC/MCC,blue cross/blue shield medicare adv,,I,17576.07,7140.60,10413.06,10944.39,10545.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",blue cross/blue shield medicare adv,,O,7.91,1.68,2.01,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",blue cross/blue shield medicare adv,,O,36.32,6.91,6.92,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,blue cross/blue shield medicare adv,,O,24173.14,2776.54,9761.85,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,151.64,21.05,38.33,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,336,ms-drg,PERITONEAL ADHESIOLYSIS WITH CC,blue cross/blue shield medicare adv,,I,67565.05,6006.27,19695.59,24239.00,40539.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,blue cross/blue shield medicare adv,,O,45.06,3.98,20.24,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,blue cross/blue shield medicare adv,,O,351.40,51.44,197.94,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",blue cross/blue shield medicare adv,,O,365.24,8.63,28.70,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",blue cross/blue shield medicare adv,,O,266.35,64.70,64.70,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",blue cross/blue shield medicare adv,,O,70.78,13.97,13.97,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,84.93,8.43,8.43,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,blue cross/blue shield medicare adv,,O,70.06,8.01,17.85,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1887,cpt,"CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)",blue cross/blue shield medicare adv,,O,357.97,72.03,81.41,218.49,214.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",blue cross/blue shield medicare adv,,I,16029.09,4785.97,6437.35,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",blue cross/blue shield medicare adv,,O,51.68,6.81,6.81,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0434,revCode,"OCCUPATIONAL THERAPY, EVALUATION OR REEVALUATION",blue cross/blue shield medicare adv,,O,316.37,96.96,124.90,124.90,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,473,ms-drg,CERVICAL SPINAL FUSION WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,73180.56,15169.99,27084.42,74397.72,43908.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",blue cross/blue shield medicare adv,,O,120.33,16.46,24.34,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,206.42,1017.53,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86707,cpt,HEPATITIS BE ANTIBODY MEASUREMENT,blue cross/blue shield medicare adv,,O,28.93,6.21,6.21,11.62,17.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",blue cross/blue shield medicare adv,,O,158.29,56.98,66.75,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,blue cross/blue shield medicare adv,,O,345.14,124.25,127.20,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,blue cross/blue shield medicare adv,,O,5902.67,923.22,924.98,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86256,cpt,MEASUREMENT OF ANTIBODY TO NONINFECTIOUS AGENT,blue cross/blue shield medicare adv,,O,71.96,12.05,12.62,12.62,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82542,cpt,CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE,blue cross/blue shield medicare adv,,O,97.91,11.61,11.61,37.36,58.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9311,cpt,"INJECTION, RITUXIMAB 10 MG AND HYALURONIDASE",blue cross/blue shield medicare adv,,O,175.06,36.40,40.40,5983.60,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",blue cross/blue shield medicare adv,,O,2069.24,93.35,381.78,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,410.17,61.80,61.80,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,552,ms-drg,MEDICAL BACK PROBLEMS WITHOUT MCC,blue cross/blue shield medicare adv,,I,21073.12,6620.86,7524.01,9898.71,12643.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82175,cpt,ARSENIC LEVEL,blue cross/blue shield medicare adv,,O,93.19,18.59,19.17,19.17,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,792,ms-drg,PREMATURITY WITHOUT MAJOR PROBLEMS,blue cross/blue shield medicare adv,,I,26570.93,4433.28,19606.71,19606.71,15942.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,blue cross/blue shield medicare adv,,O,647.78,94.48,128.29,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",blue cross/blue shield medicare adv,,O,357.64,32.78,32.78,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,blue cross/blue shield medicare adv,,O,60.16,11.87,27.45,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9047,cpt,"INFUSION, ALBUMIN (HUMAN), 25%, 50 ML",blue cross/blue shield medicare adv,,O,105.55,1.06,204.13,204.13,63.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5107,cpt,"INJECTION, BEVACIZUMAB-AWWB, BIOSIMILAR, (MVASI), 10 MG",blue cross/blue shield medicare adv,,O,251.18,28.11,69.39,474.05,150.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87902,cpt,ANALYSIS TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS,blue cross/blue shield medicare adv,,O,824.65,76.19,83.93,437.97,302.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,blue cross/blue shield medicare adv,,O,28.83,5.60,6.05,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72193,cpt,CT SCAN PELVIS WITH CONTRAST,blue cross/blue shield medicare adv,,O,1481.91,468.88,468.88,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",healthchoice,,O,52.60,8.84,11.50,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,blue cross/blue shield medicare adv,,O,4318.19,810.94,1807.92,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77075,cpt,X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY,blue cross/blue shield medicare adv,,O,735.32,61.44,61.44,97.23,441.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78014,cpt,NUCLEAR MEDICINE STUDY OF THYROID AND THYROID FUNCTION,blue cross/blue shield medicare adv,,O,1304.33,342.21,883.36,883.36,782.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",blue cross/blue shield medicare adv,,O,715.30,48.27,85.65,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,blue cross/blue shield medicare adv,,O,30.08,5.04,5.43,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9539,cpt,"TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES",blue cross/blue shield medicare adv,,O,225.10,85.93,85.93,231.85,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,blue cross/blue shield medicare adv,,O,513.11,156.86,263.33,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,blue cross/blue shield medicare adv,,O,401.42,94.39,229.19,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",blue cross/blue shield medicare adv,,O,8.17,0.89,2.87,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",blue cross/blue shield medicare adv,,O,369.82,61.44,61.44,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9022,cpt,"INJECTION, ATEZOLIZUMAB, 10 MG",blue cross/blue shield medicare adv,,O,156.30,38.92,38.92,82.27,93.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,148.64,17.37,18.81,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,blue cross/blue shield medicare adv,,O,265.10,8.75,88.63,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,blue cross/blue shield medicare adv,,O,50.01,5.20,5.49,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",blue cross/blue shield medicare adv,,O,41.28,4.92,10.98,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",blue cross/blue shield medicare adv,,O,85.03,16.92,16.92,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",blue cross/blue shield medicare adv,,O,90.84,9.28,19.10,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88720,cpt,MEASUREMENT OF BILIRUBIN,blue cross/blue shield medicare adv,,O,132.12,5.04,10.00,132.12,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74150,cpt,CT SCAN OF ABDOMEN WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1344.34,95.70,592.16,766.27,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96376,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION, IN A FACILITY",blue cross/blue shield medicare adv,,O,355.05,16.11,16.11,123.19,213.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,blue cross/blue shield medicare adv,,O,187.57,14.84,14.84,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",blue cross/blue shield medicare adv,,O,183.82,63.60,63.71,79.74,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,blue cross/blue shield medicare adv,,O,213.87,28.75,29.27,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89051,cpt,BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,blue cross/blue shield medicare adv,,O,42.58,5.49,30.20,30.20,6.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84295,cpt,BLOOD SODIUM LEVEL,blue cross/blue shield medicare adv,,O,37.50,9.29,9.29,12.33,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,blue cross/blue shield medicare adv,,O,203.82,49.80,130.50,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,blue cross/blue shield medicare adv,,O,287.62,21.62,201.80,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,blue cross/blue shield medicare adv,,O,60.16,9.91,10.42,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,blue cross/blue shield medicare adv,,O,184.32,70.33,111.57,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",blue cross/blue shield medicare adv,,O,65.11,10.15,10.54,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",blue cross/blue shield medicare adv,,O,2237.24,324.67,867.03,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84450,cpt,"LIVER ENZYME (SGOT), LEVEL",blue cross/blue shield medicare adv,,O,40.11,5.08,6.47,8.75,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,blue cross/blue shield medicare adv,,O,50.01,3.11,8.37,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,blue cross/blue shield medicare adv,,O,416.45,133.14,217.36,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0834,cpt,"INJECTION, COSYNTROPIN, 0.25 MG",blue cross/blue shield medicare adv,,O,138.82,20.13,21.73,113.47,83.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",blue cross/blue shield medicare adv,,O,41.28,3.01,8.45,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1030,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG",blue cross/blue shield medicare adv,,O,87.39,9.18,44.92,65.54,52.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),blue cross/blue shield medicare adv,,O,50.01,5.20,5.41,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82530,cpt,"CORTISOL (HORMONE) MEASUREMENT, FREE",blue cross/blue shield medicare adv,,O,184.03,14.59,24.76,24.76,110.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9190,cpt,"INJECTION, FLUOROURACIL, 500 MG",blue cross/blue shield medicare adv,,O,9.25,1.74,1.74,20.90,5.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",blue cross/blue shield medicare adv,,O,38.92,3.91,5.19,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,blue cross/blue shield medicare adv,,O,73.83,11.51,13.62,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",healthchoice,,O,7.49,1.49,24.00,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,2112.19,159.37,329.20,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,2707.46,156.22,421.49,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,blue cross/blue shield medicare adv,,O,647.78,92.64,216.32,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,blue cross/blue shield medicare adv,,O,770.33,202.50,359.62,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1753.28,96.00,400.81,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82731,cpt,FETAL FIBRONECTIN (PROTEIN) ANALYSIS,blue cross/blue shield medicare adv,,O,565.34,62.32,62.32,424.01,108.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,blue cross/blue shield medicare adv,,O,8198.69,1161.40,1571.47,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,520,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,40151.49,11585.32,15324.52,31059.69,24090.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",blue cross/blue shield medicare adv,,O,218.83,30.93,76.59,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88333,cpt,"PATHOLOGY CYTOLOGIC EXAMINATION OF SPECIMEN DURING SURGERY, INITIAL SITE",blue cross/blue shield medicare adv,,O,166.34,24.04,24.04,56.55,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,140.04,24.64,50.40,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,135.66,26.63,26.63,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",blue cross/blue shield medicare adv,,O,494.32,41.98,69.27,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84145,cpt,PROCALCITONIN (HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,97.91,26.68,32.12,32.12,32.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,73.83,12.70,12.70,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,blue cross/blue shield medicare adv,,O,188.17,19.53,19.53,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1956,cpt,"INJECTION, LEVOFLOXACIN, 250 MG",blue cross/blue shield medicare adv,,O,66.43,22.13,66.43,66.43,39.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1776,cpt,JOINT DEVICE (IMPLANTABLE),blue cross/blue shield medicare adv,,O,3788.11,198.44,198.44,18412.83,2272.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",blue cross/blue shield medicare adv,,O,199.37,74.90,74.90,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",blue cross/blue shield medicare adv,,O,1858.47,98.50,400.81,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,blue cross/blue shield medicare adv,,O,1205.09,132.64,350.11,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",blue cross/blue shield medicare adv,,O,103.81,18.28,19.74,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",blue cross/blue shield medicare adv,,O,192.85,42.50,42.50,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",blue cross/blue shield medicare adv,,O,377.65,43.63,60.83,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,blue cross/blue shield medicare adv,,I,20034.03,4988.82,8174.02,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,blue cross/blue shield medicare adv,,O,22.60,4.56,5.56,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",blue cross/blue shield medicare adv,,O,2.49,0.02,1.59,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,blue cross/blue shield medicare adv,,O,10678.57,58.46,58.46,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1781,cpt,MESH (IMPLANTABLE),blue cross/blue shield medicare adv,,O,2029.44,404.71,814.49,814.49,1217.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",blue cross/blue shield medicare adv,,O,98.78,7.87,98.78,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1040,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG",blue cross/blue shield medicare adv,,O,105.67,41.27,56.18,103.80,63.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,blue cross/blue shield medicare adv,,O,36.32,5.40,20.60,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3260,cpt,AMBULATORY SURGICAL BOOT EAC,blue cross/blue shield medicare adv,,O,340.14,93.68,93.68,134.53,204.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36416,cpt,PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,blue cross/blue shield medicare adv,,O,11.79,2.31,2.68,11.79,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80299,cpt,QUANTITATION OF THERAPEUTIC DRUG,blue cross/blue shield medicare adv,,O,46.60,5.86,5.86,18.72,27.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",blue cross/blue shield medicare adv,,O,36.32,3.59,6.80,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,107.35,17.69,17.69,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",blue cross/blue shield medicare adv,,O,4116.84,594.86,594.86,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73720,cpt,MRI SCAN OF LEG BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,325.59,947.43,1041.43,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",blue cross/blue shield medicare adv,,O,83.33,15.97,28.81,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,blue cross/blue shield medicare adv,,O,316.37,49.55,78.16,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",blue cross/blue shield medicare adv,,O,331.50,12.98,37.17,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",blue cross/blue shield medicare adv,,O,41.28,5.10,5.10,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4648,cpt,IMPLANTABLE TISSUE MARKER; MEDICAL AND SURGICAL SUPPLIES - OTHER SUPPLIES,blue cross/blue shield medicare adv,,O,4877.20,783.88,2061.90,2061.90,2926.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",blue cross/blue shield medicare adv,,O,45.06,8.66,8.96,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,blue cross/blue shield medicare adv,,O,2152.21,335.59,700.72,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,570,ms-drg,SKIN DEBRIDEMENT WITH MCC,blue cross/blue shield medicare adv,,I,75025.56,18584.20,22387.93,22387.93,45015.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,482,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,55990.08,11135.77,14401.86,19728.27,33594.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,blue cross/blue shield medicare adv,,O,252.59,75.92,216.32,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,blue cross/blue shield medicare adv,,O,76.04,10.15,27.07,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,832,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,blue cross/blue shield medicare adv,,I,13166.47,3172.81,6050.86,9094.35,7899.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",blue cross/blue shield medicare adv,,O,350.39,39.08,39.08,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1745,cpt,"INJECTION, INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG",blue cross/blue shield medicare adv,,O,282.56,34.04,59.20,75.44,169.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74174,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST,blue cross/blue shield medicare adv,,O,1840.81,323.17,417.54,1326.08,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1753.28,94.47,482.16,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87076,cpt,BACTERIAL CULTURE FOR ANAEROBIC ISOLATES,blue cross/blue shield medicare adv,,O,96.38,8.00,10.86,72.29,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",blue cross/blue shield medicare adv,,O,513.19,16.80,38.66,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92551,cpt,AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING,blue cross/blue shield medicare adv,,O,217.58,10.34,217.58,217.58,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82671,cpt,"ESTROGEN ANALYSIS, FRACTIONATED",blue cross/blue shield medicare adv,,O,436.51,31.65,65.74,65.74,261.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94640,cpt,RESPIRATORY INHALED PRESSURE OR NONPRESSURE TREATMENT TO RELIEVE AIRWAY OBSTRUCTION OR FOR SPUTUM SPECIMEN,blue cross/blue shield medicare adv,,O,223.34,51.35,51.35,99.96,134.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",blue cross/blue shield medicare adv,,O,101.45,11.20,16.69,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),blue cross/blue shield medicare adv,,O,132.12,15.79,15.79,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,blue cross/blue shield medicare adv,,O,187.57,13.08,15.46,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",blue cross/blue shield medicare adv,,O,12.72,0.71,0.71,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88312,cpt,SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,blue cross/blue shield medicare adv,,O,63.70,17.04,17.04,63.70,38.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72190,cpt,"X-RAY OF PELVIS, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,411.42,69.58,69.58,213.76,246.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84484,cpt,"TROPONIN (PROTEIN) ANALYSIS, QUANTITATIVE",blue cross/blue shield medicare adv,,O,176.37,12.22,55.45,186.95,14.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,195,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,12306.54,4159.34,8390.31,8390.31,7383.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,blue cross/blue shield medicare adv,,O,100.03,11.53,14.04,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86664,cpt,"ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), NUCLEAR ANTIGEN",blue cross/blue shield medicare adv,,O,266.62,15.35,20.87,24.87,159.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",blue cross/blue shield medicare adv,,O,50.02,5.00,5.00,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,blue cross/blue shield medicare adv,,O,303.87,29.81,69.92,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71100,cpt,"X-RAY OF RIBS OF ONE SIDE OF BODY, 2 VIEWS",blue cross/blue shield medicare adv,,O,426.43,49.08,49.08,319.82,255.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,blue cross/blue shield medicare adv,,O,3055.12,204.02,458.10,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",blue cross/blue shield medicare adv,,O,135.66,14.84,14.84,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,blue cross/blue shield medicare adv,,O,547.73,91.89,91.89,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,blue cross/blue shield medicare adv,,O,109.71,43.44,57.27,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86648,cpt,ANALYSIS FOR ANTIBODY TO DIPHTHERIA (BACTERIA),blue cross/blue shield medicare adv,,O,92.01,5.21,10.85,15.27,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,202.81,517.17,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,145.10,29.21,29.21,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),blue cross/blue shield medicare adv,,O,50.01,5.20,5.29,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",blue cross/blue shield medicare adv,,O,125.04,27.28,27.28,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9503,cpt,"TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES",blue cross/blue shield medicare adv,,O,225.10,13.65,34.48,168.82,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,blue cross/blue shield medicare adv,,O,30.08,3.63,7.21,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,183.82,24.23,70.81,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",blue cross/blue shield medicare adv,,O,298.47,56.42,56.42,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",blue cross/blue shield medicare adv,,O,502.71,78.63,84.80,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82375,cpt,CARBOXYHEMOGLOBIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,116.29,15.40,18.75,119.78,14.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,blue cross/blue shield medicare adv,,O,83.78,3.34,28.61,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88108,cpt,"CELL EXAMINATION OF SPECIMEN, CONCENTRATION TECHNIQUE",blue cross/blue shield medicare adv,,O,209.99,47.15,47.15,157.49,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,475,ms-drg,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,blue cross/blue shield medicare adv,,I,50430.81,14456.44,18120.59,18120.59,30258.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83498,cpt,"HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVEL",blue cross/blue shield medicare adv,,O,126.23,22.15,24.99,94.68,75.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",blue cross/blue shield medicare adv,,O,411.42,47.57,61.44,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73120,cpt,"X-RAY OF HAND, 2 VIEWS",blue cross/blue shield medicare adv,,O,240.10,38.01,72.72,96.93,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,blue cross/blue shield medicare adv,,I,18614.53,3748.00,9555.66,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),blue cross/blue shield medicare adv,,O,91.30,14.31,14.31,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,blue cross/blue shield medicare adv,,O,3580.43,810.94,1461.31,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",blue cross/blue shield medicare adv,,O,441.23,35.97,35.97,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,380,ms-drg,COMPLICATED PEPTIC ULCER WITH MCC,blue cross/blue shield medicare adv,,I,54507.15,12744.17,15865.59,15865.59,32704.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,blue cross/blue shield medicare adv,,O,50.00,8.06,8.06,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,blue cross/blue shield medicare adv,,O,3238.42,206.67,811.86,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),blue cross/blue shield medicare adv,,O,126.23,10.13,13.73,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",blue cross/blue shield medicare adv,,O,16.51,4.75,6.14,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85301,cpt,ANTITHROMBIN III ANTIGEN (CLOTTING INHIBITOR) LEVEL,blue cross/blue shield medicare adv,,O,56.62,10.81,56.62,56.62,33.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85306,cpt,PROTEIN S (CLOTTING INHIBITOR) MEASUREMENT,blue cross/blue shield medicare adv,,O,187.57,15.02,187.57,187.57,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",blue cross/blue shield medicare adv,,O,35.39,4.06,4.06,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9541,cpt,"TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES",blue cross/blue shield medicare adv,,O,245.09,123.76,123.76,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",blue cross/blue shield medicare adv,,O,290.00,66.00,66.00,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95806,cpt,"UNATTENDED SLEEP STUDY WITH RECORDING OF HEART RATE, OXYGEN, RESPIRATORY AIRFLOW AND EFFORT",blue cross/blue shield medicare adv,,O,1695.75,59.68,59.68,1348.12,1017.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94729,cpt,TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,blue cross/blue shield medicare adv,,O,231.34,43.74,43.74,238.28,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",blue cross/blue shield medicare adv,,O,734.07,19.80,123.81,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",blue cross/blue shield medicare adv,,O,112.07,9.78,21.75,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,blue cross/blue shield medicare adv,,O,1952.12,159.41,462.23,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,blue cross/blue shield medicare adv,,O,55.44,9.79,16.27,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",blue cross/blue shield medicare adv,,O,2042.16,944.83,949.39,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80050,cpt,GENERAL HEALTH PANEL,blue cross/blue shield medicare adv,,O,300.45,40.45,41.04,300.45,57.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71110,cpt,"X-RAY OF RIBS ON BOTH SIDES OF BODY, 3 VIEWS",blue cross/blue shield medicare adv,,O,536.84,63.39,63.39,72.72,322.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,176.32,30.07,54.36,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,439,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,blue cross/blue shield medicare adv,,I,19744.66,5026.91,7541.73,10330.99,11846.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84270,cpt,SEX HORMONE BINDING GLOBULIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,54.33,7.67,7.67,21.82,32.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,blue cross/blue shield medicare adv,,O,323.88,75.26,225.57,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2628,cpt,"CATHETER, OCCLUSION",blue cross/blue shield medicare adv,,O,405.17,139.86,139.86,303.88,243.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,blue cross/blue shield medicare adv,,O,105.03,8.42,8.42,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,795,ms-drg,NORMAL NEWBORN,blue cross/blue shield medicare adv,,I,4390.63,2140.83,2149.88,4272.65,2634.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1439,cpt,"INJECTION, FERRIC CARBOXYMALTOSE, 1 MG",blue cross/blue shield medicare adv,,O,4.71,0.79,1.37,4.99,2.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5101,cpt,"INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MICROGRAM",blue cross/blue shield medicare adv,,O,1.96,0.20,0.53,0.53,1.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,69.59,7.80,7.80,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74170,cpt,CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,2708.71,159.22,550.73,612.94,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",blue cross/blue shield medicare adv,,O,88.56,20.43,24.06,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",blue cross/blue shield medicare adv,,O,2526.13,486.47,668.90,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1343.10,94.48,482.16,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,956,ms-drg,"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",blue cross/blue shield medicare adv,,I,84475.09,46172.11,46172.11,46172.11,50685.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87799,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, QUANTIFICATION",blue cross/blue shield medicare adv,,O,264.26,35.66,35.66,174.31,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80184,cpt,PHENOBARBITAL LEVEL,blue cross/blue shield medicare adv,,O,101.33,12.53,12.53,24.37,60.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,blue cross/blue shield medicare adv,,O,754.07,203.12,216.32,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73000,cpt,X-RAY OF COLLAR BONE,blue cross/blue shield medicare adv,,O,267.61,51.43,51.43,152.54,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",blue cross/blue shield medicare adv,,O,437.43,101.00,150.65,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",blue cross/blue shield medicare adv,,O,267.61,58.94,58.94,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",blue cross/blue shield medicare adv,,O,647.78,98.50,144.42,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",blue cross/blue shield medicare adv,,O,91.30,18.02,20.59,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",blue cross/blue shield medicare adv,,O,1893.35,485.97,757.50,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,768,ms-drg,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,blue cross/blue shield medicare adv,,I,15836.34,3774.13,9412.53,17446.29,9501.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,blue cross/blue shield medicare adv,,O,53.76,5.92,7.81,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",blue cross/blue shield medicare adv,,O,19.52,4.40,5.81,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,blue cross/blue shield medicare adv,,O,792.84,92.74,216.32,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,blue cross/blue shield medicare adv,,O,71.96,15.59,16.79,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,329,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,blue cross/blue shield medicare adv,,I,114604.99,18176.89,42391.95,42391.95,68762.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",blue cross/blue shield medicare adv,,O,44.82,3.29,3.29,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,blue cross/blue shield medicare adv,,O,2112.19,159.41,491.59,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1783,cpt,"OCULAR IMPLANT, AQUEOUS DRAINAGE ASSIST DEVICE",blue cross/blue shield medicare adv,,O,8619.28,1940.49,1940.49,1940.49,5171.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,147.58,21.05,38.70,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,blue cross/blue shield medicare adv,,O,16.28,2.44,4.20,4798.21,9.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,blue cross/blue shield medicare adv,,O,41.26,8.55,12.51,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,blue cross/blue shield medicare adv,,I,17945.73,6102.59,9944.63,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",blue cross/blue shield medicare adv,,O,252.47,43.75,88.24,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7030,cpt,"INFUSION, NORMAL SALINE SOLUTION , 1000 CC",blue cross/blue shield medicare adv,,O,9.26,2.95,6.26,58.60,5.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,460,ms-drg,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,blue cross/blue shield medicare adv,,I,119532.08,24196.90,43419.14,77295.91,71719.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",blue cross/blue shield medicare adv,,O,338.89,30.54,76.59,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,blue cross/blue shield medicare adv,,O,123.87,33.18,39.35,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9516,cpt,"IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 MICROCURIES, UP TO 999 MICROCURIES",blue cross/blue shield medicare adv,,O,153.80,97.81,104.16,104.16,92.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",blue cross/blue shield medicare adv,,O,135.66,25.29,27.91,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,blue cross/blue shield medicare adv,,O,298.87,98.24,238.16,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,blue cross/blue shield medicare adv,,O,96.77,32.33,65.81,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,blue cross/blue shield medicare adv,,O,83.76,6.73,9.06,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,blue cross/blue shield medicare adv,,O,402.67,93.28,216.32,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",blue cross/blue shield medicare adv,,O,38.92,2.65,7.04,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",blue cross/blue shield medicare adv,,O,5902.67,335.59,995.57,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",blue cross/blue shield medicare adv,,O,65.06,17.18,17.18,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1479.41,92.59,482.16,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73220,cpt,MRI SCAN OF ARM BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,320.47,997.20,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",blue cross/blue shield medicare adv,,O,240.10,27.64,27.64,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0791,cpt,"INJECTION, CRIZANLIZUMAB-TMCA, 5 MG",blue cross/blue shield medicare adv,,O,441.53,125.13,441.53,441.53,264.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,2687.44,201.24,592.16,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,blue cross/blue shield medicare adv,,O,36.32,4.67,14.63,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87425,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ROTAVIRUS,blue cross/blue shield medicare adv,,O,84.93,10.39,12.87,51.31,50.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",blue cross/blue shield medicare adv,,O,101.45,25.33,25.33,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,blue cross/blue shield medicare adv,,I,74793.54,13792.29,18887.55,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78195,cpt,NUCLEAR MEDICINE STUDY OF LYMPHATIC SYSTEM,blue cross/blue shield medicare adv,,O,2847.53,457.66,1203.84,2847.53,1708.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,blue cross/blue shield medicare adv,,O,42.58,6.02,7.45,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q4130,cpt,"STRATTICE TM, PER SQUARE CENTIMETER",blue cross/blue shield medicare adv,,O,188.22,28.83,110.81,110.81,112.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71101,cpt,"X-RAY OF RIBS ON ONE SIDE OF BODY INCLUDING THE CHEST, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,377.65,61.44,61.44,228.17,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,blue cross/blue shield medicare adv,,O,412.67,92.59,144.18,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86692,cpt,ANALYSIS FOR ANTIBODY TO HEPATITIS D VIRUS,blue cross/blue shield medicare adv,,O,42.90,8.26,8.26,8.26,25.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,197,ms-drg,INTERSTITIAL LUNG DISEASE WITH CC,blue cross/blue shield medicare adv,,I,12136.23,7534.12,9015.40,10498.11,7281.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",blue cross/blue shield medicare adv,,O,281.36,90.50,90.50,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17262,cpt,"DESTRUCTION OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",blue cross/blue shield medicare adv,,O,507.74,161.17,476.84,493.37,304.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,204.02,458.10,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),blue cross/blue shield medicare adv,,O,65.11,4.25,4.25,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,blue cross/blue shield medicare adv,,O,176.37,11.81,23.10,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88300,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, LIMITED EXAMINATION",blue cross/blue shield medicare adv,,O,93.19,26.27,34.53,93.19,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,blue cross/blue shield medicare adv,,O,101.45,12.63,31.63,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,2599.91,94.47,228.66,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9305,cpt,"INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG",blue cross/blue shield medicare adv,,O,280.11,3.19,59.09,76.83,168.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6222,cpt,"GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING",blue cross/blue shield medicare adv,,O,1.25,0.67,0.84,0.99,0.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",blue cross/blue shield medicare adv,,O,315.99,85.00,85.00,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,V2632,cpt,"POST CHMBR INTRAOCULAR LENS; PROSTHETICS, ORTHOTICS, AND SUPPLIES",blue cross/blue shield medicare adv,,O,845.37,203.20,203.20,268.09,507.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88341,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, EACH ADDITIONAL PROCEDURE",blue cross/blue shield medicare adv,,O,128.79,24.89,48.30,132.54,77.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,948,ms-drg,SIGNS AND SYMPTOMS WITHOUT MCC,blue cross/blue shield medicare adv,,I,31307.98,7762.31,7762.31,8408.85,18784.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",blue cross/blue shield medicare adv,,O,127.54,21.16,112.74,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,blue cross/blue shield medicare adv,,O,60.03,7.19,7.27,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,blue cross/blue shield medicare adv,,O,31.24,2.94,5.19,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",blue cross/blue shield medicare adv,,O,85.39,17.80,17.80,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,196,ms-drg,INTERSTITIAL LUNG DISEASE WITH MCC,blue cross/blue shield medicare adv,,I,28765.16,13773.74,13773.74,13773.74,17259.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",blue cross/blue shield medicare adv,,O,238.30,71.54,71.54,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0821,revCode,HEMODIALYSIS - OUTPATIENT OR HOME COMPOSITE OR OTHER RATE,blue cross/blue shield medicare adv,,O,1970.87,462.39,462.39,462.39,1182.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),blue cross/blue shield medicare adv,,O,60.03,6.83,6.83,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross/blue shield medicare adv,,O,318.12,56.64,56.78,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",blue cross/blue shield medicare adv,,O,105.03,12.96,12.96,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",blue cross/blue shield medicare adv,,O,96.29,11.40,19.23,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9956,cpt,"INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML",blue cross/blue shield medicare adv,,O,2.49,1.87,2.49,2.49,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9959,cpt,"HIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML",blue cross/blue shield medicare adv,,O,2.49,0.64,0.64,1.87,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,243,ms-drg,PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC,blue cross/blue shield medicare adv,,I,93249.08,26210.61,26210.61,26210.61,55949.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,blue cross/blue shield medicare adv,,O,1893.35,157.27,639.66,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9301,cpt,"INJECTION, OBINUTUZUMAB, 10 MG",blue cross/blue shield medicare adv,,O,257.60,46.78,46.78,193.20,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2617,cpt,"STENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY SYSTEM",blue cross/blue shield medicare adv,,O,922.91,235.25,305.79,305.79,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3301,cpt,"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG",blue cross/blue shield medicare adv,,O,21.30,1.21,5.50,9.59,12.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,561,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",blue cross/blue shield medicare adv,,I,28538.09,6566.77,6566.77,13087.98,17122.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,blue cross/blue shield medicare adv,,O,183.82,20.77,56.44,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3105,cpt,"INJECTION, TERBUTALINE SULFATE, UP TO 1 MG",blue cross/blue shield medicare adv,,O,78.97,6.05,6.05,58.40,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,107.59,3.13,29.52,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,92.99,21.05,21.84,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,348.89,61.44,61.44,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",blue cross/blue shield medicare adv,,O,16.70,0.37,0.37,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,blue cross/blue shield medicare adv,,O,221.79,37.03,37.03,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,blue cross/blue shield medicare adv,,O,3683.73,275.00,1007.47,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,blue cross/blue shield medicare adv,,O,65.11,6.57,12.94,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",blue cross/blue shield medicare adv,,O,223.91,73.72,73.72,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,blue cross/blue shield medicare adv,,O,80.09,1.66,8.77,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,blue cross/blue shield medicare adv,,O,69.59,9.12,11.54,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,331,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,49456.93,5489.60,16836.76,19473.00,29674.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",blue cross/blue shield medicare adv,,O,82.88,8.42,24.35,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9000,cpt,"INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG",blue cross/blue shield medicare adv,,O,25.20,1.82,1.82,14.05,15.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87517,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS B VIRUS, QUANTIFICATION",blue cross/blue shield medicare adv,,O,205.27,42.71,48.89,57.99,123.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0409,revCode,OTHER IMAGING SERVICES OTHER,blue cross/blue shield medicare adv,,O,1393.12,304.37,359.99,359.99,835.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",blue cross/blue shield medicare adv,,O,4.27,1.25,1.25,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,blue cross/blue shield medicare adv,,O,45.13,4.38,45.13,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73600,cpt,"X-RAY OF ANKLE, 2 VIEWS",blue cross/blue shield medicare adv,,O,267.61,61.44,64.48,173.76,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",blue cross/blue shield medicare adv,,O,200.00,27.06,49.70,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3008.85,207.30,1036.67,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,blue cross/blue shield medicare adv,,O,30.49,2.32,4.92,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,811,ms-drg,RED BLOOD CELL DISORDERS WITH MCC,blue cross/blue shield medicare adv,,I,26952.43,9206.49,11540.81,16010.05,16171.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86769,cpt,MEASURE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIBODY,blue cross/blue shield medicare adv,,O,94.60,13.14,13.14,70.95,49.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87798,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,228.87,16.13,16.13,35.23,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,882,ms-drg,NEUROSES EXCEPT DEPRESSIVE,blue cross/blue shield medicare adv,,I,14589.21,3863.55,7883.32,11557.84,8753.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",blue cross/blue shield medicare adv,,O,230.63,78.33,159.67,159.67,138.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",blue cross/blue shield medicare adv,,O,647.78,98.50,177.32,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,206,ms-drg,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,blue cross/blue shield medicare adv,,I,26545.25,6727.00,10067.42,10067.42,15927.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",blue cross/blue shield medicare adv,,O,266.35,64.70,64.70,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,793,ms-drg,FULL TERM NEONATE WITH MAJOR PROBLEMS,blue cross/blue shield medicare adv,,I,3725.22,3725.22,3725.22,3725.22,2235.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",blue cross/blue shield medicare adv,,O,266.35,51.50,51.50,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",blue cross/blue shield medicare adv,,O,70.06,8.29,17.91,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81025,cpt,URINE PREGNANCY TEST,blue cross/blue shield medicare adv,,O,28.39,1.36,9.77,9.77,17.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,blue cross/blue shield medicare adv,,O,195.07,21.19,167.23,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,blue cross/blue shield medicare adv,,I,17457.81,5769.18,8051.65,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),blue cross/blue shield medicare adv,,O,41.28,5.08,14.71,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,blue cross/blue shield medicare adv,,O,811.59,92.97,359.62,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0702,cpt,"INJECTION, BETAMETHASONE ACETATE 3 MG AND BETAMETHASONE SODIUM PHOSPHATE 3 MG",blue cross/blue shield medicare adv,,O,31.72,5.99,5.99,12.02,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",blue cross/blue shield medicare adv,,O,632.77,59.44,59.44,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,blue cross/blue shield medicare adv,,O,112.55,9.00,28.94,1270.41,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74420,cpt,IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST AGENT,blue cross/blue shield medicare adv,,O,1067.98,275.21,1067.98,1067.98,243.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,blue cross/blue shield medicare adv,,O,188.17,66.99,199.46,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73060,cpt,"X-RAY OF UPPER ARM, MINIMUM OF 2 VIEWS",blue cross/blue shield medicare adv,,O,245.09,22.66,22.66,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82384,cpt,CATECHOLAMINES (ORGANIC NITROGEN) LEVEL,blue cross/blue shield medicare adv,,O,195.83,25.25,27.57,146.87,117.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",blue cross/blue shield medicare adv,,O,7.49,1.49,1.49,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,246.35,17.59,73.20,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",blue cross/blue shield medicare adv,,O,65.11,8.45,11.58,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,blue cross/blue shield medicare adv,,O,3595.37,280.86,528.01,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83605,cpt,LACTIC ACID LEVEL,blue cross/blue shield medicare adv,,O,71.96,5.48,18.86,53.97,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",blue cross/blue shield medicare adv,,O,184.32,70.33,111.57,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",blue cross/blue shield medicare adv,,O,50.72,5.89,8.28,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",blue cross/blue shield medicare adv,,O,345.14,36.70,51.82,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,788,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,14986.74,7771.24,7771.24,10724.94,8992.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9537,cpt,"TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES",blue cross/blue shield medicare adv,,O,245.09,59.33,157.09,157.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,blue cross/blue shield medicare adv,,O,9.11,0.50,3.81,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",blue cross/blue shield medicare adv,,O,4.12,1.10,1.68,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,blue cross/blue shield medicare adv,,O,119.15,21.42,24.19,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,blue cross/blue shield medicare adv,,O,1620.71,439.39,1038.76,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86148,cpt,PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUREMENT,blue cross/blue shield medicare adv,,O,87.30,12.69,46.36,46.36,52.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",blue cross/blue shield medicare adv,,O,209.99,16.56,32.43,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,blue cross/blue shield medicare adv,,O,113.25,11.78,13.29,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,blue cross/blue shield medicare adv,,O,94.38,2.18,11.92,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1940,cpt,"INJECTION, FUROSEMIDE, UP TO 20 MG",blue cross/blue shield medicare adv,,O,39.41,0.66,16.00,16.00,23.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",blue cross/blue shield medicare adv,,O,547.73,117.10,117.10,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,blue cross/blue shield medicare adv,,O,348.63,85.16,105.97,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,blue cross/blue shield medicare adv,,O,383.02,34.82,50.61,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",blue cross/blue shield medicare adv,,O,1007.94,158.30,158.30,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,blue cross/blue shield medicare adv,,I,22023.98,6812.39,12734.07,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",blue cross/blue shield medicare adv,,O,267.61,48.10,48.10,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9206,cpt,"INJECTION, IRINOTECAN, 20 MG",blue cross/blue shield medicare adv,,O,16.23,4.11,6.57,36.90,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,101.45,3.58,20.03,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93931,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE ARM OR LIMITED,blue cross/blue shield medicare adv,,O,646.53,92.68,216.32,216.32,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,394,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,blue cross/blue shield medicare adv,,I,20150.20,5703.31,10874.89,10874.89,12090.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,101.45,15.87,19.21,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",blue cross/blue shield medicare adv,,O,148.64,16.43,22.72,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",blue cross/blue shield medicare adv,,O,348.89,56.80,56.80,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9060,cpt,"INJECTION, CISPLATIN, POWDER OR SOLUTION, 10 MG",blue cross/blue shield medicare adv,,O,20.12,5.00,8.45,57.69,12.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,116.31,18.99,25.98,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1343.10,94.47,526.43,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,4852.19,224.32,548.19,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",blue cross/blue shield medicare adv,,O,48.36,3.92,7.95,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",blue cross/blue shield medicare adv,,O,117.54,25.46,25.46,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),blue cross/blue shield medicare adv,,O,8588.52,489.94,1469.61,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",blue cross/blue shield medicare adv,,O,52.60,8.84,9.29,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",blue cross/blue shield medicare adv,,O,101.45,14.76,25.68,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0276,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES INTRACULAR LENS,blue cross/blue shield medicare adv,,O,845.37,203.20,203.20,276.42,507.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,783,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH MCC,blue cross/blue shield medicare adv,,I,28796.81,7775.49,17845.12,17845.12,17278.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,193,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,blue cross/blue shield medicare adv,,I,28507.68,8334.78,17274.09,17274.09,17104.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,205.61,811.86,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",blue cross/blue shield medicare adv,,O,1.42,0.39,0.39,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",blue cross/blue shield medicare adv,,O,126.23,16.29,16.29,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,blue cross/blue shield medicare adv,,I,16808.50,4145.69,11946.40,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,blue cross/blue shield medicare adv,,O,190.07,28.97,30.64,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",blue cross/blue shield medicare adv,,O,226.34,61.44,61.44,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,183.82,20.70,56.67,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81241,cpt,GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIANT,blue cross/blue shield medicare adv,,O,331.51,68.48,331.51,331.51,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",blue cross/blue shield medicare adv,,O,63.63,6.74,10.27,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,blue cross/blue shield medicare adv,,O,1159.26,202.49,359.62,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,812,ms-drg,RED BLOOD CELL DISORDERS WITHOUT MCC,blue cross/blue shield medicare adv,,I,17513.39,3290.25,10433.81,22466.97,10508.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,blue cross/blue shield medicare adv,,O,1880.84,106.44,265.25,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2270,cpt,"INJECTION, MORPHINE SULFATE, UP TO 10 MG",blue cross/blue shield medicare adv,,O,84.59,0.76,19.85,82.91,50.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",blue cross/blue shield medicare adv,,O,212.36,14.48,63.05,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",blue cross/blue shield medicare adv,,O,45.06,8.39,9.24,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,blue cross/blue shield medicare adv,,O,67.58,5.08,12.32,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,blue cross/blue shield medicare adv,,O,50.72,6.35,7.17,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77049,cpt,MRI OF BOTH BREASTS WITH AND WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3191.43,928.19,928.19,928.19,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,blue cross/blue shield medicare adv,,O,78.05,7.37,29.75,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,blue cross/blue shield medicare adv,,O,175.06,87.53,121.07,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0360,cpt,"INJECTION, HYDRALAZINE HCL, UP TO 20 MG",blue cross/blue shield medicare adv,,O,85.01,26.37,29.83,85.01,51.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,312,ms-drg,SYNCOPE AND COLLAPSE,blue cross/blue shield medicare adv,,I,19356.82,5264.37,7437.32,7437.32,11614.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",blue cross/blue shield medicare adv,,O,116.79,7.81,15.72,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84140,cpt,PREGNENOLONE (REPRODUCTIVE HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,51.68,19.77,19.77,19.77,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",blue cross/blue shield medicare adv,,O,240.10,61.44,61.44,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",blue cross/blue shield medicare adv,,O,47.53,3.60,9.45,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",blue cross/blue shield medicare adv,,O,190.94,53.23,53.23,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",blue cross/blue shield medicare adv,,O,40.11,3.87,7.54,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,96.29,17.55,20.63,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",blue cross/blue shield medicare adv,,O,226.34,61.44,61.44,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",blue cross/blue shield medicare adv,,O,252.47,44.06,107.20,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",blue cross/blue shield medicare adv,,O,327.67,47.93,47.93,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84075,cpt,"PHOSPHATASE (ENZYME) LEVEL, ALKALINE",blue cross/blue shield medicare adv,,O,40.11,5.08,5.63,5.63,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,blue cross/blue shield medicare adv,,I,32181.45,11429.58,19783.18,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",blue cross/blue shield medicare adv,,O,691.54,93.84,236.18,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,862,ms-drg,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,blue cross/blue shield medicare adv,,I,41021.29,8957.01,15812.54,15812.54,24612.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",blue cross/blue shield medicare adv,,O,245.09,61.44,61.44,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,blue cross/blue shield medicare adv,,O,93.19,5.27,10.19,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",blue cross/blue shield medicare adv,,O,4.22,1.00,1.11,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82157,cpt,ANDROSTENEDIONE (HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,168.69,23.80,23.80,29.40,101.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,blue cross/blue shield medicare adv,,O,71.96,7.48,7.48,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",blue cross/blue shield medicare adv,,O,801.60,189.21,209.96,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72157,cpt,MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,4054.33,330.07,427.38,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9965,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 100-199 MG/ML IODINE CONCENTRATION, PER ML",blue cross/blue shield medicare adv,,O,7.98,1.70,1.93,6.34,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66991,cpt,EXTRACAPSULAR REMOVAL OF CATARACT WITH INSERTION OF ARTIFICIAL LENS AND INSERTION OF DRAINAGE DEVICE IN FRONT CHAMBER OF EYE,blue cross/blue shield medicare adv,,O,9278.04,2229.79,2229.79,3757.14,5566.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",blue cross/blue shield medicare adv,,O,16.23,1.83,3.53,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82040,cpt,ALBUMIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,37.50,4.85,9.11,33.12,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",blue cross/blue shield medicare adv,,O,422.68,79.92,79.93,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,blue cross/blue shield medicare adv,,O,560.24,92.59,216.32,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",blue cross/blue shield medicare adv,,O,85.94,24.92,31.99,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76080,cpt,IMAGING FOR ABSCESS OR ABNORMAL DRAINAGE TRACT PROCEDURE,blue cross/blue shield medicare adv,,O,1318.08,176.36,176.36,661.02,790.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,817,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,blue cross/blue shield medicare adv,,I,40670.94,21843.51,21843.51,21843.51,24402.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",blue cross/blue shield medicare adv,,O,734.07,114.82,115.03,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,blue cross/blue shield medicare adv,,O,42.58,4.32,7.85,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,blue cross/blue shield medicare adv,,O,51.39,9.33,10.22,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82310,cpt,"CALCIUM LEVEL, TOTAL",blue cross/blue shield medicare adv,,O,38.80,5.06,8.86,11.12,23.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70360,cpt,X-RAY OF SOFT TISSUE OF NECK,blue cross/blue shield medicare adv,,O,240.10,61.44,61.44,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,blue cross/blue shield medicare adv,,O,52.60,6.75,9.14,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84432,cpt,THYROGLOBULIN (THYROID RELATED HORMONE) LEVEL,blue cross/blue shield medicare adv,,O,93.19,15.90,24.00,24.00,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",blue cross/blue shield medicare adv,,O,13.80,2.61,2.65,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,787,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,blue cross/blue shield medicare adv,,I,18030.21,6935.18,11666.15,13885.01,10818.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,blue cross/blue shield medicare adv,,O,93.19,11.22,11.22,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",blue cross/blue shield medicare adv,,O,267.61,46.08,46.08,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77047,cpt,MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1605.13,202.29,1017.53,1203.85,963.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",blue cross/blue shield medicare adv,,O,217.58,10.34,217.58,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,blue cross/blue shield medicare adv,,O,102.63,10.90,10.90,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",blue cross/blue shield medicare adv,,O,70.01,13.01,13.01,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83704,cpt,"LIPOPROTEIN LEVEL, QUANTITATION OF LIPOPROTEIN PARTICLE NUMBER(S)",blue cross/blue shield medicare adv,,O,85.48,85.48,85.48,85.48,51.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2210,cpt,"INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG",blue cross/blue shield medicare adv,,O,126.15,25.92,38.74,38.74,75.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,blue cross/blue shield medicare adv,,O,95.55,14.26,15.35,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,90.02,12.05,12.29,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",blue cross/blue shield medicare adv,,O,650.28,61.44,61.44,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,4054.33,327.84,410.13,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",blue cross/blue shield medicare adv,,O,35.00,2.32,4.66,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,67.58,3.47,10.60,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,blue cross/blue shield medicare adv,,O,502.71,78.63,99.28,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",blue cross/blue shield medicare adv,,O,108.49,21.05,37.50,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",blue cross/blue shield medicare adv,,O,267.61,61.44,61.44,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,206.42,1213.55,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,107.59,3.13,28.22,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,blue cross/blue shield medicare adv,,O,842.86,94.39,216.32,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,blue cross/blue shield medicare adv,,O,694.00,180.07,206.67,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,blue cross/blue shield medicare adv,,O,266.35,64.70,64.70,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),blue cross/blue shield medicare adv,,O,166.34,27.39,31.62,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3099.12,461.58,777.50,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",blue cross/blue shield medicare adv,,O,132.12,25.53,28.61,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,blue cross/blue shield medicare adv,,O,831.61,156.22,252.80,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9303,cpt,"INJECTION, PANITUMUMAB, 10 MG",blue cross/blue shield medicare adv,,O,565.00,142.42,161.04,170.68,339.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,blue cross/blue shield medicare adv,,O,236.36,11.30,35.05,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2629,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, LASER",blue cross/blue shield medicare adv,,O,666.53,193.31,666.53,666.53,399.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3420,cpt,"INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG",blue cross/blue shield medicare adv,,O,14.29,1.32,3.18,3.18,8.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1815,cpt,"INJECTION, INSULIN, PER 5 UNITS",blue cross/blue shield medicare adv,,O,29.26,4.48,14.09,14.09,17.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,blue cross/blue shield medicare adv,,O,231.34,36.98,36.98,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,1869.58,206.26,1017.53,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,155,ms-drg,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",blue cross/blue shield medicare adv,,I,26229.54,6053.79,7743.63,7743.63,15737.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,blue cross/blue shield medicare adv,,I,19710.37,4922.26,4922.26,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",blue cross/blue shield medicare adv,,O,231.34,36.97,36.97,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,93.19,15.38,15.38,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",blue cross/blue shield medicare adv,,O,300.00,109.46,109.46,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",blue cross/blue shield medicare adv,,O,50.01,4.43,9.33,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9263,cpt,"INJECTION, OXALIPLATIN, 0.5 MG",blue cross/blue shield medicare adv,,O,8.74,0.07,2.02,24.00,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2765,cpt,"INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG",blue cross/blue shield medicare adv,,O,79.57,14.40,15.45,59.62,47.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,112.55,10.48,37.16,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9267,cpt,"INJECTION, PACLITAXEL, 1 MG",blue cross/blue shield medicare adv,,O,4.99,0.12,1.36,189.00,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84244,cpt,RENIN (KIDNEY ENZYME) LEVEL,blue cross/blue shield medicare adv,,O,145.10,21.55,23.35,27.49,87.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",blue cross/blue shield medicare adv,,I,18651.52,4921.84,8755.49,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,4054.33,319.17,754.68,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0275,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES PACEMAKER,blue cross/blue shield medicare adv,,O,17504.50,5978.85,5978.85,9158.16,10502.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,blue cross/blue shield medicare adv,,O,79.04,16.60,45.68,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",blue cross/blue shield medicare adv,,O,130.95,13.50,13.98,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73552,cpt,"X-RAY OF THIGH BONE, MINIMUM 2 VIEWS",blue cross/blue shield medicare adv,,O,327.63,38.17,62.95,173.76,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,784,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH CC,blue cross/blue shield medicare adv,,I,14784.88,6415.40,9277.48,20022.84,8870.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,blue cross/blue shield medicare adv,,O,351.40,92.60,228.66,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1335,cpt,"INJECTION, ERTAPENEM SODIUM, 500 MG",blue cross/blue shield medicare adv,,O,93.92,25.89,25.89,187.83,56.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",blue cross/blue shield medicare adv,,O,90.84,3.51,28.92,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",blue cross/blue shield medicare adv,,O,422.68,79.93,79.93,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",blue cross/blue shield medicare adv,,O,82.61,19.42,22.52,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,175,ms-drg,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,blue cross/blue shield medicare adv,,I,23982.29,5734.35,12664.18,14746.99,14389.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",blue cross/blue shield medicare adv,,O,36.32,4.04,6.06,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,blue cross/blue shield medicare adv,,I,12315.58,3063.82,5961.63,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,blue cross/blue shield medicare adv,,O,101.33,11.74,11.74,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,blue cross/blue shield medicare adv,,I,84785.32,12190.37,19495.26,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9202,cpt,"GOSERELIN ACETATE IMPLANT, PER 3.6 MG",blue cross/blue shield medicare adv,,O,3100.29,142.49,142.49,647.44,1860.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",blue cross/blue shield medicare adv,,O,157.91,56.85,71.27,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,580,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",blue cross/blue shield medicare adv,,I,52656.26,7319.59,13423.44,18388.00,31593.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",blue cross/blue shield medicare adv,,O,1645.73,583.80,637.40,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",blue cross/blue shield medicare adv,,O,140.38,11.21,11.21,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,blue cross/blue shield medicare adv,,O,42.51,2.00,6.16,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,blue cross/blue shield medicare adv,,O,1952.12,344.86,344.86,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",blue cross/blue shield medicare adv,,O,281.00,8.75,106.86,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73723,cpt,MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,3471.56,325.59,463.88,3471.56,2082.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,blue cross/blue shield medicare adv,,O,123.87,5.34,13.92,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,233,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,blue cross/blue shield medicare adv,,I,285898.27,47239.96,86794.01,86794.01,171538.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",blue cross/blue shield medicare adv,,O,101.45,14.76,17.69,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,308,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,blue cross/blue shield medicare adv,,I,28408.75,7603.87,14046.88,14046.88,17045.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,blue cross/blue shield medicare adv,,O,989.19,218.69,638.18,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross/blue shield medicare adv,,O,100.04,20.74,20.74,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,blue cross/blue shield medicare adv,,O,84.93,8.09,8.09,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",blue cross/blue shield medicare adv,,O,113.79,13.73,13.73,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86870,cpt,IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,blue cross/blue shield medicare adv,,O,303.20,21.62,21.62,263.51,181.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",blue cross/blue shield medicare adv,,O,373.90,92.59,114.61,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,blue cross/blue shield medicare adv,,O,3055.12,204.95,458.10,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,blue cross/blue shield medicare adv,,O,306.38,103.42,103.42,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",blue cross/blue shield medicare adv,,O,212.59,22.86,77.54,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",blue cross/blue shield medicare adv,,O,52.60,5.67,6.19,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",blue cross/blue shield medicare adv,,O,56.26,6.34,10.81,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82010,cpt,"KETONE BODIES ANALYSIS, QUANTITATIVE",blue cross/blue shield medicare adv,,O,70.06,11.22,12.36,12.36,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,blue cross/blue shield medicare adv,,O,2289.17,554.60,968.64,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,blue cross/blue shield medicare adv,,O,167.56,25.68,27.01,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,blue cross/blue shield medicare adv,,O,3055.12,203.12,700.81,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,blue cross/blue shield medicare adv,,O,752.83,92.79,216.32,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,blue cross/blue shield medicare adv,,O,138.03,9.70,73.30,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),blue cross/blue shield medicare adv,,O,283.14,16.69,61.76,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",blue cross/blue shield medicare adv,,O,117.54,58.77,117.54,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,blue cross/blue shield medicare adv,,O,108.53,13.66,13.66,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,blue cross/blue shield medicare adv,,O,647.78,92.97,176.91,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0171,cpt,"INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG",blue cross/blue shield medicare adv,,O,5.83,0.81,0.81,3.70,3.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",blue cross/blue shield medicare adv,,O,365.14,61.44,61.44,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,blue cross/blue shield medicare adv,,I,14560.83,3337.55,7280.52,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82575,cpt,CREATININE CLEARANCE MEASUREMENT TO TEST FOR KIDNEY FUNCTION,blue cross/blue shield medicare adv,,O,80.22,9.31,20.42,20.42,11.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,blue cross/blue shield medicare adv,,O,122.03,31.49,31.49,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",blue cross/blue shield medicare adv,,O,331.51,119.35,151.28,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3489,cpt,"INJECTION, ZOLEDRONIC ACID, 1 MG",blue cross/blue shield medicare adv,,O,147.55,10.36,24.59,110.66,88.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",blue cross/blue shield medicare adv,,O,62.51,14.38,14.38,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82365,cpt,INFRARED ANALYSIS OF STONE,blue cross/blue shield medicare adv,,O,73.14,12.65,27.10,38.76,15.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,234,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,blue cross/blue shield medicare adv,,I,205358.74,31986.81,50803.66,50803.66,123215.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74415,cpt,IMAGING OF URINARY TRACT USING INFUSION TECHNIQUE WITH KIDNEY SECTION FILMING,blue cross/blue shield medicare adv,,O,1067.98,404.65,404.65,404.65,640.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,blue cross/blue shield medicare adv,,O,3055.12,202.50,1110.96,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1788,cpt,"PORT, INDWELLING (IMPLANTABLE)",blue cross/blue shield medicare adv,,O,1737.02,466.81,512.60,1737.02,1042.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86381,cpt,MEASUREMENT OF MITOCHONDRIAL ANTIBODY,blue cross/blue shield medicare adv,,O,63.63,8.37,8.37,25.45,38.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,blue cross/blue shield medicare adv,,O,101.33,21.90,21.90,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,blue cross/blue shield medicare adv,,O,130.11,30.48,30.48,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82985,cpt,GLYCATED PROTEIN LEVEL,blue cross/blue shield medicare adv,,O,41.90,8.48,8.48,8.48,25.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",blue cross/blue shield medicare adv,,O,60.16,6.38,12.39,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1650,cpt,"INJECTION, ENOXAPARIN SODIUM, 10 MG",blue cross/blue shield medicare adv,,O,21.39,7.39,7.39,64.18,12.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",blue cross/blue shield medicare adv,,O,93.19,13.33,15.08,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84112,cpt,CERVICOVAGINAL SECRETION OF PLACENTA PROTEIN,blue cross/blue shield medicare adv,,O,257.65,98.11,257.65,257.65,49.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85347,cpt,"COAGULATION TIME MEASUREMENT, ACTIVATED",blue cross/blue shield medicare adv,,O,116.31,1.48,1.48,62.61,22.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",blue cross/blue shield medicare adv,,O,10827.72,2513.53,2770.49,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",blue cross/blue shield medicare adv,,O,376.41,61.44,61.44,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,blue cross/blue shield medicare adv,,O,56.62,7.92,10.44,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",blue cross/blue shield medicare adv,,O,345.14,75.82,75.82,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",blue cross/blue shield medicare adv,,O,117.61,12.87,20.59,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,healthchoice,,O,213.87,28.75,59.54,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87350,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS BE SURFACE ANTIGEN,blue cross/blue shield medicare adv,,O,28.83,6.19,6.19,19.42,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76937,cpt,ULTRASOUND GUIDANCE FOR ACCESSING INTO BLOOD VESSEL,blue cross/blue shield medicare adv,,O,690.62,300.63,359.99,359.99,157.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,blue cross/blue shield medicare adv,,I,16915.97,4140.71,6854.95,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",blue cross/blue shield medicare adv,,O,13.78,1.69,1.69,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,831,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,blue cross/blue shield medicare adv,,I,29659.97,5961.46,8870.45,8870.45,17795.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86593,cpt,SYPHILIS TEST,blue cross/blue shield medicare adv,,O,50.01,2.27,2.27,6.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,blue cross/blue shield medicare adv,,O,183.82,19.97,60.63,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,blue cross/blue shield medicare adv,,O,419.99,136.22,179.11,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",blue cross/blue shield medicare adv,,O,0.59,0.15,0.15,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89060,cpt,CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,blue cross/blue shield medicare adv,,O,40.11,7.18,28.45,40.11,8.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,809,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,blue cross/blue shield medicare adv,,I,46992.19,7372.16,9364.35,9364.35,28195.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,blue cross/blue shield medicare adv,,O,531.48,100.50,100.50,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",blue cross/blue shield medicare adv,,O,50.72,7.45,7.45,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70470,cpt,CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST,blue cross/blue shield medicare adv,,O,2708.71,159.41,199.96,450.85,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,blue cross/blue shield medicare adv medicare advantage,,O,188.17,66.99,106.64,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,blue cross/blue shield medicare adv medicare advantage,,O,547.73,91.89,289.32,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",blue cross/blue shield medicare adv medicare advantage,,O,547.73,117.10,289.32,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",blue cross/blue shield medicare adv medicare advantage,,O,93.77,21.35,36.85,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9358,cpt,"INJECTION, FAM-TRASTUZUMAB DERUXTECAN-NXKI, 1 MG",blue cross/blue shield medicare adv medicare advantage,,O,97.75,19.27,25.93,25.93,58.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,blue cross/blue shield medicare adv medicare advantage,,O,383.02,34.82,71.75,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",cigna,,O,91.30,6.24,91.30,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",cigna,,O,70.78,13.97,70.78,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",cigna,,O,1997.14,273.93,514.25,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,cigna,,O,50.01,3.11,50.01,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",cigna,,O,52.60,8.84,52.60,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",cigna,,O,85.05,7.99,73.83,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80050,cpt,GENERAL HEALTH PANEL,cigna,,O,300.45,40.45,300.45,300.45,57.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",cigna,,O,754.07,158.88,754.07,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,cigna,,E,292.62,111.66,260.03,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",cigna,,O,147.58,21.05,147.58,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",cigna,,O,1997.14,430.17,514.25,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,cigna,,O,73.83,11.51,73.83,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,cigna,,O,401.42,94.39,229.19,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,cigna,,O,76.68,5.83,76.68,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",cigna,,O,71.96,7.91,44.90,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",cigna,,O,3457.28,1078.00,2046.77,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,cigna,,O,101.33,21.90,101.33,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",cigna,,O,135.66,25.29,135.66,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,cigna,,O,67.58,3.47,67.58,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,cigna,,O,647.78,92.64,229.19,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,cigna,,O,2289.17,554.60,765.24,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",cigna,,O,183.82,20.70,114.70,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,cigna,,O,41.19,1.80,50.56,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",cigna,,O,246.35,17.59,153.72,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,cigna,,O,41.26,8.55,13.52,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,cigna,,O,754.07,203.12,754.07,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",cigna,,O,199.37,74.90,117.37,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,cigna,,O,183.82,20.77,114.71,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",cigna,,O,147.58,21.05,147.58,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",cigna,,O,56.26,6.34,56.26,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",cigna,,O,151.46,8.03,151.46,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,cigna,,O,9.11,0.50,5.29,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",cigna,,O,157.91,56.85,98.54,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,cigna,,O,31.24,2.94,29.48,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,cigna,,O,3222.12,719.92,2046.77,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",cigna,,O,183.82,24.23,114.71,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",cigna,,O,50.01,4.43,50.01,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",cigna,,O,238.30,71.54,117.37,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,cigna,,E,880.03,214.07,319.64,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",cigna,,O,4.12,1.10,2.57,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,151.64,21.05,44.88,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9303,cpt,"INJECTION, PANITUMUMAB, 10 MG",healthchoice,,O,565.00,142.42,170.68,170.68,339.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,493,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",healthchoice,,I,69921.76,14158.62,24367.50,24367.50,41953.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",healthchoice,,O,757.37,185.43,283.82,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,healthchoice,,O,351.40,51.44,87.17,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,healthchoice,,O,4630.63,693.07,3534.90,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19301,cpt,PARTIAL REMOVAL OF BREAST,healthchoice,,O,31896.98,2805.32,5844.26,12984.24,19138.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",healthchoice,,O,2073.43,311.07,717.44,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2270,cpt,"INJECTION, MORPHINE SULFATE, UP TO 10 MG",healthchoice,,O,84.59,0.76,0.76,82.91,50.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,healthchoice,,O,792.84,92.74,213.76,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",healthchoice,,O,650.28,61.44,213.76,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),healthchoice,,O,283.14,16.69,21.63,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",healthchoice,,O,266.35,51.50,173.76,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",healthchoice,,O,19538.26,2569.95,5064.25,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9171,cpt,"INJECTION, DOCETAXEL, 1 MG",healthchoice,,O,54.77,0.66,0.66,12.96,32.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,healthchoice,,O,3055.12,204.95,583.80,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",healthchoice,,O,519.10,54.18,106.38,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,healthchoice,,O,109.71,43.44,75.21,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",healthchoice,,O,266.35,64.70,197.39,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,healthchoice,,O,36.32,3.85,4.91,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21556,cpt,REMOVAL OF (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,healthchoice,,O,18486.84,2243.72,4391.53,4391.53,11092.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",healthchoice,,O,267.61,48.10,173.76,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",healthchoice,,O,209.99,16.56,23.00,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9267,cpt,"INJECTION, PACLITAXEL, 1 MG",healthchoice,,O,4.99,0.12,18.20,189.00,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84590,cpt,VITAMIN A LEVEL,healthchoice,,O,29.03,11.66,14.51,15.88,17.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15275,cpt,"APPLICATION OF SKIN SUBSTITUTE (WOUND SURFACE UP TO 100 SQ CM) TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, EYE REGION, GENITALS, HANDS, FEET, AND/OR MULTIPLE FINGERS OR TOES (FIRST 25 SQ CM OR LESS)",healthchoice,,O,9281.17,3155.16,3155.16,8146.08,5568.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9202,cpt,"GOSERELIN ACETATE IMPLANT, PER 3.6 MG",healthchoice,,O,3100.29,142.49,647.44,647.44,1860.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",healthchoice,,O,73.14,3.60,4.59,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,healthchoice,,O,138.03,9.70,31.81,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",healthchoice,,O,190.94,53.23,80.09,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94640,cpt,RESPIRATORY INHALED PRESSURE OR NONPRESSURE TREATMENT TO RELIEVE AIRWAY OBSTRUCTION OR FOR SPUTUM SPECIMEN,healthchoice,,O,223.34,51.35,88.34,99.96,134.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,796,ms-drg,VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,healthchoice,,I,43380.59,26546.00,26546.00,26546.00,26028.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,healthchoice,,O,83.76,6.73,42.45,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",healthchoice,,O,13.80,2.61,3.96,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",healthchoice,,O,100.04,20.74,98.78,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",healthchoice,,O,1099.23,114.80,266.76,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",healthchoice,,O,183.82,24.23,48.73,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,healthchoice,,O,36.32,5.40,6.89,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,healthchoice,,O,28.83,5.59,30.55,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,healthchoice,,O,3055.12,202.94,467.04,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27447,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE AND OUTSIDE AREA",healthchoice,,O,76738.27,10981.15,23221.27,59556.87,46042.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80197,cpt,TACROLIMUS LEVEL,healthchoice,,O,674.82,13.49,17.16,57.77,16.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,healthchoice,,O,42.58,4.32,9.00,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",healthchoice,,O,3191.43,324.07,626.33,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71120,cpt,"X-RAY OF BREAST BONE, MINIMUM OF 2 VIEWS",healthchoice,,O,252.44,21.72,173.76,173.76,151.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37799,cpt,OTHER PROCEDURE ON BLOOD VESSEL,healthchoice,,O,25554.94,3410.10,5064.25,13483.00,15332.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82310,cpt,"CALCIUM LEVEL, TOTAL",healthchoice,,O,38.80,5.06,6.45,11.12,23.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,healthchoice,,I,22023.98,6812.39,14585.00,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",healthchoice,,O,85.94,24.92,28.29,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,healthchoice,,O,3055.12,204.02,583.80,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19281,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MAMMOGRAPHIC GUIDANCE, FIRST LESION",healthchoice,,O,21298.80,131.53,357.64,5148.44,12779.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43251,cpt,"REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE USING A MECHANICAL SNARE",healthchoice,,O,6666.20,1457.56,2960.70,3664.49,3999.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,healthchoice,,O,1952.12,159.41,360.68,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",healthchoice,,O,298.47,66.35,66.35,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55700,cpt,BIOPSY OF PROSTATE GLAND,healthchoice,,O,15825.28,1612.35,3153.30,4133.17,1936.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",healthchoice,,O,125.04,27.28,118.07,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86343,cpt,WHITE BLOOD CELL HISTAMINE (IMMUNE SYSTEM CHEMICAL) RELEASE TEST,healthchoice,,O,31.15,12.51,15.58,27.07,18.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",healthchoice,,O,441.23,35.97,71.85,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,healthchoice,,O,67.58,3.47,7.23,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",healthchoice,,O,2069.24,93.35,267.20,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58662,cpt,DESTRUCTION OR REMOVAL OF OVARY OR GROWTH OF PELVIS USING AN ENDOSCOPE,healthchoice,,O,30175.18,4607.33,8860.66,22301.14,18105.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",healthchoice,,O,647.78,98.50,213.76,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,healthchoice,,O,7543.40,1294.20,2978.70,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",healthchoice,,O,36.32,3.59,3.59,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78195,cpt,NUCLEAR MEDICINE STUDY OF LYMPHATIC SYSTEM,healthchoice,,O,2847.53,457.66,457.66,2847.53,1708.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",healthchoice,,O,376.41,61.44,213.76,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,healthchoice,,O,1630.73,338.97,777.36,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",healthchoice,,O,348.89,53.55,173.76,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,healthchoice,,O,265.10,8.75,265.10,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4648,cpt,IMPLANTABLE TISSUE MARKER; MEDICAL AND SURGICAL SUPPLIES - OTHER SUPPLIES,healthchoice,,O,4877.20,783.88,783.88,2061.90,2926.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",healthchoice,,O,411.42,47.57,213.76,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80202,cpt,VANCOMYCIN (ANTIBIOTIC) LEVEL,healthchoice,,O,92.78,13.27,16.93,27.34,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",healthchoice,,O,89.65,10.18,16.49,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),healthchoice,,O,8588.52,489.94,3075.05,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5122,cpt,"INJECTION, PEGFILGRASTIM-APGF, BIOSIMILAR, (NYVEPRIA), 0.5 MG",healthchoice,,O,855.42,167.19,167.19,623.41,513.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",healthchoice,,O,369.82,61.44,173.76,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,healthchoice,,O,2149.71,310.75,717.44,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76857,cpt,"ULTRASOUND OF PELVIS, LIMITED, NOT PREGNANCY RELATED",healthchoice,,O,187.57,93.59,198.82,198.82,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,healthchoice,,O,123.87,33.18,42.33,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24071,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF UPPER ARM OR ELBOW,healthchoice,,O,20596.09,2107.80,4391.53,4391.53,12357.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10005,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, FIRST GROWTH",healthchoice,,O,2576.47,558.51,1632.05,1932.35,1545.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,336,ms-drg,PERITONEAL ADHESIOLYSIS WITH CC,healthchoice,,I,67565.05,6006.27,24239.00,24239.00,40539.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11642,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",healthchoice,,O,3061.00,710.75,2453.97,2453.97,1836.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",healthchoice,,O,650.28,61.44,213.76,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",healthchoice,,O,494.32,41.98,53.55,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3246,cpt,"INJECTION, TIROFIBAN HCL, 0.25 MG",healthchoice,,O,296.48,9.76,574.60,574.60,177.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,healthchoice,,O,89.65,18.15,23.15,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,healthchoice,,O,6554.34,441.62,4025.12,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),healthchoice,,O,126.23,10.13,126.23,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,healthchoice,,O,306.38,103.42,266.76,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",healthchoice,,O,148.64,16.43,20.96,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80178,cpt,LITHIUM LEVEL,healthchoice,,O,56.26,6.48,8.26,42.20,7.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,805,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,healthchoice,,I,14483.73,3890.14,6288.66,11041.35,8690.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,healthchoice,,O,287.62,77.37,203.47,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",healthchoice,,O,83.33,15.97,39.92,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,healthchoice,,O,148.64,17.37,23.49,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",healthchoice,,O,50.01,4.43,5.65,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",healthchoice,,O,41.28,3.01,6.39,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",healthchoice,,O,140.04,24.64,52.70,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",healthchoice,,O,117.54,58.77,124.59,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),healthchoice,,O,41.28,5.08,6.48,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3489,cpt,"INJECTION, ZOLEDRONIC ACID, 1 MG",healthchoice,,O,147.55,10.36,10.36,110.66,88.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85460,cpt,"FETAL HEMOGLOBIN OR RED BLOOD CELLS MEASUREMENT FOR ASSESSMENT OF FETAL-MATERNAL CIRCULATION, DIFFERENTIAL LYSIS",healthchoice,,O,251.28,7.76,9.66,199.76,150.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82671,cpt,"ESTROGEN ANALYSIS, FRACTIONATED",healthchoice,,O,436.51,31.65,40.38,65.74,261.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,healthchoice,,O,19028.38,1098.56,2075.03,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,healthchoice,,O,51.39,9.33,17.65,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,healthchoice,,O,106.28,8.57,10.93,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",healthchoice,,O,1434.39,436.85,855.32,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0276,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES INTRACULAR LENS,healthchoice,,O,845.37,203.20,205.57,276.42,507.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,healthchoice,,O,3595.37,280.86,736.86,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",healthchoice,,I,217.58,127.74,217.58,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,healthchoice,,O,1481.91,158.58,360.68,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80050,cpt,GENERAL HEALTH PANEL,healthchoice,,O,300.45,40.45,59.84,300.45,57.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93990,cpt,ULTRASOUND OF HEMODIALYSIS ACCESS,healthchoice,,O,254.87,124.44,181.70,181.70,152.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,healthchoice,,O,41.19,1.80,1.80,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78014,cpt,NUCLEAR MEDICINE STUDY OF THYROID AND THYROID FUNCTION,healthchoice,,O,1304.33,342.21,777.36,883.36,782.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,healthchoice,,I,18614.53,3748.00,10327.00,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86709,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),healthchoice,,O,106.28,11.04,14.08,19.42,63.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",healthchoice,,O,252.47,43.75,75.21,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74220,cpt,X-RAY OF ESOPHAGUS WITH SINGLE CONTRAST,healthchoice,,O,585.25,65.33,360.68,360.68,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",healthchoice,,O,547.73,117.10,547.73,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9263,cpt,"INJECTION, OXALIPLATIN, 0.5 MG",healthchoice,,O,8.74,0.07,24.00,24.00,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9537,cpt,"TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES",healthchoice,,O,245.09,59.33,59.33,157.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11406,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF BODY, ARMS, OR LEGS, MORE THAN 4.0 CM",healthchoice,,O,17469.26,1304.93,2549.24,5506.99,10481.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,healthchoice,,I,30232.58,9248.60,15905.00,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17250,cpt,APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,healthchoice,,O,703.02,157.08,554.17,777.14,421.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15851,cpt,REMOVAL OF SUTURES UNDER ANESTHESIA BY OTHER SURGEON,healthchoice,,O,20060.25,3031.21,3031.21,3031.21,12036.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3358,cpt,"USTEKINUMAB, FOR INTRAVENOUS INJECTION, 1 MG",healthchoice,,O,37.06,37.06,37.06,37.06,22.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",healthchoice,,O,130.95,13.50,22.92,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88341,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, EACH ADDITIONAL PROCEDURE",healthchoice,,O,128.79,24.89,36.04,132.54,77.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,healthchoice,,O,2687.44,201.24,467.04,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,healthchoice,,O,203.82,49.80,100.59,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0260,cpt,"INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY",healthchoice,,O,2193.04,562.74,1003.01,1003.01,1315.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1892,cpt,"INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE, PEEL-AWAY",healthchoice,,O,1586.87,297.12,297.12,1440.00,952.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64479,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",healthchoice,,O,7223.75,739.73,1621.96,2764.46,4334.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",healthchoice,,O,16.51,4.75,5.94,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1758,cpt,"CATHETER, URETERAL",healthchoice,,O,112.55,32.52,32.52,37.04,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J8501,cpt,"APREPITANT, ORAL, 5 MG",healthchoice,,O,78.57,18.19,18.19,21.34,47.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",healthchoice,,O,281.36,90.50,145.02,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",healthchoice,,O,647.78,98.50,213.76,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,healthchoice,,O,69.59,7.80,20.58,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77003,cpt,FLUOROSCOPIC GUIDANCE FOR INJECTION INTO SPINE OR MUSCLE NEXT TO SPINE,healthchoice,,O,675.30,171.47,171.47,171.47,405.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",healthchoice,,O,175.06,87.53,105.04,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19285,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",healthchoice,,O,31940.44,2805.32,5844.26,7734.30,19164.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86161,cpt,MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM PROTEINS),healthchoice,,O,30.00,9.98,15.00,15.00,18.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,healthchoice,,O,3099.12,461.58,467.04,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",healthchoice,,O,356.40,83.75,145.02,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82365,cpt,INFRARED ANALYSIS OF STONE,healthchoice,,O,73.14,12.65,16.13,38.76,15.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,healthchoice,,I,65131.57,7666.11,27982.00,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0171,cpt,"INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG",healthchoice,,O,5.83,0.81,1.38,3.70,3.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,healthchoice,,O,1343.10,94.47,267.20,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,healthchoice,,O,2707.46,156.22,450.85,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,healthchoice,,O,647.78,94.48,213.76,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86671,cpt,ANALYSIS FOR ANTIBODY TO FUNGUS,healthchoice,,O,30.63,5.89,30.62,30.62,18.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",healthchoice,,O,1645.73,583.80,800.00,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86317,cpt,"DETECTION OF INFECTIOUS AGENT ANTIBODY, QUANTITATIVE",healthchoice,,O,148.64,8.99,18.74,29.14,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",healthchoice,,O,365.24,8.63,17.98,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87625,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), TYPES 16 AND 18 ONLY",healthchoice,,O,119.58,50.69,50.69,93.91,71.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,healthchoice,,O,3055.12,205.61,583.80,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,healthchoice,,O,73.83,12.70,18.24,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,healthchoice,,O,40.11,4.65,5.93,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,786,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,healthchoice,,I,26502.24,8570.18,18405.00,31953.68,15901.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22551,cpt,"FUSION OF SPINE BONES WITH REMOVAL OF DISC AT UPPER SPINAL COLUMN, ANTERIOR APPROACH, COMPLEX",healthchoice,,O,65424.14,11349.44,22181.74,22181.74,39254.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",healthchoice,,O,212.36,14.48,65.36,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",healthchoice,,O,200.00,27.06,27.06,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",healthchoice,,O,365.14,48.65,173.76,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,healthchoice,,O,116.31,18.99,24.23,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,healthchoice,,O,38.92,4.65,5.94,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,healthchoice,,O,55.44,9.79,14.43,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",healthchoice,,O,422.68,79.93,422.68,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",healthchoice,,O,1893.35,485.97,1144.94,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",healthchoice,,O,117.54,25.46,118.07,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5112,cpt,"INJECTION, TRASTUZUMAB-DTTB, BIOSIMILAR, (ONTRUZANT), 10 MG",healthchoice,,O,297.75,13.43,2873.58,2873.58,178.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,healthchoice,,O,87.53,4.18,5.34,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,healthchoice,,O,101.33,21.90,37.00,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11622,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",healthchoice,,O,18159.00,159.22,2453.97,2453.97,10895.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,healthchoice,,O,3222.12,719.92,1421.86,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9540,cpt,"TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES",healthchoice,,O,245.09,31.50,31.50,31.50,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5111,cpt,"INJECTION, PEGFILGRASTIM-CBQV, BIOSIMILAR, (UDENYCA), 0.5 MG",healthchoice,,O,1252.50,150.78,171.89,171.89,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,healthchoice,,O,113.25,11.78,17.84,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",healthchoice,,O,252.47,44.06,75.21,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",healthchoice,,O,245.09,61.44,173.76,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,healthchoice,,O,132.54,29.82,118.07,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7030,cpt,"INFUSION, NORMAL SALINE SOLUTION , 1000 CC",healthchoice,,O,9.26,2.95,2.95,58.60,5.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",healthchoice,,O,183.82,20.21,42.53,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84207,cpt,VITAMIN B-6 LEVEL,healthchoice,,O,134.49,18.96,35.13,142.55,80.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,healthchoice,,O,76.68,7.98,14.24,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0121,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK,healthchoice,,O,3195.82,717.96,1255.30,1255.30,1917.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,healthchoice,,O,28365.62,4521.08,8860.66,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",healthchoice,,O,513.19,16.80,21.43,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25607,cpt,"TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST, ABOVE WRIST, WITH PLACEMENT OF STABILIZING DEVICE",healthchoice,,O,35608.49,5736.03,11244.87,11244.87,21365.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,healthchoice,,O,520.22,353.23,520.22,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),healthchoice,,O,60.03,6.83,14.98,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28730,cpt,FUSION OF MULTIPLE FOOT JOINTS WITHOUT A BONE INCISION,healthchoice,,O,48954.48,10198.40,22181.74,22181.74,29372.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69436,cpt,INCISION OF EARDRUM WITH PLACEMENT OF EARDRUM TUBE UNDER GENERAL ANESTHESIA,healthchoice,,O,13970.08,1227.06,9077.44,9077.44,8382.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,healthchoice,,O,42.58,3.22,4.10,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,healthchoice,,I,1031.60,200.87,200.87,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",healthchoice,,O,1997.14,273.93,855.32,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,healthchoice,,O,252.59,55.19,118.07,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",healthchoice,,O,233.84,30.94,59.50,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",healthchoice,,O,41.28,4.92,6.50,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,healthchoice,,O,401.42,94.39,213.76,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,healthchoice,,O,1446.95,312.71,659.22,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,healthchoice,,O,316.37,49.55,145.02,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",healthchoice,,O,267.61,46.08,173.76,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",healthchoice,,O,154.76,24.25,114.73,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",healthchoice,,O,50.72,7.45,15.00,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88300,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, LIMITED EXAMINATION",healthchoice,,O,93.19,26.27,26.27,93.19,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,healthchoice,,O,2152.21,335.59,777.36,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,healthchoice,,O,203.82,49.80,100.59,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73060,cpt,"X-RAY OF UPPER ARM, MINIMUM OF 2 VIEWS",healthchoice,,O,245.09,22.66,173.76,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11424,cpt,"REMOVAL OF GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",healthchoice,,O,15617.60,1304.33,2549.24,9370.59,9370.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",healthchoice,,O,298.47,56.42,145.02,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",healthchoice,,O,437.43,101.00,197.39,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1788,cpt,"PORT, INDWELLING (IMPLANTABLE)",healthchoice,,O,1737.02,466.81,466.81,1737.02,1042.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",healthchoice,,E,1724.51,232.62,959.65,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,healthchoice,,O,4852.19,224.32,736.86,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,healthchoice,,O,414.89,93.99,213.76,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",healthchoice,,O,101.45,14.76,14.76,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,healthchoice,,O,3055.12,320.47,736.86,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88311,cpt,PREPARATION OF TISSUE FOR EXAMINATION BY REMOVING ANY CALCIUM PRESENT,healthchoice,,O,46.00,18.36,18.36,34.50,27.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78472,cpt,NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION BY LABELING RED BLOOD CELLS WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER MULTIPLE CYCLES,healthchoice,,O,2436.09,342.21,777.36,777.36,1461.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,252,ms-drg,OTHER VASCULAR PROCEDURES WITH MCC,healthchoice,,I,66686.69,20797.71,38100.00,38100.00,40012.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,healthchoice,,O,178.08,50.28,64.14,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",healthchoice,,O,98.78,7.87,16.79,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,healthchoice,,O,83.76,14.03,17.90,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52601,cpt,REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE,healthchoice,,O,21140.75,3922.58,7993.71,12709.61,12684.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",healthchoice,,O,1724.51,97.60,959.65,959.65,801.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,healthchoice,,O,1620.71,439.39,1009.00,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,healthchoice,,O,396.41,290.00,420.19,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",healthchoice,,O,126.23,16.29,24.19,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",healthchoice,,O,38.92,2.65,3.38,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",healthchoice,,O,20.05,1.78,3.89,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",healthchoice,,O,88.24,14.05,21.22,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",healthchoice,,O,245.09,44.06,173.76,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9040,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",healthchoice,,O,756.23,259.12,388.68,756.23,453.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",healthchoice,,O,362.65,61.08,173.76,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,100.03,11.76,93.18,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",healthchoice,,O,4.22,1.00,1.29,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,healthchoice,,O,1893.35,157.27,717.44,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",healthchoice,,O,285.11,61.44,173.76,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0378,cpt,"HOSPITAL OBSERVATION SERVICE, PER HOUR",healthchoice,,O,16.99,2.44,2.44,22.26,10.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93454,cpt,INSERTION OF CATHETER FOR IMAGING OF HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,healthchoice,,O,40037.22,2564.66,18046.03,18046.03,24022.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,healthchoice,,I,12315.58,3063.82,7195.00,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,healthchoice,,O,123.87,5.34,11.13,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38505,cpt,NEEDLE BIOPSY OR REMOVAL OF SURFACE LYMPH NODES,healthchoice,,O,13047.69,1305.53,2549.24,3254.84,7828.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,149.83,34.39,44.88,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,healthchoice,,O,60.16,9.91,16.13,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,healthchoice,,O,4318.19,810.94,1635.17,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",healthchoice,,O,71.96,7.91,10.88,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0702,cpt,"INJECTION, BETAMETHASONE ACETATE 3 MG AND BETAMETHASONE SODIUM PHOSPHATE 3 MG",healthchoice,,O,31.72,5.99,7.30,12.02,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,healthchoice,,O,16.28,2.44,2.44,4798.21,9.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9308,cpt,"INJECTION, RAMUCIRUMAB, 5 MG",healthchoice,,O,244.70,36.68,76.22,175.88,146.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1030,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG",healthchoice,,O,87.39,9.18,9.18,65.54,52.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29875,cpt,PARTIAL REMOVAL OF KNEE JOINT LINING USING AN ENDOSCOPE,healthchoice,,O,21676.78,485.10,5060.32,5060.32,13006.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,healthchoice,,O,79.04,16.60,21.18,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",healthchoice,,O,246.35,17.59,39.25,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",healthchoice,,O,96.29,11.40,11.40,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,healthchoice,,O,383.02,34.82,187.57,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",healthchoice,,O,39.88,13.23,15.99,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",healthchoice,,O,212.59,22.86,47.07,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,healthchoice,,O,108.53,13.66,18.21,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",healthchoice,,O,1007.94,158.30,390.09,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83498,cpt,"HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVEL",healthchoice,,O,126.23,22.15,33.96,94.68,75.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36902,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT AND BALLOON DILATION OF DIALYSIS SEGMENT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",healthchoice,,O,17042.54,4518.00,8866.18,17456.98,10225.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1442,cpt,"INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM",healthchoice,,O,4.99,0.72,269.36,269.36,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,healthchoice,,O,3055.12,202.81,467.04,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,healthchoice,,O,43.18,10.79,21.59,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2185,cpt,"INJECTION, MEROPENEM, 100 MG",healthchoice,,O,7.14,0.71,0.71,3.32,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,healthchoice,,O,78.05,7.37,9.40,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",healthchoice,,O,300.00,109.46,238.44,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3357,cpt,"USTEKINUMAB, FOR SUBCUTANEOUS INJECTION, 1 MG",healthchoice,,O,714.09,714.09,714.09,714.09,428.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,440,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,healthchoice,,I,12850.05,3815.31,6911.00,12183.21,7710.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9060,cpt,"INJECTION, CISPLATIN, POWDER OR SOLUTION, 10 MG",healthchoice,,O,20.12,5.00,13.44,57.69,12.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",healthchoice,,O,365.14,61.44,173.76,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,healthchoice,,O,183.82,19.97,42.53,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88177,cpt,"PAP TEST, EVALUATION OF FINE NEEDLE ASPIRATE, IMMEDIATE, EACH ADDITIONAL EVALUATION EPISODE",healthchoice,,O,49.54,27.92,81.12,81.12,29.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,healthchoice,,O,3683.73,275.00,835.78,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0170,revCode,NURSERY GENERAL,healthchoice,,I,1569.44,869.27,2307.00,3331.37,941.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,healthchoice,,O,416.45,133.14,235.88,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",healthchoice,,O,5902.67,335.59,2654.54,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",healthchoice,,O,31.24,4.67,6.63,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,healthchoice,,I,16915.97,4140.71,9067.00,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",healthchoice,,O,101.45,25.33,32.26,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,healthchoice,,O,45.06,3.98,8.29,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",healthchoice,,O,226.34,61.44,173.76,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,healthchoice,,O,5902.67,923.22,2654.54,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",healthchoice,,O,734.07,114.82,128.10,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5107,cpt,"INJECTION, BEVACIZUMAB-AWWB, BIOSIMILAR, (MVASI), 10 MG",healthchoice,,O,251.18,28.11,474.05,474.05,150.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,healthchoice,,O,237.59,106.92,237.59,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",healthchoice,,O,238.84,35.53,52.06,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",healthchoice,,O,223.91,73.72,145.02,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29827,cpt,REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE,healthchoice,,O,38417.80,5736.03,11244.87,17014.63,23050.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49329,cpt,OTHER PROCEDURE ON ABDOMEN USING AN ENDOSCOPE,healthchoice,,O,30927.63,7890.38,16584.77,28017.68,18556.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1876,cpt,"STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM",healthchoice,,O,922.91,270.48,270.48,733.71,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,healthchoice,,O,35679.28,5647.61,11244.87,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q4130,cpt,"STRATTICE TM, PER SQUARE CENTIMETER",healthchoice,,O,188.22,28.83,68.90,110.81,112.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",healthchoice,,O,1858.47,98.50,450.85,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",healthchoice,,O,520.22,353.36,520.22,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,healthchoice,,O,31160.78,7903.69,15448.41,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11604,cpt,"REMOVAL OF MALIGNANT GROWTH (3.1 TO 4 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",healthchoice,,O,2188.53,1834.45,1834.45,1834.45,1313.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57288,cpt,CREATION OF SLING AROUND BLADDER CANAL (URETHRA) TO CONTROL LEAKAGE,healthchoice,,O,34340.73,4097.25,23328.10,23328.10,20604.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,healthchoice,,O,65.11,6.57,8.38,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",healthchoice,,O,826.60,242.61,490.11,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",healthchoice,,O,47.53,8.48,10.81,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,832,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,healthchoice,,I,13166.47,3172.81,7983.00,9094.35,7899.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47562,cpt,REMOVAL OF GALLBLADDER USING AN ENDOSCOPE,healthchoice,,O,25184.23,4521.08,8860.66,9136.32,5405.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",healthchoice,,O,734.07,19.80,128.10,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1725,cpt,"CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE, INFUSION/PERFUSION CAPABILITY)",healthchoice,,O,2861.88,440.55,440.55,2459.23,1717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37230,cpt,"INSERTION OF STENTS INTO ARTERY IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",healthchoice,,O,81353.63,14941.36,29201.92,29201.92,48812.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",healthchoice,,O,238.30,63.70,145.02,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1884,cpt,EMBOLIZATION PROTECTIVE SYSTEM,healthchoice,,O,32.49,0.64,3.28,15.48,19.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9541,cpt,"TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES",healthchoice,,O,245.09,123.76,245.09,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",healthchoice,,O,70.06,8.29,10.58,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,healthchoice,,O,351.40,92.60,213.76,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33225,cpt,INSERTION OF LEFT LOWER HEART ELECTRODE FOR PACEMAKER OR DEFIBRILLATOR,healthchoice,,O,44936.34,16251.07,17558.91,17558.91,26961.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,healthchoice,,O,50.72,6.35,8.10,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",healthchoice,,O,3583.92,323.18,703.70,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,healthchoice,,O,41.28,5.78,8.09,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,healthchoice,,O,694.00,180.07,180.07,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,healthchoice,,O,3055.12,204.02,467.04,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99202,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 20 MINUTES",healthchoice,,O,303.87,102.69,102.69,178.28,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72020,cpt,"X-RAY OF SPINE, 1 VIEW",healthchoice,,O,240.10,72.01,95.83,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,healthchoice,,O,4054.33,327.84,736.86,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2623,cpt,"CATHETER, TRANSLUMINAL ANGIOPLASTY, DRUG-COATED, NON-LASER",healthchoice,,O,5633.79,50.57,50.57,50.57,3380.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73120,cpt,"X-RAY OF HAND, 2 VIEWS",healthchoice,,O,240.10,38.01,38.01,96.93,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52356,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) WITH STENT USING AN ENDOSCOPE,healthchoice,,O,26186.13,3916.85,7993.71,10931.90,15711.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,healthchoice,,O,16541.64,1561.79,3055.78,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",healthchoice,,O,348.89,56.80,173.76,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",healthchoice,,O,62.51,14.38,62.51,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,healthchoice,,O,60.03,7.19,14.98,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72157,cpt,MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST,healthchoice,,O,4054.33,330.07,736.86,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,healthchoice,,O,252.59,75.92,173.76,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",healthchoice,,O,410.17,61.80,213.76,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,healthchoice,,O,42.58,6.02,7.68,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82731,cpt,FETAL FIBRONECTIN (PROTEIN) ANALYSIS,healthchoice,,O,565.34,62.32,80.51,424.01,108.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72190,cpt,"X-RAY OF PELVIS, MINIMUM OF 3 VIEWS",healthchoice,,O,411.42,69.58,213.76,213.76,246.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,healthchoice,,I,4152.82,995.38,10433.00,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11046,cpt,"REMOVAL OF MUSCLE AND/OR TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",healthchoice,,O,3414.96,473.85,1078.95,1078.95,2048.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9351,cpt,"INJECTION, TOPOTECAN, 0.1 MG",healthchoice,,O,9.99,0.94,0.94,0.94,5.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1887,cpt,"CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)",healthchoice,,O,357.97,72.03,218.49,218.49,214.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",healthchoice,,O,377.65,43.63,213.76,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,545,ms-drg,CONNECTIVE TISSUE DISORDERS WITH MCC,healthchoice,,I,48844.58,17493.50,18019.79,18019.79,29306.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,healthchoice,,O,24173.14,2776.54,5448.70,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1650,cpt,"INJECTION, ENOXAPARIN SODIUM, 10 MG",healthchoice,,O,21.39,7.39,11.62,64.18,12.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,healthchoice,,O,531.48,100.50,490.11,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",healthchoice,,O,15729.98,1862.99,3671.05,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,healthchoice,,O,135.66,26.63,63.58,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1580,cpt,"INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG",healthchoice,,O,9.46,3.41,3.41,5.64,5.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,healthchoice,,O,188.17,66.99,181.29,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,healthchoice,,O,1159.26,202.49,396.98,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,healthchoice,,O,252.59,54.84,118.07,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57260,cpt,"PLASTIC REPAIR OF VAGINA AND TISSUE SEPARATING VAGINA, RECTUM, AND BLADDER",healthchoice,,O,42179.41,7936.42,11664.05,11664.05,25307.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",healthchoice,,O,82.61,19.42,19.42,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,healthchoice,,O,440.18,84.89,84.89,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,healthchoice,,O,71.96,7.48,15.51,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,healthchoice,,O,56.62,7.92,11.00,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29826,cpt,SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE,healthchoice,,O,33765.02,2631.25,11244.87,16721.96,6904.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,897,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",healthchoice,,I,20249.18,5831.92,9701.00,9701.00,12149.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,healthchoice,,O,1958.01,473.85,1078.95,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",healthchoice,,O,35.00,2.32,2.96,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",healthchoice,,O,31.88,3.63,4.55,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",healthchoice,,O,44.82,3.29,11.98,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,776,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,healthchoice,,I,14024.63,2935.28,7944.00,9541.48,8414.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",healthchoice,,O,240.10,27.64,213.76,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,healthchoice,,O,31.24,2.94,4.50,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,healthchoice,,O,752.83,92.79,213.76,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74270,cpt,SINGLE CONTRAST X-RAY OF LARGE INTESTINE,healthchoice,,O,725.32,158.70,360.68,360.68,435.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",healthchoice,,O,41.06,11.36,13.10,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,healthchoice,,O,31.88,2.63,15.57,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,287,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",healthchoice,,I,42121.79,7205.02,12538.00,13887.33,25273.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77001,cpt,"FLUOROSCOPIC GUIDANCE FOR INSERTION, REPLACEMENT OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",healthchoice,,O,847.87,227.86,227.86,847.87,508.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37234,cpt,"INSERTION OF STENTS INTO ARTERY IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE, EACH ADDITIONAL VESSEL",healthchoice,,O,98970.54,29201.92,29201.92,29201.92,59382.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22552,cpt,"FUSION OF SPINE BONES WITH REMOVAL OF DISC IN UPPER SPINAL COLUMN BELOW SECOND VERTEBRA OF NECK , ANTERIOR APPROACH",healthchoice,,O,83429.70,11349.44,22181.74,22181.74,50057.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",healthchoice,,O,91.30,18.02,22.99,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82542,cpt,CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE,healthchoice,,O,97.91,11.61,31.13,37.36,58.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,healthchoice,,O,187.57,13.08,187.57,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,healthchoice,,I,36086.42,12423.48,22304.00,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1769,cpt,GUIDE WIRE,healthchoice,,O,338.79,40.02,53.90,304.82,203.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,healthchoice,,O,3238.42,206.67,583.80,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",healthchoice,,O,47.53,3.60,4.59,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74420,cpt,IMAGING OF URINARY TRACT FOLLOWING INJECTION OF A CONTRAST AGENT,healthchoice,,O,1067.98,275.21,275.21,1067.98,243.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,856,ms-drg,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,healthchoice,,I,62065.22,50287.00,50287.00,117603.82,37239.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78070,cpt,NUCLEAR MEDICINE STUDY OF PARATHYROID,healthchoice,,O,1393.12,337.82,777.36,777.36,835.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88333,cpt,"PATHOLOGY CYTOLOGIC EXAMINATION OF SPECIMEN DURING SURGERY, INITIAL SITE",healthchoice,,O,166.34,24.04,56.55,56.55,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22853,cpt,INSERTION OF DEVICE INTO INTERVERTEBRAL DISC SPACE OF SPINE AND FUSION OF VERTEBRAE,healthchoice,,O,79400.06,11349.44,22181.74,22181.74,47640.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5120,cpt,"INJECTION, PEGFILGRASTIM-BMEZ, BIOSIMILAR, (ZIEXTENZO), 0.5 MG",healthchoice,,O,1004.49,80.06,411.12,411.12,602.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",healthchoice,,O,1.42,0.39,5.77,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",healthchoice,,O,127.54,21.16,72.65,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1940,cpt,"INJECTION, FUROSEMIDE, UP TO 20 MG",healthchoice,,O,39.41,0.66,0.66,16.00,23.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,394,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,healthchoice,,I,20150.20,5703.31,10746.00,10874.89,12090.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84432,cpt,THYROGLOBULIN (THYROID RELATED HORMONE) LEVEL,healthchoice,,O,93.19,15.90,20.75,24.00,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,787,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,healthchoice,,I,18030.21,6935.18,12140.00,13885.01,10818.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",healthchoice,,O,85.05,7.99,11.50,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,healthchoice,,O,419.99,136.22,235.88,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,healthchoice,,O,266.35,64.70,197.39,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",healthchoice,,O,377.65,61.44,213.76,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33286,cpt,REMOVAL OF HEART RHYTHM MONITOR FROM UNDER THE SKIN,healthchoice,,O,7365.37,568.32,17558.91,17558.91,4419.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81291,cpt,"GENE ANALYSIS (5, 10-METHYLENETETRAHYDROFOLATE REDUCTASE) COMMON VARIANTS",healthchoice,,O,244.24,81.68,81.68,237.13,146.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",healthchoice,,O,48.36,3.92,4.90,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,healthchoice,,O,67.58,5.08,6.48,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,healthchoice,,O,8198.69,1161.40,2681.34,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76937,cpt,ULTRASOUND GUIDANCE FOR ACCESSING INTO BLOOD VESSEL,healthchoice,,O,690.62,300.63,311.09,359.99,157.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74019,cpt,"X-RAY OF ABDOMEN, 2 VIEWS",healthchoice,,O,365.14,61.44,213.76,213.76,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99215,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 40 MINUTES",healthchoice,,O,569.98,60.00,256.54,427.48,341.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1781,cpt,MESH (IMPLANTABLE),healthchoice,,O,2029.44,404.71,499.78,814.49,1217.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,healthchoice,,O,95.55,14.26,18.19,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73020,cpt,"X-RAY OF SHOULDER, 1 VIEW",healthchoice,,O,240.10,40.75,40.75,100.71,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,healthchoice,,I,17457.81,5769.18,9679.00,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,healthchoice,,O,19198.81,2406.74,5947.31,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,healthchoice,,O,3008.85,207.30,467.04,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",healthchoice,,O,60.16,6.38,8.14,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",healthchoice,,I,18651.52,4921.84,8975.00,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47000,cpt,"NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN",healthchoice,,O,11195.22,1299.27,2548.25,6518.37,6717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,healthchoice,,O,252.59,4.78,194.80,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84484,cpt,"TROPONIN (PROTEIN) ANALYSIS, QUANTITATIVE",healthchoice,,O,176.37,12.22,15.59,186.95,14.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3660,cpt,"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, OFF-THE-SHELF",healthchoice,,O,100.04,19.56,34.63,99.21,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,healthchoice,,O,36.32,4.67,7.52,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83497,cpt,HYDROXYINDOLACETIC ACID (PRODUCT OF METABOLISM) LEVEL,healthchoice,,O,212.36,12.64,16.13,31.86,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",healthchoice,,O,91.43,5.96,5.96,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1751,cpt,"CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN HEMODIALYSIS)",healthchoice,,O,1072.97,129.75,296.86,296.86,643.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),healthchoice,,O,132.12,15.79,27.93,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,healthchoice,,O,50.01,5.20,16.88,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",healthchoice,,O,1029.19,93.54,213.76,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88302,cpt,PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE,healthchoice,,O,148.64,44.04,44.04,89.81,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),healthchoice,,O,53.08,5.52,16.10,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",healthchoice,,O,114.43,3.13,3.13,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,healthchoice,,O,784.37,233.55,671.99,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28289,cpt,CORRECTION OF RIGID DEFORMITY OF FIRST JOINT OF BIG TOE,healthchoice,,O,20673.13,5060.32,5060.32,5060.32,12403.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",healthchoice,,O,12.72,0.71,5.25,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19084,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND, EACH ADDITIONAL GROWTH",healthchoice,,O,13165.69,1257.73,2878.34,2878.34,7899.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,healthchoice,,O,547.73,91.89,547.73,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9000,cpt,"INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG",healthchoice,,O,25.20,1.82,14.05,14.05,15.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",healthchoice,,O,281.00,8.75,265.10,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,236,ms-drg,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,healthchoice,,I,167790.54,25758.09,46477.00,46477.00,100674.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82085,cpt,ALDOLASE (ENZYME) LEVEL,healthchoice,,O,50.72,6.25,12.14,28.91,30.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",healthchoice,,O,93.19,13.33,17.00,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",healthchoice,,O,113.79,13.73,2736.00,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,healthchoice,,O,76.68,5.83,12.14,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,healthchoice,,O,90.02,12.05,17.04,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,healthchoice,,I,6.27,0.90,24.82,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,331,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,healthchoice,,I,49456.93,5489.60,19473.00,19473.00,29674.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85347,cpt,"COAGULATION TIME MEASUREMENT, ACTIVATED",healthchoice,,O,116.31,1.48,3.13,62.61,22.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1776,cpt,JOINT DEVICE (IMPLANTABLE),healthchoice,,O,3788.11,198.44,1187.73,18412.83,2272.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",healthchoice,,O,622.77,61.44,213.76,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,healthchoice,,O,2289.17,554.60,1403.37,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,healthchoice,,O,101.45,12.63,18.25,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",healthchoice,,O,50.02,5.17,10.06,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),healthchoice,,O,91.30,14.31,28.97,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",healthchoice,,O,36.32,4.04,5.36,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80375,cpt,"DRUGS OR SUBSTANCES MEASUREMENT, 1-3",healthchoice,,O,337.65,337.65,337.65,337.65,202.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28308,cpt,INCISION TO STRAIGHTEN TOE BONE (OTHER THAN THE BIG TOE) AT THE MIDFOOT BONE (METATARSAL) LEVEL,healthchoice,,O,31569.82,5060.32,5060.32,5847.07,18941.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,healthchoice,,O,9.11,0.50,17.45,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),healthchoice,,O,50.01,5.20,16.10,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,healthchoice,,O,50.00,8.06,16.19,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",healthchoice,,O,51.68,6.81,22.95,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88331,cpt,"PATHOLOGY EXAMINATION OF SPECIMEN DURING SURGERY, FIRST TISSUE BLOCK",healthchoice,,O,464.83,198.20,198.20,198.20,278.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,healthchoice,,O,402.67,93.28,213.76,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",healthchoice,,O,0.59,0.15,0.23,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,healthchoice,,O,101.33,11.74,31.00,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",healthchoice,,O,635.27,137.73,635.27,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29581,cpt,APPLICATION OF VEIN WOUND COMPRESSION SYSTEM LOWER LEG BELOW KNEE INCLUDING ANKLE AND FOOT,healthchoice,,O,1305.86,230.97,554.17,926.72,783.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,healthchoice,,O,899.10,136.27,777.36,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,healthchoice,,O,30.08,5.04,6.40,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",healthchoice,,O,350.39,39.08,77.48,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",healthchoice,,O,70.01,13.01,27.61,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",healthchoice,,O,801.60,189.21,479.82,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92960,cpt,EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT,healthchoice,,O,854.12,508.26,905.36,905.36,512.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3480,cpt,"INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ",healthchoice,,O,2.49,0.19,1.30,1.30,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",healthchoice,,O,162.48,33.29,33.29,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,96.29,17.55,44.88,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),healthchoice,,O,65.11,4.25,10.51,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23470,cpt,PARTIAL REPLACEMENT OF SHOULDER JOINT,healthchoice,,O,58187.49,22181.74,22181.74,22181.74,34912.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",healthchoice,,O,266.35,64.70,197.39,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",healthchoice,,O,63.63,6.74,8.59,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",healthchoice,,O,60.03,13.90,17.73,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0780,cpt,"INJECTION, PROCHLORPERAZINE, UP TO 10 MG",healthchoice,,O,84.30,3.36,3.36,62.66,50.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28270,cpt,INCISION OF JOINT CAPSULE OF FOOT AND TOE,healthchoice,,O,43492.65,2630.53,22181.74,22181.74,26095.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52352,cpt,REMOVAL OR MANIPULATION OF STONE IN URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE,healthchoice,,O,22874.73,2781.70,5448.70,5448.70,13724.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),healthchoice,,O,166.34,27.39,34.93,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9045,cpt,"INJECTION, CARBOPLATIN, 50 MG",healthchoice,,O,17.50,2.78,10.80,45.93,10.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62320,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK,healthchoice,,O,1594.50,564.08,1107.52,1436.46,956.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,healthchoice,,O,221.79,37.03,48.28,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,healthchoice,,O,190.07,28.97,190.07,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",healthchoice,,O,107.59,3.13,3.13,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3380,cpt,"INJECTION, VEDOLIZUMAB, 1 MG",healthchoice,,O,68.13,21.84,3747.37,3747.37,40.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,healthchoice,,I,26508.25,6362.98,16941.00,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,healthchoice,,O,646.53,93.49,181.70,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93660,cpt,EVALUATION OF HEART FUNCTION USING TILT TABLE,healthchoice,,O,1208.02,288.64,821.83,821.83,724.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,healthchoice,,O,811.59,92.97,181.70,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,132.12,25.53,44.88,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,healthchoice,,O,3055.12,206.42,467.04,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,healthchoice,,O,1205.09,132.64,362.57,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",healthchoice,,O,373.90,92.59,213.76,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84260,cpt,SEROTONIN (HORMONE) LEVEL,healthchoice,,O,234.76,4.98,4.98,33.15,140.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84244,cpt,RENIN (KIDNEY ENZYME) LEVEL,healthchoice,,O,145.10,21.55,27.49,27.49,87.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9370,cpt,VINCRISTINE SULFATE 1 MG INJ,healthchoice,,O,58.11,8.53,8.53,49.70,34.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",healthchoice,,O,93.77,21.35,74.15,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,healthchoice,,O,1952.12,144.93,144.93,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",healthchoice,,O,19.52,4.40,4.40,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1300,cpt,"INJECTION, ECULIZUMAB, 10 MG",healthchoice,,O,975.43,164.71,23209.20,23209.20,585.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",healthchoice,,O,502.71,78.63,476.10,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,673,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,healthchoice,,I,69347.05,21366.97,39818.00,39818.00,41608.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",healthchoice,,O,91.30,6.24,6.24,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",healthchoice,,O,183.82,20.70,42.53,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",healthchoice,,O,218.83,30.93,59.50,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,healthchoice,,O,862.88,61.44,213.76,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,healthchoice,,O,647.78,92.97,213.76,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",healthchoice,,O,715.30,48.27,213.76,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",healthchoice,,O,151.46,8.03,16.74,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80307,cpt,"TESTING FOR PRESENCE OF DRUG, BY CHEMISTRY ANALYZERS",healthchoice,,O,197.60,49.05,77.68,77.68,118.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",healthchoice,,O,50.02,5.00,10.01,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,healthchoice,,O,40.11,4.18,5.34,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0744,cpt,"INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG",healthchoice,,O,67.52,16.35,16.35,50.64,40.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73723,cpt,MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST,healthchoice,,O,3471.56,325.59,736.86,3471.56,2082.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,147.58,21.05,44.88,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",healthchoice,,O,203.82,32.52,12292.00,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86148,cpt,PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUREMENT,healthchoice,,O,87.30,12.69,20.88,46.36,52.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,healthchoice,,O,567.74,115.42,567.74,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",healthchoice,,O,66.26,9.83,22.80,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",healthchoice,,O,267.61,58.94,173.76,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,healthchoice,,O,754.07,203.12,396.98,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",healthchoice,,O,3595.37,208.18,736.86,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L1830,cpt,"KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, OFF-THE-SHELF",healthchoice,,O,405.73,68.25,232.04,232.04,243.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",healthchoice,,O,25.94,5.08,6.48,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",healthchoice,,O,56.26,6.34,8.09,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,healthchoice,,O,287.62,21.62,149.57,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,healthchoice,,O,80.09,5.66,11.80,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,healthchoice,,I,19710.37,4922.26,11715.00,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,healthchoice,,O,231.34,36.98,97.72,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29880,cpt,REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE,healthchoice,,O,21409.78,2586.84,5060.32,7284.82,12845.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,healthchoice,,O,989.19,218.69,525.86,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80156,cpt,"CARBAMAZEPINE LEVEL, TOTAL",healthchoice,,O,108.53,14.42,18.21,19.65,65.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6197,cpt,"ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING",healthchoice,,O,25.00,9.00,25.00,39.75,15.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",healthchoice,,O,184.32,70.33,184.32,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,healthchoice,,O,4054.33,322.67,736.86,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,healthchoice,,O,26791.18,4521.08,8860.66,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",healthchoice,,O,65.06,17.18,22.92,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,healthchoice,,O,89.65,6.58,22.48,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86920,cpt,"BLOOD UNIT COMPATIBILITY TEST, IMMEDIATE SPIN TECHNIQUE",healthchoice,,O,378.98,183.76,196.56,291.33,81.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),healthchoice,,O,3857.66,938.20,3303.91,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,healthchoice,,O,3055.12,203.12,467.04,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,healthchoice,,O,138.03,20.16,26.54,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",healthchoice,,O,4496.04,1078.59,2743.52,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45381,cpt,"INJECTIONS BENEATH LINING OF LARGE BOWEL, USING A FLEXIBLE ENDOSCOPE",healthchoice,,O,6984.17,1407.16,3146.55,3276.29,4190.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36569,cpt,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER FOR INFUSION (PICC), PATIENT 5 YEARS OR OLDER",healthchoice,,O,2853.53,1292.67,2529.35,2529.35,1712.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,785,ms-drg,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,healthchoice,,I,14108.83,5205.40,10198.00,10198.00,8465.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),healthchoice,,O,50.01,5.20,17.99,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",healthchoice,,O,250.10,18.15,23.15,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,healthchoice,,O,107.35,17.69,24.54,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",healthchoice,,O,327.67,47.93,88.69,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75635,cpt,CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES WITH CONTRAST,healthchoice,,O,1952.12,159.41,360.68,528.47,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9181,cpt,"INJECTION, ETOPOSIDE, 10 MG",healthchoice,,O,4.37,0.99,8.01,8.01,2.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85384,cpt,FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,healthchoice,,O,56.26,7.19,12.15,75.59,11.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,779,ms-drg,ABORTION WITHOUT D&C,healthchoice,,I,5098.91,4359.27,11608.00,11608.00,3059.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88313,cpt,SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE INCLUDING INTERPRETATION AND REPORT,healthchoice,,O,119.15,50.94,50.94,94.72,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",healthchoice,,O,290.00,66.00,182.65,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2765,cpt,"INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG",healthchoice,,O,79.57,14.40,19.34,59.62,47.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,473,ms-drg,CERVICAL SPINAL FUSION WITHOUT CC/MCC,healthchoice,,I,73180.56,15169.99,28890.00,74397.72,43908.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,healthchoice,,O,50.02,4.84,10.06,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",healthchoice,,O,8992.46,1299.03,2549.24,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,healthchoice,,O,93.19,15.38,26.01,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,healthchoice,,O,130.11,30.48,49.08,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",healthchoice,,O,82.88,8.42,22.25,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82088,cpt,ALDOSTERONE HORMONE LEVEL,healthchoice,,O,209.99,28.44,28.44,40.99,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",healthchoice,,O,54.32,13.67,11037.60,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",healthchoice,,O,2526.13,486.47,1144.94,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0696,cpt,"INJECTION, CEFTRIAXONE SODIUM, PER 250 MG",healthchoice,,O,32.72,0.60,0.60,14.73,19.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,healthchoice,,O,175.06,87.53,111.34,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,healthchoice,,O,298.87,98.24,256.45,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",healthchoice,,O,67.24,14.75,18.81,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,286,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",healthchoice,,I,55760.94,13702.32,24171.00,26072.17,33456.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",healthchoice,,O,1680.75,111.66,966.51,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",healthchoice,,O,90.84,3.51,3.51,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11420,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF SCALP, NECK, HANDS, FEET, OR GENITALS, 0.5 CM OR LESS",healthchoice,,O,24424.89,1325.54,7879.69,7879.69,14654.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9311,cpt,"INJECTION, RITUXIMAB 10 MG AND HYALURONIDASE",healthchoice,,O,175.06,36.40,5983.60,5983.60,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2617,cpt,"STENT, NON-CORONARY, TEMPORARY, WITHOUT DELIVERY SYSTEM",healthchoice,,O,922.91,235.25,235.25,305.79,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,healthchoice,,O,60.16,11.87,15.14,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",healthchoice,,O,754.07,158.88,396.98,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,healthchoice,,O,908.09,156.44,359.78,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,healthchoice,,O,101.45,3.58,3.58,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",healthchoice,,O,240.10,61.44,173.76,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64718,cpt,RELEASE AND/OR RELOCATION OF ULNAR NERVE AT ELBOW,healthchoice,,O,18467.33,1563.58,6111.56,14075.51,11080.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",healthchoice,,O,112.07,9.78,20.38,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",healthchoice,,O,348.89,46.07,173.76,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58558,cpt,BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE,healthchoice,,O,24068.17,2373.69,4806.65,19315.13,14440.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",healthchoice,,O,345.14,36.70,74.15,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82552,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, ISOENZYMES",healthchoice,,O,66.05,9.38,16.74,25.20,39.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1630,cpt,"INJECTION, HALOPERIDOL, UP TO 5 MG",healthchoice,,O,78.96,21.20,21.20,59.22,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",healthchoice,,O,331.51,119.35,235.88,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",healthchoice,,O,345.14,75.82,345.14,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,healthchoice,,O,112.55,9.00,25.00,1270.41,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",healthchoice,,O,117.61,12.87,16.09,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86337,cpt,INSULIN ANTIBODY MEASUREMENT,healthchoice,,O,104.49,20.98,26.76,26.76,62.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,healthchoice,,I,19597.90,4492.16,10285.50,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",healthchoice,,O,94.14,7.61,9.71,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77002,cpt,FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE,healthchoice,,O,1932.70,187.94,187.94,1101.64,1159.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,healthchoice,,O,102.63,10.90,26.51,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",healthchoice,,O,238.30,71.54,145.02,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,healthchoice,,O,187.57,14.84,193.51,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,761,ms-drg,MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,healthchoice,,I,18037.21,6447.00,6447.00,6447.00,10822.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50200,cpt,"NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN",healthchoice,,O,9979.95,1172.33,2549.24,3057.19,5987.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,healthchoice,,O,4054.33,319.17,921.08,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",healthchoice,,O,8.17,0.89,2.29,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9190,cpt,"INJECTION, FLUOROURACIL, 500 MG",healthchoice,,O,9.25,1.74,20.90,20.90,5.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88309,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, HIGH COMPLEXITY",healthchoice,,O,696.07,195.29,296.80,296.80,417.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1561,cpt,"INJECTION, IMMUNE GLOBULIN, (GAMUNEX-C/GAMMAKED), NON-LYOPHILIZED (E.G., LIQUID), 500 MG",healthchoice,,O,181.32,15.19,57.73,57.73,108.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70482,cpt,CT SCAN OF CRANIAL CAVITY BEFORE AND AFTER CONTRAST,healthchoice,,O,2175.56,360.68,360.68,417.97,1305.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1439,cpt,"INJECTION, FERRIC CARBOXYMALTOSE, 1 MG",healthchoice,,O,4.71,0.79,1.26,4.99,2.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,healthchoice,,O,1753.28,94.47,267.20,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",healthchoice,,O,318.12,56.64,245.22,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,healthchoice,,E,880.03,214.07,525.59,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",healthchoice,,O,422.68,79.92,422.68,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80145,cpt,MEASUREMENT OF ADALIMUMAB,healthchoice,,O,96.43,23.48,96.43,96.43,57.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84305,cpt,SOMATOMEDIN (GROWTH FACTOR) LEVEL,healthchoice,,O,256.01,20.83,26.58,34.48,153.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",healthchoice,,O,45.06,8.66,22.41,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1819,cpt,SURGICAL TISSUE LOCALIZATION AND EXCISION DEVICE (IMPLANTABLE),healthchoice,,O,656.94,40.85,40.85,183.05,394.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20600,cpt,ASPIRATION AND/OR INJECTION OF SMALL JOINT OR JOINT CAPSULE,healthchoice,,O,720.58,867.89,867.89,5970.31,432.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84112,cpt,CERVICOVAGINAL SECRETION OF PLACENTA PROTEIN,healthchoice,,O,257.65,98.11,122.64,257.65,49.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64484,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",healthchoice,,O,7561.13,743.72,1449.83,2728.97,4536.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,healthchoice,,O,412.67,92.59,213.76,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9538,cpt,"TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES",healthchoice,,O,218.69,67.25,67.25,67.25,131.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,healthchoice,,O,41.26,8.55,68.47,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",healthchoice,,O,176.32,30.07,52.92,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52332,cpt,INSERTION OF STENT IN URINARY DUCT (URETER) USING AN ENDOSCOPE,healthchoice,,O,20654.85,2781.70,5448.70,17672.06,12392.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",healthchoice,,O,101.45,11.20,14.29,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",healthchoice,,O,52.60,5.67,11.80,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",healthchoice,,O,90.84,9.28,11.84,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",healthchoice,,O,108.49,21.05,44.88,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,healthchoice,,O,69.59,8.01,24.63,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9035,cpt,"PLATELETS, PHERESIS, LEUKOCYTES REDUCED, EACH UNIT",healthchoice,,O,2.35,1.69,2.35,2.35,1.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45330,cpt,DIAGNOSTIC EXAMINATION OF THE LOWER PORTION OF THE LARGE BOWEL USING AN ENDOSCOPE,healthchoice,,O,3245.25,719.92,2991.30,2991.30,1947.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,healthchoice,,O,842.86,94.39,213.76,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2628,cpt,"CATHETER, OCCLUSION",healthchoice,,O,405.17,139.86,161.44,303.88,243.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,698,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,healthchoice,,I,27219.24,6918.41,18262.00,18262.00,16331.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96409,cpt,ADMINISTRATION OF CHEMOTHERAPY INTO VEIN USING PUSH TECHNIQUE,healthchoice,,O,448.94,102.13,361.50,361.50,269.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",healthchoice,,O,221.79,37.73,48.13,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",healthchoice,,O,40.11,3.87,4.94,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3370,cpt,"INJECTION, VANCOMYCIN HCL, 500 MG",healthchoice,,O,70.84,21.28,21.28,66.54,42.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,healthchoice,,O,93.19,11.22,15.06,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52281,cpt,DILATION OF BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,healthchoice,,O,15500.95,1609.63,3153.30,5605.90,9300.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86777,cpt,ANALYSIS FOR ANTIBODY TO TOXOPLASMA (PARASITE),healthchoice,,O,152.18,17.99,17.99,17.99,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86617,cpt,CONFIRMATION TEST FOR ANTIBODY TO BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),healthchoice,,O,35.39,15.26,29.04,29.04,21.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,healthchoice,,O,1880.84,106.44,450.85,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9503,cpt,"TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES",healthchoice,,O,225.10,13.65,13.65,168.82,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59820,cpt,TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER,healthchoice,,O,18205.61,2373.69,4806.65,13386.01,10923.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9037,cpt,"PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",healthchoice,,O,3190.10,638.19,957.29,2179.70,1914.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,healthchoice,,O,323.88,75.26,173.76,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,healthchoice,,I,16493.28,2797.28,2797.28,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21014,cpt,REMOVAL OF (2 CENTIMETERS OR GREATER) MUSCLE GROWTH OF FACE AND SCALP,healthchoice,,O,18703.97,2243.72,4391.53,4391.53,11222.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92978,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL OR GRAFT WITH REVIEW BY RADIOLOGIST, INITIAL VESSEL",healthchoice,,O,81139.05,9201.74,18046.03,27750.61,48683.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87106,cpt,"FUNGAL CULTURE, YEAST",healthchoice,,O,112.65,7.28,7.28,16.71,67.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64480,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",healthchoice,,O,6973.44,739.73,1630.78,2920.54,4184.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9100,cpt,PATHOGEN(S) TEST FOR PLATELETS,healthchoice,,O,142.13,30.02,65.53,97.18,85.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1459,cpt,"INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG",healthchoice,,O,90.06,10.62,54.25,54.25,54.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84446,cpt,VITAMIN E LEVEL,healthchoice,,O,83.76,7.84,17.73,66.59,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",healthchoice,,E,5953.08,743.91,1746.82,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42820,cpt,REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS),healthchoice,,O,18532.26,4720.05,9077.44,13899.20,3780.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",healthchoice,,O,135.66,25.29,32.26,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",healthchoice,,O,41.28,5.10,6.53,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86778,cpt,ANALYSIS FOR ANTIBODY (IGM) TO TOXOPLASMA (PARASITE),healthchoice,,O,152.18,18.01,18.01,18.01,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0409,revCode,OTHER IMAGING SERVICES OTHER,healthchoice,,O,1393.12,304.37,311.09,359.99,835.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57425,cpt,SURGICAL REPAIR OF VAGINAL DEFECT USING AN ENDOSCOPE,healthchoice,,O,45441.30,8045.59,27112.46,27112.46,27264.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,healthchoice,,O,256.35,58.45,118.07,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,healthchoice,,I,5986.20,1090.17,2495.75,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0640,cpt,"INJECTION, LEUCOVORIN CALCIUM, PER 50 MG",healthchoice,,O,24.48,4.06,38.80,38.80,14.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",healthchoice,,O,65.11,10.15,18.38,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83090,cpt,HOMOCYSTEINE (AMINO ACID) LEVEL,healthchoice,,O,48.76,14.61,22.40,22.40,29.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,640,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",healthchoice,,I,24682.45,5356.97,14419.00,14419.00,14809.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76098,cpt,IMAGING OF SURGICAL SPECIMEN,healthchoice,,O,1318.08,258.94,258.94,557.24,790.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",healthchoice,,O,116.79,7.81,7.81,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,healthchoice,,O,119.15,21.42,27.79,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,healthchoice,,O,176.37,11.81,15.63,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38525,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, OPEN PROCEDURE",healthchoice,,O,34276.96,4931.97,8766.28,12984.24,20566.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80185,cpt,"PHENYTOIN LEVEL, TOTAL",healthchoice,,O,108.53,12.98,16.56,17.58,15.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,healthchoice,,O,3953.80,1077.08,2642.61,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76882,cpt,LIMITED ULTRASOUND SCAN OF JOINT OR OTHER EXTREMITY STRUCTURE LACKING BLOOD VESSELS,healthchoice,,O,266.63,213.76,213.76,213.76,159.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,healthchoice,,I,75778.57,12009.61,21788.00,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,healthchoice,,O,67.58,8.51,10.85,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",healthchoice,,O,241.34,30.35,59.50,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,healthchoice,,O,521.47,92.78,213.76,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19125,cpt,"REMOVAL OF GROWTH OF BREAST IDENTIFIED BY X-RAY MARKER, FIRST GROWTH",healthchoice,,O,21433.30,5844.26,5844.26,5844.26,12859.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",healthchoice,,O,13.78,1.69,5.34,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,healthchoice,,E,2880.28,490.23,1045.72,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,healthchoice,,O,96.77,32.33,32.33,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,788,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,healthchoice,,I,14986.74,7771.24,9942.00,10724.94,8992.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,healthchoice,,O,84.93,8.09,27.38,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9206,cpt,"INJECTION, IRINOTECAN, 20 MG",healthchoice,,O,16.23,4.11,36.90,36.90,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,healthchoice,,O,71.96,9.99,16.56,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,healthchoice,,O,70.06,8.01,10.21,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",healthchoice,,O,199.37,74.90,145.02,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,healthchoice,,O,3055.12,206.42,583.80,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86738,cpt,ANALYSIS FOR ANTIBODY TO MYCOPLASMA (BACTERIA),healthchoice,,O,33.10,16.55,16.55,16.55,19.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,784,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH CC,healthchoice,,I,14784.88,6415.40,11897.00,20022.84,8870.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,healthchoice,,O,101.45,15.87,20.23,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",healthchoice,,O,230.63,78.33,88.34,159.67,138.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58561,cpt,REMOVAL OF GROWTH OF MUSCLE OF UTERUS USING AN ENDOSCOPE,healthchoice,,O,26766.09,7879.69,7879.69,7879.69,16059.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37224,cpt,"BALLOON DILATION OF ARTERIES IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",healthchoice,,O,41978.34,4519.00,18046.03,18046.03,25187.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,healthchoice,,O,1590.91,567.62,1322.39,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",healthchoice,,O,88.56,20.43,20.43,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5110,cpt,"INJECTION, FILGRASTIM-AAFI, BIOSIMILAR, (NIVESTYM), 1 MICROGRAM",healthchoice,,O,2.63,0.29,0.34,0.82,1.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,healthchoice,,O,1343.10,94.48,1343.10,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",healthchoice,,O,85.39,17.80,25.89,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",healthchoice,,O,357.64,32.78,173.76,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84166,cpt,"PROTEIN MEASUREMENT, BODY FLUID",healthchoice,,O,61.34,6.87,22.29,30.15,20.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73600,cpt,"X-RAY OF ANKLE, 2 VIEWS",healthchoice,,O,267.61,61.44,173.76,173.76,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",healthchoice,,O,4.27,1.25,27.31,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",healthchoice,,O,231.34,36.97,97.72,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",healthchoice,,O,226.34,61.44,173.76,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,866,ms-drg,VIRAL ILLNESS WITHOUT MCC,healthchoice,,I,15194.06,2895.07,10253.00,10253.00,9116.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9312,cpt,"INJECTION, RITUXIMAB, 10 MG",healthchoice,,O,338.23,76.93,6015.75,6015.75,202.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89060,cpt,CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,healthchoice,,O,40.11,7.18,11.00,40.11,8.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4616,cpt,TUBING (OXYGEN) PER FOOT; MEDICAL AND SURGICAL SUPPLIES - RESPIRATORY SUPPLIES AND EQUIPMENT,healthchoice,,O,1580.92,500.52,1675.77,1675.77,948.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,92.99,21.05,44.88,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77072,cpt,IMAGING FOR BONE AGE ASSESSMENT,healthchoice,,O,240.10,52.12,213.76,213.76,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12042,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF NECK, HANDS, FEET, AND/OR GENITALS",healthchoice,,O,14792.08,1273.00,2549.24,2549.24,8875.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",healthchoice,,O,36.32,6.91,17.18,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,healthchoice,,I,14560.83,3337.55,8371.00,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,345,ms-drg,MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,healthchoice,,I,76812.78,17681.00,17681.00,17681.00,46087.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",healthchoice,,O,108.88,10.16,21.18,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,healthchoice,,O,53.76,5.92,8.00,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,healthchoice,,O,71.96,15.59,19.89,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1756,cpt,"INJECTION, IRON SUCROSE, 1 MG",healthchoice,,O,2.08,0.23,0.23,0.94,1.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",healthchoice,,O,122.56,1.48,1.48,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,healthchoice,,E,292.62,111.66,174.61,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9539,cpt,"TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES",healthchoice,,O,225.10,85.93,231.85,231.85,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",healthchoice,,O,318.54,72.28,99.82,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82390,cpt,CERULOPLASMIN (PROTEIN) LEVEL,healthchoice,,O,71.96,2.18,2.18,26.69,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,healthchoice,,O,145.10,29.21,51.60,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29877,cpt,REMOVAL OR SHAVING OF KNEE JOINT CARTILAGE USING AN ENDOSCOPE,healthchoice,,O,20747.46,2550.50,5060.32,7792.87,12448.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",healthchoice,,O,7.91,1.68,1.68,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",healthchoice,,O,68064.84,9197.64,18046.03,27750.61,40838.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,310,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,healthchoice,,I,15215.00,3354.50,6281.00,6648.19,9129.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0461,cpt,"INJECTION, ATROPINE SULFATE, 0.01 MG",healthchoice,,O,1.15,0.19,11.00,11.00,0.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2210,cpt,"INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG",healthchoice,,O,126.15,25.92,28.17,38.74,75.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,healthchoice,,O,770.33,202.50,396.98,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,healthchoice,,O,30.08,3.63,4.55,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,healthchoice,,O,27089.15,2439.68,5029.38,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36838,cpt,REPAIR OF HEMODIALYSIS ACCESS IN ARM,healthchoice,,O,19456.81,7711.31,8737.59,8737.59,11674.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,healthchoice,,I,1386.23,364.58,2772.46,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74170,cpt,CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,healthchoice,,O,2708.71,159.22,450.85,612.94,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",healthchoice,,O,632.77,59.44,279.90,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29881,cpt,REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE,healthchoice,,O,21489.40,2516.47,5060.32,7609.83,3025.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,healthchoice,,O,22.60,4.56,4.56,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11400,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF BODY, ARMS, OR LEGS, 0.5 CM OR LESS",healthchoice,,O,27553.29,5844.26,5844.26,5844.26,16531.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82330,cpt,"CALCIUM LEVEL, IONIZED",healthchoice,,O,89.65,13.41,17.10,21.16,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0101,cpt,CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION,healthchoice,,O,313.23,66.78,113.78,166.01,187.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",healthchoice,,O,10827.72,2513.53,2853.58,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,healthchoice,,O,183.82,20.77,42.53,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29823,cpt,REMOVAL OF EXTENSIVE SHOULDER JOINT TISSUE USING AN ENDOSCOPE,healthchoice,,O,29196.97,2631.16,5060.32,5060.32,17518.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73552,cpt,"X-RAY OF THIGH BONE, MINIMUM 2 VIEWS",healthchoice,,O,327.63,38.17,173.76,173.76,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",healthchoice,,O,38.92,3.91,4.99,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",healthchoice,,O,103.81,18.28,23.23,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,healthchoice,,O,330.33,24.94,31.81,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,healthchoice,,I,18716.13,4221.86,10708.00,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",healthchoice,,O,338.89,30.54,59.50,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,healthchoice,,O,236.36,11.30,14.41,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,healthchoice,,O,647.78,92.64,213.76,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",healthchoice,,O,348.89,61.44,173.76,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,healthchoice,,O,83.78,3.34,8.03,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9965,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 100-199 MG/ML IODINE CONCENTRATION, PER ML",healthchoice,,O,7.98,1.70,1.70,6.34,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70470,cpt,CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST,healthchoice,,O,2708.71,159.41,450.85,450.85,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",healthchoice,,O,1252.50,103.81,1520.52,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,healthchoice,,O,5444.73,938.10,2539.86,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",healthchoice,,O,16.70,0.37,0.89,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",healthchoice,,I,142.55,29.95,29.95,151.10,85.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",healthchoice,,O,16.23,1.83,1.83,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,579,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",healthchoice,,I,79681.30,19975.13,100840.81,100840.81,47808.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89051,cpt,BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,healthchoice,,O,42.58,5.49,8.40,30.20,6.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,healthchoice,,O,2599.91,94.47,267.20,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,healthchoice,,O,50.01,3.11,6.48,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",healthchoice,,O,147.58,21.05,44.88,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",healthchoice,,O,4.99,0.54,138.02,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28313,cpt,RECONSTRUCTION OF SOFT TISSUE ANGULAR DEFORMITY OF TOE,healthchoice,,O,36456.69,5060.32,5060.32,5847.07,21874.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",healthchoice,,O,85.03,16.92,27.73,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80051,cpt,"BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM, CHLORIDE, CARBON DIOXIDE)",healthchoice,,O,65.11,6.87,8.76,48.83,39.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",healthchoice,,O,240.10,61.44,173.76,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33208,cpt,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER INCLUDING UPPER AND LOWER CHAMBER ELECTRODES,healthchoice,,O,42383.14,9221.09,17558.91,17558.91,25429.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,healthchoice,,O,1869.58,206.26,467.04,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36475,cpt,DESTRUCTION OF FIRST INCOMPETENT VEIN OF ARM OR LEG USING RADIOFREQUENCY AND IMAGING GUIDANCE,healthchoice,,O,27732.57,3410.10,10128.50,10128.50,16639.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",healthchoice,,O,192.85,42.50,171.65,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9228,cpt,"INJECTION, IPILIMUMAB, 1 MG",healthchoice,,O,624.02,124.58,188.98,827.27,374.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,healthchoice,,O,143.17,18.59,23.70,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,healthchoice,,O,94.38,2.18,2.18,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",healthchoice,,O,4116.84,594.86,897.34,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,healthchoice,,O,45.13,4.38,4.38,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1898,cpt,"LEAD, PACEMAKER, OTHER THAN TRANSVENOUS VDD SINGLE PASS",healthchoice,,O,6877.16,1251.24,1251.24,1251.24,4126.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37228,cpt,"BALLOON DILATION OF ARTERY OF ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",healthchoice,,O,63926.71,9198.02,18046.03,18046.03,38356.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,healthchoice,,O,303.87,29.81,118.07,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",healthchoice,,O,3395.81,1103.79,1449.83,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",healthchoice,,O,101.45,14.76,14.76,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,healthchoice,,O,28.83,5.60,14.41,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9516,cpt,"IODINE I-123 SODIUM IODIDE, DIAGNOSTIC, PER 100 MICROCURIES, UP TO 999 MICROCURIES",healthchoice,,O,153.80,97.81,97.81,104.16,92.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",healthchoice,,O,3919.67,159.22,1834.45,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73090,cpt,"X-RAY OF FOREARM, 2 VIEWS",healthchoice,,O,245.09,38.03,173.76,183.82,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,healthchoice,,O,93.19,5.27,62.68,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,healthchoice,,I,163.02,40.45,569.98,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",healthchoice,,O,691.54,93.84,213.76,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",healthchoice,,O,312.63,61.44,173.76,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",healthchoice,,O,4184.57,938.10,2073.32,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87210,cpt,SMEAR FOR INFECTIOUS AGENTS,healthchoice,,O,101.45,7.28,7.28,76.09,19.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L0120,cpt,"CERVICAL, FLEXIBLE, NON-ADJUSTABLE, PREFABRICATED, OFF-THE-SHELF (FOAM COLLAR)",healthchoice,,O,48.76,13.09,13.09,13.09,29.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28750,cpt,FUSION OF GREAT TOE AT THE JOINT WITH THE FOOT,healthchoice,,O,33226.41,5666.83,11244.87,11244.87,19935.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",healthchoice,,O,4.12,1.10,1.10,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52351,cpt,"DIAGNOSTIC EXAMINATION OF THE BLADDER, BLADDER CANAL (URETHRA), AND URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE",healthchoice,,O,17224.91,2833.20,5448.70,9916.07,10334.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3301,cpt,"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG",healthchoice,,O,21.30,1.21,1.21,9.59,12.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1900,cpt,"LEAD, LEFT VENTRICULAR CORONARY VENOUS SYSTEM",healthchoice,,O,8593.85,1563.58,1563.58,1563.58,5156.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",healthchoice,,O,120.33,16.46,21.00,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86141,cpt,"MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION, HIGH SENSITIVITY",healthchoice,,O,83.78,12.69,16.19,17.55,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36819,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, UPPER ARM, BASILIC VEIN",healthchoice,,O,28569.86,4455.22,8737.59,8737.59,17141.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,healthchoice,,O,122.03,31.49,34.35,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1763,cpt,"CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)",healthchoice,,O,5191.09,570.72,1267.40,4126.91,3114.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,healthchoice,,O,52.60,6.75,8.61,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37766,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, GREATER THAN 20 INCISIONS",healthchoice,,O,24542.50,3410.10,5064.25,5064.25,14725.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,healthchoice,,O,513.11,156.86,360.68,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78709,cpt,"NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT OF BLOOD FLOW AND FUNCTION, WITH OR WITHOUT DRUGS, MULTIPLE STUDIES",healthchoice,,O,1411.87,444.24,1009.00,1009.00,847.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69205,cpt,REMOVAL OF FOREIGN BODY FROM EAR CANAL UNDER ANESTHESIA,healthchoice,,O,13077.72,1325.54,13123.66,13123.66,7846.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36247,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL THIRD ORDER BRANCH",healthchoice,,O,26881.27,2581.62,29201.92,29201.92,16128.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12034,cpt,"REPAIR OF WOUND (7.6 TO 12.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",healthchoice,,O,18980.81,325.18,2549.24,4577.95,11388.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,healthchoice,,O,30.49,2.32,2.96,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",healthchoice,,O,331.50,12.98,16.55,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2060,cpt,"INJECTION, LORAZEPAM, 2 MG",healthchoice,,O,78.01,14.44,14.44,77.43,46.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,healthchoice,,O,100.03,11.53,14.71,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",healthchoice,,O,50.72,5.89,7.51,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",healthchoice,,O,183.82,63.60,79.74,79.74,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57522,cpt,REMOVAL OR DESTRUCTION OF CERVIX WITH ELECTRICAL CAUTERY,healthchoice,,O,19085.48,2436.56,4806.65,5572.53,11451.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2621,cpt,"PACEMAKER, OTHER THAN SINGLE OR DUAL CHAMBER (IMPLANTABLE)",healthchoice,,O,31553.25,5740.84,5740.84,5740.84,18931.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",healthchoice,,O,135.66,14.84,22.99,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",healthchoice,,O,270.00,64.89,128.82,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,healthchoice,,O,152.18,14.75,19.10,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74150,cpt,CT SCAN OF ABDOMEN WITHOUT CONTRAST,healthchoice,,O,1344.34,95.70,213.76,766.27,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19081,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, FIRST GROWTH",healthchoice,,O,6548.62,1273.00,2549.24,5582.75,3929.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",healthchoice,,O,419.99,46.79,235.88,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,healthchoice,,O,188.17,19.53,118.07,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,healthchoice,,O,42.51,2.00,2.81,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5103,cpt,"INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG",healthchoice,,O,109.30,19.12,22.24,109.12,65.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28008,cpt,INCISION OF TISSUES OF MUSCLE COMPARTMENT OF FOOT AND/OR TOE,healthchoice,,O,19100.45,5060.32,5060.32,15484.76,11460.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,healthchoice,,O,3580.43,810.94,1635.17,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,healthchoice,,O,1479.41,92.59,213.76,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,253,ms-drg,OTHER VASCULAR PROCEDURES WITH CC,healthchoice,,I,71874.05,17117.07,30235.61,31459.36,43124.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,healthchoice,,I,74793.54,13792.29,24762.00,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,healthchoice,,O,2112.19,159.37,360.68,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75716,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMAGING OF ARTERIES OF BOTH ARMS OR LEGS,healthchoice,,O,7596.99,64.33,64.33,5697.74,4558.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,healthchoice,,O,69.59,9.12,11.63,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",healthchoice,,O,107.59,3.13,3.13,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,healthchoice,,O,3055.12,202.50,467.04,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,healthchoice,,O,167.56,25.68,33.38,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,healthchoice,,O,6833.06,1646.56,4391.53,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,444,ms-drg,DISORDERS OF THE BILIARY TRACT WITH MCC,healthchoice,,I,20204.60,18971.00,18971.00,18971.00,12122.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26615,cpt,OPEN TREATMENT OF FRACTURE OF BONE IN THE MIDPORTION OF THE HAND BETWEEN THE WRIST AND FINGERS,healthchoice,,O,27635.38,2631.25,5060.32,5060.32,16581.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,healthchoice,,O,80.09,1.66,1.66,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",healthchoice,,O,65.11,8.45,10.78,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,healthchoice,,O,502.71,78.63,476.10,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,healthchoice,,O,195.07,21.19,87.17,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",healthchoice,,O,267.61,61.44,91.92,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,healthchoice,,O,84.93,8.43,15.73,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,healthchoice,,I,84785.32,12190.37,21761.00,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,healthchoice,,O,4054.33,324.17,736.86,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76942,cpt,ULTRASONIC GUIDANCE IMAGING SUPERVISION AND INTERPRETATION FOR INSERTION OF NEEDLE,healthchoice,,O,252.59,96.03,96.03,200.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",healthchoice,,O,70.78,13.97,31.84,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",healthchoice,,O,220.61,25.26,58.73,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52260,cpt,DILATION OF THE BLADDER USING AN ENDOSCOPE UNDER GENERAL OR SPINAL ANESTHESIA,healthchoice,,O,14534.61,1612.75,3153.30,7644.43,8720.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,healthchoice,,I,108746.38,30644.47,55852.00,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,healthchoice,,O,290.12,59.69,266.76,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",healthchoice,,O,315.99,85.00,298.11,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",healthchoice,,O,35.39,4.06,8.09,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",healthchoice,,O,468.95,93.59,213.76,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,healthchoice,,O,351.40,81.48,207.88,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87497,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS, QUANTIFICATION",healthchoice,,O,232.41,21.19,53.55,53.55,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",healthchoice,,O,2.49,0.02,0.02,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58563,cpt,EXAMINATION OF UTERUS WITH DESTRUCTION OF UTERINE LINING USING AN ENDOSCOPE,healthchoice,,O,30147.26,4351.66,8860.66,12495.98,18088.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63030,cpt,PARTIAL REMOVAL OF BONE WITH RELEASE OF SPINAL CORD OR SPINAL NERVES OF 1 INTERSPACE IN LOWER SPINE,healthchoice,,O,29485.64,5732.13,11244.87,22114.23,17691.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,healthchoice,,O,184.32,70.33,184.32,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78582,cpt,NUCLEAR MEDICINE STUDY OF LUNG VENTILATION AND BLOOD CIRCULATION IN THE LUNGS,healthchoice,,O,3241.45,445.84,1009.00,1009.00,1944.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55040,cpt,REMOVAL OF FLUID ACCUMULATION IN ONE TESTICLE AND SPERM RESERVOIR,healthchoice,,O,18318.75,3130.82,6021.28,6021.28,10991.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58661,cpt,REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE,healthchoice,,O,27191.57,4592.49,8860.66,23996.68,16314.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,healthchoice,,O,3055.12,206.42,467.04,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,healthchoice,,O,2112.19,159.41,450.85,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94729,cpt,TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,healthchoice,,O,231.34,43.74,77.75,238.28,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,460,ms-drg,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,healthchoice,,I,119532.08,24196.90,50532.15,77295.91,71719.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,healthchoice,,O,1753.28,96.00,213.76,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,healthchoice,,O,345.14,124.25,345.14,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0720,revCode,LABOR ROOM/DELIVERY GENERAL,healthchoice,,I,150.64,21.34,4826.59,4826.59,90.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86747,cpt,ANALYSIS FOR ANTIBODY TO PARVOVIRUS,healthchoice,,O,70.78,12.91,18.79,18.79,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82375,cpt,CARBOXYHEMOGLOBIN (PROTEIN) LEVEL,healthchoice,,O,116.29,15.40,15.40,119.78,14.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,healthchoice,,O,10678.57,95.85,95.85,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9606,cpt,"PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF ACUTE TOTAL/SUBTOTAL OCCLUSION DURING ACUTE MYOCARDIAL INFARCTION, CORONARY ARTERY OR CORONARY ARTERY BYPASS GRAFT, ANY COMBINATION OF DRUG-ELUTING INTRA",healthchoice,,O,90998.61,5029.38,5029.38,5029.38,54599.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,healthchoice,,O,560.24,92.59,213.76,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",healthchoice,,O,1997.14,430.17,855.32,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83516,cpt,"ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, MULTIPLE STEP METHOD",healthchoice,,O,55.44,9.63,14.41,41.58,13.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",healthchoice,,O,45.06,8.39,14.44,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",healthchoice,,O,826.60,239.39,490.11,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",healthchoice medicare advantage,,O,90.84,9.28,9.28,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",healthchoice medicare advantage,,O,38.92,3.91,41.25,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",healthchoice medicare advantage,,O,91.30,6.24,102.57,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,healthchoice medicare advantage,,O,9.11,0.50,2.63,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",healthchoice medicare advantage,,O,71.96,7.91,7.91,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",healthchoice medicare advantage,,O,70.06,8.29,8.29,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,healthchoice medicare advantage,,O,53.76,5.92,56.98,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,healthchoice medicare advantage,,O,41.19,1.80,2.49,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",healthchoice medicare advantage,,O,190.94,53.23,198.82,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,healthchoice medicare advantage,,O,80.09,5.66,9.25,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,healthchoice medicare advantage,,O,76.68,5.83,9.61,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",healthchoice medicare advantage,,O,52.60,5.67,9.25,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,healthchoice medicare advantage,,O,30.08,5.04,30.08,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",healthchoice medicare advantage,,O,3595.37,208.18,3595.37,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),healthchoice medicare advantage,,O,60.03,6.83,11.74,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9967,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 300-399 MG/ML IODINE CONCENTRATION, PER ML",healthchoice medicare advantage,,O,2.49,0.45,2.49,2.49,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",healthchoice medicare advantage,,O,120.33,16.46,16.46,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",healthchoice medicare advantage,,O,65.11,8.45,8.45,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,healthchoice medicare advantage,,O,31.24,2.94,33.11,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,healthchoice medicare advantage,,O,123.87,5.34,8.72,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,healthchoice medicare advantage,,O,3595.37,280.86,3703.23,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,healthchoice medicare advantage,,O,90.02,12.05,95.42,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",healthchoice medicare advantage,,O,100.03,11.76,36.53,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,healthchoice medicare advantage,,O,41.26,8.55,4130.10,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36416,cpt,PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,healthchoice medicare advantage,,O,11.79,2.31,11.79,11.79,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",healthchoice medicare advantage,,O,94.14,7.61,99.78,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",healthchoice medicare advantage,,O,1858.47,98.50,1880.84,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",healthchoice medicare advantage,,O,94.14,7.61,7.61,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,healthchoice medicare advantage,,O,1880.84,106.44,1937.27,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",healthchoice medicare advantage,,O,85.05,7.99,7.99,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",healthchoice medicare advantage,,O,13.80,2.61,3.13,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",healthchoice medicare advantage,,O,91.30,6.24,10.40,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",healthchoice medicare advantage,,O,151.46,8.03,13.19,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",healthchoice medicare advantage,,O,148.64,16.43,16.43,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",healthchoice medicare advantage,,O,85.05,7.99,49.12,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,healthchoice medicare advantage,,O,60.03,7.19,11.74,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,healthchoice medicare advantage,,O,188.17,19.53,198.82,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,healthchoice medicare advantage,,O,87.53,4.18,4.18,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",humana,,O,91.30,6.24,68.48,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,humana,,O,1446.95,312.71,312.71,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",humana,,O,56.26,6.34,42.20,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,humana,,O,80.09,1.66,60.07,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",humana,,E,5953.08,743.91,3773.70,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",humana,,O,85.05,7.99,110.69,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",humana,,O,13.80,2.61,10.35,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,humana,,O,183.82,20.77,137.87,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,humana,,O,647.78,92.64,351.71,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),humana,,O,50.01,5.20,37.51,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,humana,,O,31.24,2.94,22.11,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",humana,,O,94.14,7.61,66.62,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",humana,,O,130.95,13.50,98.21,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",humana,,O,71.96,7.91,53.97,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,humana,,O,101.33,11.74,76.00,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",humana,,O,52.60,8.84,39.45,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),humana,,O,126.23,10.13,94.67,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",humana,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",humana,,O,238.30,63.70,178.73,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,humana,,O,76.68,5.83,57.51,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",humana,,O,151.46,8.03,113.60,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",humana,,O,468.95,93.59,351.71,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),humana,,O,53.08,5.52,39.81,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,humana,,O,113.25,11.78,84.94,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,humana,,O,93.19,5.27,69.89,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,humana,,O,383.02,34.82,312.71,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",humana,,O,183.82,20.70,137.87,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",humana,,O,120.33,16.46,90.25,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",humana,,O,331.50,12.98,248.63,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",humana,,O,176.32,30.07,132.24,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,humana,,O,401.42,94.39,301.07,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,humana,,O,647.78,94.48,485.84,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,humana,,O,83.76,6.73,62.82,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",humana,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",humana - medicare advantage,,O,36.32,6.91,13.47,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,808,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,humana - medicare advantage,,I,33019.93,13774.56,13774.56,18365.56,19811.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,147.58,21.05,34.39,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",humana - medicare advantage,,O,240.10,61.44,76.11,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,humana - medicare advantage,,O,95.55,14.26,14.26,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,humana - medicare advantage,,O,752.83,92.79,94.39,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36569,cpt,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER FOR INFUSION (PICC), PATIENT 5 YEARS OR OLDER",humana - medicare advantage,,O,2853.53,1292.67,1294.80,2529.35,1712.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19084,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND, EACH ADDITIONAL GROWTH",humana - medicare advantage,,O,13165.69,1257.73,1353.95,2878.34,7899.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55876,cpt,INSERTION OF RADIATION THERAPY DEVICES IN PROSTATE GLAND FOR RADIATION THERAPY GUIDANCE,humana - medicare advantage,,O,27054.40,2670.10,4074.01,16970.47,16232.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,51720,cpt,INSTILLATION OF ANTI-CANCER DRUG INTO BLADDER,humana - medicare advantage,,O,21903.12,2737.19,2737.19,2737.19,13141.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13133,cpt,"COMPLICATED REPAIR OF WOUND OF FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, UNDERARMS, GENITALS, HANDS, OR FEET, EACH ADDITIONAL 5.0 CM OR LESS",humana - medicare advantage,,O,23804.86,2243.72,2243.72,2243.72,14282.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,humana - medicare advantage,,I,19597.90,4492.16,6080.13,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,humana - medicare advantage,,O,4630.63,693.07,1537.76,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,963,ms-drg,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,humana - medicare advantage,,I,9400.19,9212.17,9212.17,9212.17,5640.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,39402,cpt,EXAMINATION OF CHEST USING AN ENDOSCOPE WITH LYMPH NODE BIOPSY,humana - medicare advantage,,O,22457.12,4491.89,4491.89,4491.89,13474.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,humana - medicare advantage,,O,908.09,156.44,156.44,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72020,cpt,"X-RAY OF SPINE, 1 VIEW",humana - medicare advantage,,O,240.10,72.01,72.01,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19085,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH MRI GUIDANCE, FIRST LESION",humana - medicare advantage,,O,11216.07,1273.00,1304.33,6117.24,6729.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19000,cpt,"ASPIRATION OF CYST OF BREAST, FIRST CYST",humana - medicare advantage,,O,1993.54,1253.04,1253.04,1435.09,1196.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",humana - medicare advantage,,O,691.54,93.84,93.84,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",humana - medicare advantage,,O,203.82,32.52,47.66,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20930,cpt,FRAGMENTED DONOR BONE GRAFT OR PLACEMENT OF MATERIAL TO PROMOTE BONE GROWTH FOR SPINE SURGERY,humana - medicare advantage,,O,75615.32,11349.44,11349.44,18976.00,45369.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,312.63,61.44,75.57,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58558,cpt,BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE,humana - medicare advantage,,O,24068.17,2373.69,2393.52,19315.13,14440.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",humana - medicare advantage,,O,93.77,21.35,36.70,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,humana - medicare advantage,,O,647.78,92.64,94.39,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84207,cpt,VITAMIN B-6 LEVEL,humana - medicare advantage,,O,134.49,18.96,27.82,142.55,80.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,humana - medicare advantage,,O,531.48,100.50,235.61,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",humana - medicare advantage,,O,36.32,4.04,4.20,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,humana - medicare advantage,,O,41.28,5.78,6.34,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",humana - medicare advantage,,O,650.28,61.44,94.39,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,humana - medicare advantage,,I,4152.82,995.38,2128.17,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86784,cpt,ANALYSIS FOR ANTIBODY TO TRICHINELLA (WORM PARASITE),humana - medicare advantage,,O,31.40,12.31,12.31,12.31,18.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,humana - medicare advantage,,O,989.19,218.69,228.37,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29877,cpt,REMOVAL OR SHAVING OF KNEE JOINT CARTILAGE USING AN ENDOSCOPE,humana - medicare advantage,,O,20747.46,2550.50,2550.50,7792.87,12448.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,humana - medicare advantage,,I,26926.14,6286.85,6626.73,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,humana - medicare advantage,,O,138.03,9.70,24.94,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",humana - medicare advantage,,O,290.00,66.00,240.49,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,humana - medicare advantage,,I,27884.18,6142.25,8086.59,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,308,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,humana - medicare advantage,,I,28408.75,7603.87,7859.93,14046.88,17045.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52332,cpt,INSERTION OF STENT IN URINARY DUCT (URETER) USING AN ENDOSCOPE,humana - medicare advantage,,O,20654.85,2781.70,2782.44,17672.06,12392.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",humana - medicare advantage,,O,13.78,1.69,4.18,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",humana - medicare advantage,,O,130.95,13.50,17.70,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,270,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,humana - medicare advantage,,I,66302.58,30493.48,30493.48,58398.86,39781.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85301,cpt,ANTITHROMBIN III ANTIGEN (CLOTTING INHIBITOR) LEVEL,humana - medicare advantage,,O,56.62,10.81,10.81,56.62,33.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5111,cpt,"INJECTION, PEGFILGRASTIM-CBQV, BIOSIMILAR, (UDENYCA), 0.5 MG",humana - medicare advantage,,O,1252.50,150.78,164.71,171.89,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93459,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND/OR GRAFTS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,humana - medicare advantage,,O,28921.96,2582.89,2582.89,5906.55,17353.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,811,ms-drg,RED BLOOD CELL DISORDERS WITH MCC,humana - medicare advantage,,I,26952.43,9206.49,9206.49,16010.05,16171.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,humana - medicare advantage,,I,1133.33,141.17,1464.70,1464.70,680.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78472,cpt,NUCLEAR MEDICINE STUDY OF HEART PUMPING FUNCTION BY LABELING RED BLOOD CELLS WITH MEASUREMENT OF INTERNAL BLOOD VOLUME EJECTED WITH EVERY BEAT OVER MULTIPLE CYCLES,humana - medicare advantage,,O,2436.09,342.21,342.21,777.36,1461.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,519,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,humana - medicare advantage,,I,59832.80,12366.04,12366.04,12366.04,35899.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83498,cpt,"HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVEL",humana - medicare advantage,,O,126.23,22.15,26.63,94.68,75.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),humana - medicare advantage,,O,29523.82,4577.80,10938.52,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10060,cpt,SIMPLE OR SINGLE DRAINAGE OF SKIN ABSCESS,humana - medicare advantage,,O,1091.80,417.40,1495.21,1495.21,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,humana - medicare advantage,,O,4318.19,810.94,814.54,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,humana - medicare advantage,,O,502.71,78.63,244.41,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",humana - medicare advantage,,O,494.32,41.98,41.98,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",humana - medicare advantage,,O,1040.92,159.87,160.12,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22845,cpt,"INSERTION OF ANTERIOR SPINAL INSTRUMENTATION FOR SPINAL STABILIZATION, 2 TO 3 VERTEBRAL SEGMENTS",humana - medicare advantage,,O,65424.14,11349.44,11349.44,11533.98,39254.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,humana - medicare advantage,,O,83.76,14.03,14.03,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,humana - medicare advantage,,O,351.40,51.44,81.48,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49180,cpt,"NEEDLE BIOPSY OF ABDOMINAL CAVITY GROWTH, ACCESSED THROUGH THE SKIN",humana - medicare advantage,,O,11548.67,999.86,999.86,1325.18,6929.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5117,cpt,"INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG",humana - medicare advantage,,O,320.89,24.34,32.84,107.23,192.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23650,cpt,CLOSED TREATMENT OF SHOULDER DISLOCATION WITH MANIPULATION,humana - medicare advantage,,O,16201.22,2056.57,2056.57,2056.57,9720.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",humana - medicare advantage,,I,3595.37,858.13,1778.01,2535.33,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",humana - medicare advantage,,O,47.53,8.48,8.48,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",humana - medicare advantage,,O,1893.35,485.97,496.62,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,humana - medicare advantage,,O,2687.44,201.24,206.42,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21932,cpt,"REMOVAL OF GROWTH OF MUSCLE OF BACK OR LOWER SIDES, LESS THAN 5.0 CM",humana - medicare advantage,,O,19214.65,2246.95,2246.95,2246.95,11528.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31623,cpt,EXAMINATION OF LUNG AIRWAYS USING AN ENDOSCOPE,humana - medicare advantage,,O,19988.36,1331.96,1331.96,3763.71,11993.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,787,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,humana - medicare advantage,,I,18030.21,6935.18,6935.18,13885.01,10818.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74170,cpt,CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,2708.71,159.22,159.22,612.94,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,humana - medicare advantage,,O,42.51,2.00,2.20,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,314,ms-drg,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,humana - medicare advantage,,I,33150.59,4847.80,13027.53,22580.00,19890.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",humana - medicare advantage,,O,52.60,5.67,9.25,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,humana - medicare advantage,,O,1952.12,159.41,159.41,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11406,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF BODY, ARMS, OR LEGS, MORE THAN 4.0 CM",humana - medicare advantage,,O,17469.26,1304.93,1304.93,5506.99,10481.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82671,cpt,"ESTROGEN ANALYSIS, FRACTIONATED",humana - medicare advantage,,O,436.51,31.65,31.65,65.74,261.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,humana - medicare advantage,,O,416.45,133.14,133.14,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,humana - medicare advantage,,O,84.93,8.09,20.67,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,96.29,17.55,34.39,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,269,ms-drg,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,humana - medicare advantage,,I,126793.83,26601.95,26601.95,29409.56,76076.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,humana - medicare advantage,,O,28.83,5.60,11.35,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72202,cpt,"X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE, 3 OR MORE VIEWS",humana - medicare advantage,,O,267.61,36.00,97.71,212.75,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,humana - medicare advantage,,O,2261.82,101.22,564.08,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,207,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,humana - medicare advantage,,I,183013.56,35773.89,40158.29,40158.29,109808.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,humana - medicare advantage,,O,3055.12,206.42,208.18,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,humana - medicare advantage,,O,3595.37,280.86,377.64,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,humana - medicare advantage,,I,26508.25,6362.98,10254.34,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29827,cpt,REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE,humana - medicare advantage,,O,38417.80,5736.03,5736.03,17014.63,23050.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,humana - medicare advantage,,O,330.33,24.94,24.94,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,humana - medicare advantage,,I,62688.63,11498.14,12943.83,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,234,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,humana - medicare advantage,,I,205358.74,31986.81,32423.05,50803.66,123215.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,617,ms-drg,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",humana - medicare advantage,,I,39556.14,7942.02,12596.49,33689.17,23733.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,humana - medicare advantage,,O,265.10,8.75,151.95,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,humana - medicare advantage,,O,10678.57,58.46,2581.62,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73120,cpt,"X-RAY OF HAND, 2 VIEWS",humana - medicare advantage,,O,240.10,38.01,95.66,96.93,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72220,cpt,"X-RAY OF SACRUM AND TAILBONE, MINIMUM OF 2 VIEWS",humana - medicare advantage,,O,240.10,33.96,75.57,75.57,88.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",humana - medicare advantage,,O,1997.14,430.17,436.85,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55866,cpt,REMOVAL OF PROSTATE AND LYMPH NODES USING AN ENDOSCOPE,humana - medicare advantage,,O,48920.89,8001.96,8001.96,8058.37,8805.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33208,cpt,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER INCLUDING UPPER AND LOWER CHAMBER ELECTRODES,humana - medicare advantage,,O,42383.14,9221.09,9221.09,17558.91,25429.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,humana - medicare advantage,,O,221.79,37.03,37.85,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,humana - medicare advantage,,O,1481.91,158.58,159.41,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,humana - medicare advantage,,O,316.37,49.55,49.55,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,humana - medicare advantage,,I,18651.11,4387.85,5737.83,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,humana - medicare advantage,,O,56.62,7.92,7.92,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,441,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",humana - medicare advantage,,I,27183.75,11619.11,11619.11,20379.28,16310.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37226,cpt,"INSERTION OF STENTS INTO ARTERIES IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",humana - medicare advantage,,O,79683.80,11770.38,11770.38,14994.33,47810.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62370,cpt,ELECTRONIC ANALYSIS REPROGRAMMING AND REFILL OF SPINAL CANAL DRUG INFUSION PUMP BY PHYSICIAN,humana - medicare advantage,,O,2663.70,244.51,245.80,245.80,1598.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11606,cpt,"REMOVAL OF MALIGNANT GROWTH (OVER 4.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",humana - medicare advantage,,O,19392.87,4577.95,5154.34,5620.25,11635.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82575,cpt,CREATININE CLEARANCE MEASUREMENT TO TEST FOR KIDNEY FUNCTION,humana - medicare advantage,,O,80.22,9.31,9.31,20.42,11.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",humana - medicare advantage,,O,373.90,92.59,92.59,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27687,cpt,LENGTHENING OF CALF MUSCLE,humana - medicare advantage,,O,18786.36,2631.16,5759.36,13419.43,11271.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74270,cpt,SINGLE CONTRAST X-RAY OF LARGE INTESTINE,humana - medicare advantage,,O,725.32,158.70,158.70,360.68,435.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,humana - medicare advantage,,O,1880.84,106.44,159.41,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76857,cpt,"ULTRASOUND OF PELVIS, LIMITED, NOT PREGNANCY RELATED",humana - medicare advantage,,O,187.57,93.59,93.59,198.82,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,humana - medicare advantage,,I,16915.97,4140.71,5420.23,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",humana - medicare advantage,,O,266.35,64.70,101.78,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",humana - medicare advantage,,I,1356.71,52.51,52.51,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23350,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOINT,humana - medicare advantage,,O,5340.22,795.73,966.76,4000.22,3204.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,humana - medicare advantage,,I,30232.58,9248.60,9248.60,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28118,cpt,REMOVAL OF HEEL BONE,humana - medicare advantage,,O,31022.88,2578.63,5736.03,15484.76,18613.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,268,ms-drg,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,humana - medicare advantage,,I,18273.76,15118.51,42995.65,44762.62,10964.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",humana - medicare advantage,,O,223.91,73.72,94.58,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52005,cpt,INSERTION OF CATHETER INTO URINARY DUCT (URETER) USING AN ENDOSCOPE THROUGH THE BLADDER AREA,humana - medicare advantage,,O,15929.97,1594.04,1594.04,8382.60,9557.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",humana - medicare advantage,,O,93.19,13.33,13.33,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52281,cpt,DILATION OF BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,humana - medicare advantage,,O,15500.95,1609.63,1609.63,5605.90,9300.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86709,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),humana - medicare advantage,,O,106.28,11.04,11.21,19.42,63.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,348,ms-drg,ANAL AND STOMAL PROCEDURES WITH CC,humana - medicare advantage,,I,45281.59,9162.68,9162.68,16691.97,27168.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89051,cpt,BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,humana - medicare advantage,,O,42.58,5.49,5.49,30.20,6.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72157,cpt,MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,4054.33,330.07,330.07,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29828,cpt,RELEASE OF TENDON CONNECTING BICEPS MUSCLE AND SHOULDER USING AN ENDOSCOPE,humana - medicare advantage,,O,45470.39,5674.87,5674.87,16913.72,27282.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82330,cpt,"CALCIUM LEVEL, IONIZED",humana - medicare advantage,,O,89.65,13.41,13.49,21.16,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9395,cpt,"INJECTION, FULVESTRANT, 25 MG",humana - medicare advantage,,O,421.43,10.87,10.87,316.07,252.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,175,ms-drg,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,humana - medicare advantage,,I,23982.29,5734.35,9635.75,14746.99,14389.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90694,cpt,"INFLUENZA VIRUS VACCINE, QUADRIVALENT (AIIV4), INACTIVATED, ADJUVANTED, PRESERVATIVE FREE, FOR INJECTION INTO MUSCLE, 0.5 ML DOSAGE",humana - medicare advantage,,O,205.61,31.23,31.23,31.24,123.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37220,cpt,"BALLOON DILATION OF ARTERY IN ONE SIDE OF GROIN, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",humana - medicare advantage,,O,79851.70,9380.74,9380.74,9380.74,47911.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52601,cpt,REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE,humana - medicare advantage,,O,21140.75,3922.58,3922.58,12709.61,12684.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,388,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH MCC,humana - medicare advantage,,I,18498.53,9672.06,9672.06,9672.06,11099.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9144,cpt,"INJECTION, DARATUMUMAB, 10 MG AND HYALURONIDASE-FIHJ",humana - medicare advantage,,O,148.31,44.88,45.65,48.33,88.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",humana - medicare advantage,,O,4.99,0.54,0.54,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70488,cpt,CT SCAN OF FACE BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,2238.92,268.93,268.93,268.93,1343.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",humana - medicare advantage,,O,369.82,61.44,92.59,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31541,cpt,REMOVAL OF GROWTH OF TONGUE AND/OR STRIPPING OF VOCAL CORD USING AN ENDOSCOPE WITH OPERATING MICROSCOPE OR TELESCOPE,humana - medicare advantage,,O,20996.12,2757.71,2757.71,2757.71,12597.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,humana - medicare advantage,,O,30.08,3.63,3.63,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,humana - medicare advantage,,O,3055.12,205.61,206.42,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,137,ms-drg,MOUTH PROCEDURES WITH CC/MCC,humana - medicare advantage,,I,55629.89,9749.84,9749.84,9749.84,33377.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,humana - medicare advantage,,I,18716.13,4221.86,6227.23,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,humana - medicare advantage,,O,831.61,156.22,158.02,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,humana - medicare advantage,,O,3055.12,202.50,208.18,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,humana - medicare advantage,,O,67.58,3.47,5.66,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23430,cpt,ANCHORING OF BICEPS TENDON,humana - medicare advantage,,O,33884.87,5667.02,5753.52,5846.87,20330.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31536,cpt,BIOPSY OF VOICE BOX USING AN ENDOSCOPE WITH OPERATING MICROSCOPE OR TELESCOPE,humana - medicare advantage,,O,19316.41,2899.66,2899.66,2946.71,11589.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",humana - medicare advantage,,O,241.34,30.35,30.94,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12035,cpt,"REPAIR OF WOUND (12.6 TO 20.0 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",humana - medicare advantage,,O,20510.28,2283.49,5154.34,5154.34,12306.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,521,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,humana - medicare advantage,,I,91075.32,18634.25,19182.93,21775.75,54645.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,humana - medicare advantage,,O,323.88,75.26,76.16,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,512,ms-drg,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",humana - medicare advantage,,I,52854.47,10536.39,10536.39,14107.45,31712.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,humana - medicare advantage,,O,80.09,1.66,10.12,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83935,cpt,URINE OSMOLALITY (CONCENTRATION) MEASUREMENT,humana - medicare advantage,,O,104.49,6.68,6.68,6.69,62.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",humana - medicare advantage,,O,107.59,3.13,19.65,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",humana - medicare advantage,,O,126.23,16.29,18.96,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",humana - medicare advantage,,O,12.72,0.71,3.94,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,humana - medicare advantage,,O,28365.62,4521.08,4521.08,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",humana - medicare advantage,,O,56.26,6.34,6.34,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10180,cpt,COMPLEX DRAINAGE OF WOUND INFECTION AFTER SURGERY,humana - medicare advantage,,O,19831.00,324.08,324.08,11072.05,11898.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52234,cpt,DESTRUCTION AND/OR REMOVAL OF (0.5 TO 2.0 CENTIMETERS) SMALL GROWTHS OF THE BLADDER USING AN ENDOSCOPE,humana - medicare advantage,,O,16688.36,2781.70,2782.44,5224.45,10013.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",humana - medicare advantage,,O,16.70,0.37,17.48,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,humana - medicare advantage,,O,351.40,92.60,97.51,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,humana - medicare advantage,,E,292.62,111.66,122.91,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",humana - medicare advantage,,O,125.04,27.28,58.45,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36470,cpt,INJECTION OF CHEMICAL AGENT INTO SINGLE INCOMPETENT VEIN,humana - medicare advantage,,O,25938.51,2586.52,2586.52,2633.29,15563.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87449,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF ORGANISM BY IMMUNOASSAY TECHNIQUE, MULTIPLE-STEP METHOD",humana - medicare advantage,,O,29.95,11.79,11.79,11.79,17.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,humana - medicare advantage,,O,190.07,28.97,100.59,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),humana - medicare advantage,,O,60.03,6.83,11.74,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",humana - medicare advantage,,O,135.66,25.29,25.29,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,216,ms-drg,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,humana - medicare advantage,,I,542202.99,89387.47,89387.47,91922.66,325321.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,humana - medicare advantage,,I,6.27,0.90,6.10,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63035,cpt,"PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF UPPER OR LOWER SPINAL CORD OR NERVES AND/OR REMOVAL OF DISC, EACH ADDITIONAL INTERSPACE",humana - medicare advantage,,O,43130.78,5753.52,5753.52,5847.07,25878.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",humana - medicare advantage,,O,221.79,37.73,37.73,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,humana - medicare advantage,,O,26791.18,4521.08,4521.08,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,389,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH CC,humana - medicare advantage,,I,17143.70,5530.39,5530.39,18965.92,10286.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,humana - medicare advantage,,O,35679.28,5647.61,5647.61,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0128,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) REHABILITATION,humana - medicare advantage,,I,969.17,949.79,949.79,949.79,581.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11771,cpt,EXTENSIVE REMOVAL OF CYST OF TAILBONE,humana - medicare advantage,,O,19648.60,2145.13,2243.72,5607.96,11789.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,348.89,46.07,76.26,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",humana - medicare advantage,,O,122.56,1.48,9.98,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",humana - medicare advantage,,I,212.36,46.07,153.18,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",humana - medicare advantage,,O,25.94,5.08,5.08,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",humana - medicare advantage,,O,1434.39,436.85,436.85,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29875,cpt,PARTIAL REMOVAL OF KNEE JOINT LINING USING AN ENDOSCOPE,humana - medicare advantage,,O,21676.78,485.10,485.10,5060.32,13006.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",humana - medicare advantage,,O,91.30,6.24,10.35,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,551,ms-drg,MEDICAL BACK PROBLEMS WITH MCC,humana - medicare advantage,,I,43126.53,10113.34,10113.34,11872.78,25875.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75635,cpt,CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES WITH CONTRAST,humana - medicare advantage,,O,1952.12,159.41,159.41,528.47,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",humana - medicare advantage,,O,1099.23,114.80,116.01,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,humana - medicare advantage,,O,646.53,93.49,93.49,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20936,cpt,HARVEST OF BONE FROM SAME SPINE INCISION FOR GRAFT,humana - medicare advantage,,O,73036.79,11349.44,11349.44,13487.02,43822.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85397,cpt,MEASUREMENT OF BLOOD COAGULATION AND FIBRINOLYSIS (CLOT DISSOLVING) FUNCTION,humana - medicare advantage,,O,77.15,30.24,30.24,30.24,46.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26951,cpt,AMPUTATION OF FINGER OR THUMB WITH DIRECT CLOSURE,humana - medicare advantage,,O,26141.42,2589.15,2589.15,2589.15,15684.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77047,cpt,MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST,humana - medicare advantage,,O,1605.13,202.29,202.29,1203.85,963.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,humana - medicare advantage,,O,45.06,3.98,6.50,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,humana - medicare advantage,,I,84785.32,12190.37,12190.37,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,100.03,11.76,36.53,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,humana - medicare advantage,,O,71.96,7.48,12.16,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83003,cpt,HUMAN GROWTH HORMONE LEVEL,humana - medicare advantage,,O,101.45,16.34,16.34,16.67,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,humana - medicare advantage,,O,3099.12,461.58,461.58,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",humana - medicare advantage,,E,5953.08,743.91,904.30,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,humana - medicare advantage,,O,303.87,29.81,54.97,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92921,cpt,"BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORONARY ARTERY OR BRANCH (ACCESSED THROUGH THE SKIN), SINGLE ARTERY OR BRANCH",humana - medicare advantage,,O,70163.07,9197.64,9197.64,9388.77,42097.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,humana - medicare advantage,,O,80.09,5.66,9.25,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36901,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",humana - medicare advantage,,O,15374.12,2544.37,2544.37,4389.29,9224.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36556,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, NOT TUNNELED",humana - medicare advantage,,O,18017.97,2538.20,9233.37,9233.37,10810.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,4054.33,322.67,324.17,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43255,cpt,"CONTROL OF BLEEDING OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",humana - medicare advantage,,O,6706.29,1451.88,1514.87,1514.87,4023.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,humana - medicare advantage,,I,78211.42,12813.14,13631.24,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",humana - medicare advantage,,O,1680.75,111.66,507.04,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",humana - medicare advantage,,O,298.47,56.42,94.58,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",humana - medicare advantage,,O,40.11,3.87,3.89,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,humana - medicare advantage,,O,102.63,10.90,20.83,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,260,ms-drg,CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC,humana - medicare advantage,,I,44523.27,21722.92,21722.92,21722.92,26713.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",humana - medicare advantage,,O,233.84,30.94,30.94,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33241,cpt,REMOVAL OF DEFIBRILLATOR PULSE GENERATOR,humana - medicare advantage,,O,44183.41,16251.07,16251.07,16251.07,26510.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",humana - medicare advantage,,I,225.50,61.14,198.52,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",humana - medicare advantage,,O,184.32,70.33,104.22,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49411,cpt,"INSERTION OF DEVICES IN ABDOMINAL CAVITY FOR RADIATION THERAPY GUIDANCE, ACCESSED THROUGH THE SKIN",humana - medicare advantage,,O,8305.75,1167.30,1167.30,1167.30,4983.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",humana - medicare advantage,,O,2073.43,311.07,311.35,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",humana - medicare advantage,,O,240.10,61.44,75.57,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",humana - medicare advantage,,O,252.47,44.06,44.06,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,humana - medicare advantage,,O,3222.12,719.92,719.92,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,humana - medicare advantage,,O,42.58,3.22,3.23,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87799,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, QUANTIFICATION",humana - medicare advantage,,O,264.26,35.66,41.99,174.31,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12002,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, NECK, UNDERARMS, GENITALS, TRUNK, ARMS AND/OR LEGS",humana - medicare advantage,,O,26605.46,2589.15,2589.15,2589.15,15963.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,humana - medicare advantage,,O,36.32,3.85,3.85,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,humana - medicare advantage,,O,31160.78,7903.69,7903.69,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,humana - medicare advantage,,O,396.41,290.00,310.75,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,humana - medicare advantage,,O,93.19,15.38,20.39,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,humana - medicare advantage,,O,123.87,33.18,33.18,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",humana - medicare advantage,,O,3583.92,323.18,324.08,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,674,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,humana - medicare advantage,,I,60019.19,15090.19,15090.19,23273.88,36011.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,humana - medicare advantage,,O,101.45,12.63,14.31,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,44389,cpt,BIOPSIES OF LARGE BOWEL USING AN ENDOSCOPE INSERTED THROUGH SURGICALLY CREATED OPENING INTO LARGE BOWEL FROM BODY WALL (COLOSTOMY),humana - medicare advantage,,O,4608.78,919.44,919.44,919.44,2765.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,humana - medicare advantage,,I,17945.73,6102.59,7257.42,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0124,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) PSYCHIATRIC,humana - medicare advantage,,I,2472.22,1769.25,1769.25,1769.25,1483.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,humana - medicare advantage,,I,752.83,203.26,394.62,719.74,451.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,humana - medicare advantage,,E,2880.28,490.23,493.19,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3660,cpt,"SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, OFF-THE-SHELF",humana - medicare advantage,,O,100.04,19.56,99.21,99.21,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",humana - medicare advantage,,O,50.72,7.45,11.90,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",humana - medicare advantage,,O,298.47,66.35,280.77,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",humana - medicare advantage,,O,116.79,7.81,10.53,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,humana - medicare advantage,,I,1274.16,335.11,1365.53,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25607,cpt,"TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST, ABOVE WRIST, WITH PLACEMENT OF STABILIZING DEVICE",humana - medicare advantage,,O,35608.49,5736.03,5736.03,11244.87,21365.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",humana - medicare advantage,,O,1015.48,95.84,111.91,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71100,cpt,"X-RAY OF RIBS OF ONE SIDE OF BODY, 2 VIEWS",humana - medicare advantage,,O,426.43,49.08,76.26,319.82,255.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,147.58,21.05,34.39,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28315,cpt,REMOVAL OF SMALL BONE UNDERLYING LONG BONE OF FOOT AT BIG TOE JOINT,humana - medicare advantage,,O,20880.08,5759.36,5759.36,5759.36,12528.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,841,ms-drg,LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,humana - medicare advantage,,I,17872.50,10187.24,10187.24,10187.24,10723.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55041,cpt,REMOVAL OF FLUID ACCUMULATION IN BOTH TESTICLES AND SPERM RESERVOIRS,humana - medicare advantage,,O,17448.05,3074.20,3074.20,3074.20,10468.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,humana - medicare advantage,,O,1753.28,94.47,94.48,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32555,cpt,ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE,humana - medicare advantage,,O,2695.58,507.04,507.04,1831.81,1617.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,485,ms-drg,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC,humana - medicare advantage,,I,279384.42,26144.14,26144.14,26144.14,167630.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,394,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,humana - medicare advantage,,I,20150.20,5703.31,6182.72,10874.89,12090.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89060,cpt,CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,humana - medicare advantage,,O,40.11,7.18,7.18,40.11,8.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93572,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL DURING DIAGNOSIS OR TREATMENT, EACH ADDITIONAL VESSEL",humana - medicare advantage,,O,39972.83,4536.44,4536.44,4610.05,23983.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,435,ms-drg,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,humana - medicare advantage,,I,15750.09,11417.63,11417.63,11417.63,9450.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17111,cpt,DESTRUCTION OF 15 OR MORE NON-CANCEROUS SKIN GROWTHS,humana - medicare advantage,,O,507.74,161.17,161.17,161.17,304.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,humana - medicare advantage,,I,124.70,13.59,120.90,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13102,cpt,"COMPLICATED REPAIR OF WOUND OF TRUNK, EACH ADDITIONAL 5.0 CM OR LESS",humana - medicare advantage,,O,18473.24,1304.93,1304.93,1325.50,11083.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,humana - medicare advantage,,O,73.83,12.70,14.30,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,humana - medicare advantage,,I,20034.03,4988.82,5493.85,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",humana - medicare advantage,,O,757.37,185.43,186.43,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27369,cpt,INJECTION OF CONTRAST FOR IMAGING OF KNEE JOINT,humana - medicare advantage,,O,3155.01,479.40,481.29,481.29,1893.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,280,ms-drg,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",humana - medicare advantage,,I,31302.10,10044.53,10044.53,76220.28,18781.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63048,cpt,"PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF SPINAL CORD AND/OR NERVES, EACH ADDITIONAL SEGMENT",humana - medicare advantage,,O,44366.77,5559.58,5559.58,13162.95,26620.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11981,cpt,INSERTION OF DRUG DELIVERY IMPLANT INTO TISSUE,humana - medicare advantage,,O,40615.05,2631.16,5736.03,5776.91,24369.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,humana - medicare advantage,,O,130.11,30.48,38.47,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11443,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH, 2.1-3.0 CM",humana - medicare advantage,,O,17371.14,2243.72,2243.72,2243.72,10422.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29876,cpt,REMOVAL OF JOINT LINING FROM TWO OR MORE KNEE JOINT COMPARTMENTS USING AN ENDOSCOPE,humana - medicare advantage,,O,22731.95,2550.70,2550.70,8021.63,13639.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12034,cpt,"REPAIR OF WOUND (7.6 TO 12.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",humana - medicare advantage,,O,18980.81,325.18,325.18,4577.95,11388.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,humana - medicare advantage,,O,93.19,5.27,44.06,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,374,ms-drg,DIGESTIVE MALIGNANCY WITH MCC,humana - medicare advantage,,I,21410.93,11344.37,12885.84,12885.84,12846.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,621,ms-drg,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,humana - medicare advantage,,I,48014.63,10223.98,10223.98,32094.15,28808.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,humana - medicare advantage,,O,89.65,6.58,17.87,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87497,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS, QUANTIFICATION",humana - medicare advantage,,O,232.41,21.19,41.98,53.55,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72192,cpt,CT SCAN OF PELVIS WITHOUT CONTRAST,humana - medicare advantage,,O,1344.34,94.48,94.48,98.50,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93453,cpt,INSERTION OF TUBE IN RIGHT AND LEFT HEART CHAMBERS FOR DIAGNOSIS WITH REVIEW BY RADIOLOGIST,humana - medicare advantage,,O,18636.01,2563.86,2563.86,2563.86,11181.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,humana - medicare advantage,,O,16541.64,1561.79,1563.06,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80299,cpt,QUANTITATION OF THERAPEUTIC DRUG,humana - medicare advantage,,O,46.60,5.86,18.34,18.72,27.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",humana - medicare advantage,,O,5902.67,335.59,1155.68,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73222,cpt,MRI SCAN OF ARM JOINT WITH CONTRAST,humana - medicare advantage,,O,3055.12,461.27,641.69,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,humana - medicare advantage,,O,41.26,8.55,78.52,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43251,cpt,"REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE USING A MECHANICAL SNARE",humana - medicare advantage,,O,6666.20,1457.56,1457.56,3664.49,3999.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,humana - medicare advantage,,O,36.32,4.67,4.76,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36832,cpt,"REVISION OF DIALYSIS GRAFT, OPEN PROCEDURE",humana - medicare advantage,,O,21325.08,4464.51,4464.51,4543.19,12795.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",humana - medicare advantage,,O,547.73,117.10,288.14,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,humana - medicare advantage,,O,647.78,92.97,97.23,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36821,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, ANY SITE AS SEPARATE PROCEDURE",humana - medicare advantage,,O,21470.01,2569.92,2569.92,10309.61,12882.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62320,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK,humana - medicare advantage,,O,1594.50,564.08,564.08,1436.46,956.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),humana - medicare advantage,,O,53.08,5.52,12.62,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",humana - medicare advantage,,O,47.53,3.60,3.61,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25111,cpt,"REMOVAL OF CYST AT WRIST, INITIAL OR PRIMARY",humana - medicare advantage,,O,17783.77,1248.37,1248.37,4924.66,10670.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,humana - medicare advantage,,O,65.11,6.57,6.57,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,184,ms-drg,MAJOR CHEST TRAUMA WITH CC,humana - medicare advantage,,I,16454.36,7110.38,7110.38,10197.70,9872.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0260,cpt,"INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY",humana - medicare advantage,,O,2193.04,562.74,564.08,1003.01,1315.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77387,cpt,GUIDANCE FOR LOCALIZATION OF TARGET DELIVERY OF RADIATION TREATMENT,humana - medicare advantage,,O,256.94,157.33,157.33,313.88,58.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,humana - medicare advantage,,O,9.11,0.50,5.30,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,humana - medicare advantage,,O,101.45,15.87,16.18,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70480,cpt,CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,humana - medicare advantage,,O,1343.10,93.35,96.92,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17250,cpt,APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,humana - medicare advantage,,O,703.02,157.08,157.08,777.14,421.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46260,cpt,REMOVAL OF MULTIPLE INTERNAL AND EXTERNAL HEMORRHOID GROUPS,humana - medicare advantage,,O,18904.18,2231.78,2231.78,4726.84,11342.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,humana - medicare advantage,,O,3953.80,1077.08,1078.59,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",humana - medicare advantage,,O,2237.24,324.67,324.67,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,humana - medicare advantage,,O,45.13,4.38,129.65,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31625,cpt,BIOPSY OF LUNG AIRWAYS USING AN ENDOSCOPE,humana - medicare advantage,,O,19596.48,1331.96,1331.96,3763.71,11757.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84166,cpt,"PROTEIN MEASUREMENT, BODY FLUID",humana - medicare advantage,,O,61.34,6.87,17.65,30.15,20.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",humana - medicare advantage,,O,148.64,16.43,16.43,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",humana - medicare advantage,,O,680.29,236.16,243.60,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,humana - medicare advantage,,O,93.19,11.22,12.05,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27691,cpt,TRANSPLANT OF DEEP TENDON WITH MUSCLE REROUTING AT LOWER LEG OR ANKLE,humana - medicare advantage,,O,29148.64,5759.36,5759.36,5847.07,17489.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",humana - medicare advantage,,O,331.50,12.98,12.98,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11401,cpt,"REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",humana - medicare advantage,,O,1956.76,309.74,310.22,2169.65,1174.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",humana - medicare advantage,,I,302.21,52.32,257.27,528.83,181.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,humana - medicare advantage,,O,76.68,5.83,9.52,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",humana - medicare advantage,,O,252.47,43.75,43.75,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37221,cpt,"INSERTION OF STENTS IN ARTERY IN ONE SIDE OF GROIN, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",humana - medicare advantage,,O,79435.82,14297.99,14297.99,15180.19,47661.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36589,cpt,REMOVAL OF CENTRAL VENOUS CATHETER FOR INFUSION,humana - medicare advantage,,O,1252.35,2586.12,2586.12,4542.11,751.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11643,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",humana - medicare advantage,,O,5466.42,1248.81,1304.93,1304.93,3279.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0009,cpt,ADMINISTRATION OF PNEUMOCOCCAL VACCINE,humana - medicare advantage,,O,105.03,36.70,36.70,36.70,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",humana - medicare advantage,,O,2526.13,486.47,486.47,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,humana - medicare advantage,,O,754.07,203.12,203.19,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72132,cpt,CT SCAN OF LOWER SPINE WITH CONTRAST,humana - medicare advantage,,O,1879.58,326.51,326.51,326.51,1127.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19301,cpt,PARTIAL REMOVAL OF BREAST,humana - medicare advantage,,O,31896.98,2805.32,2805.32,12984.24,19138.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73525,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF HIP JOINT,humana - medicare advantage,,O,1211.78,322.42,327.84,327.84,727.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",humana - medicare advantage,,O,105.03,12.96,35.49,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",humana - medicare advantage,,O,10827.72,2513.53,2569.27,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",humana - medicare advantage,,O,108.88,10.16,16.60,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",humana - medicare advantage,,O,91.30,18.02,18.11,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82040,cpt,ALBUMIN (PROTEIN) LEVEL,humana - medicare advantage,,O,37.50,4.85,4.85,33.12,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27566,cpt,OPEN TREATMENT OF KNEE CAP DISLOCATION,humana - medicare advantage,,O,103626.85,10938.52,10938.52,10938.52,62176.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,857,ms-drg,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,humana - medicare advantage,,I,58450.53,13402.18,13402.18,19974.44,35070.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,humana - medicare advantage,,O,1590.91,567.62,744.12,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87305,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ASPERGILLUS (FUNGUS),humana - medicare advantage,,O,30.85,11.79,11.79,22.46,18.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27093,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF HIP JOINT,humana - medicare advantage,,O,3830.16,486.86,486.86,980.47,2298.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",humana - medicare advantage,,O,240.10,27.64,94.39,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82175,cpt,ARSENIC LEVEL,humana - medicare advantage,,O,93.19,18.59,18.59,19.17,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,humana - medicare advantage,,O,101.45,3.58,20.44,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,humana - medicare advantage,,O,252.59,55.19,55.19,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",humana - medicare advantage,,O,345.14,36.70,36.70,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",humana - medicare advantage,,O,101.45,14.76,20.68,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73552,cpt,"X-RAY OF THIGH BONE, MINIMUM 2 VIEWS",humana - medicare advantage,,O,327.63,38.17,73.18,173.76,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",humana - medicare advantage,,I,231.34,60.43,60.43,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21556,cpt,REMOVAL OF (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,humana - medicare advantage,,O,18486.84,2243.72,2243.72,4391.53,11092.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,181,ms-drg,RESPIRATORY NEOPLASMS WITH CC,humana - medicare advantage,,I,29033.86,7196.02,7196.02,7196.02,17420.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93571,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL DURING DIAGNOSIS OR TREATMENT, INITIAL VESSEL",humana - medicare advantage,,O,40842.66,4536.44,4536.44,4610.05,24505.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70150,cpt,"X-RAY OF BONES OF FACE, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,495.21,61.44,93.99,371.41,297.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93279,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT SINGLE LEAD PACEMAKER SYSTEM IN ONE CHAMBER OF HEART WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",humana - medicare advantage,,O,191.31,30.35,30.94,33.02,114.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55874,cpt,INJECTION OF BIODEGRADABLE MATERIAL NEXT TO PROSTATE,humana - medicare advantage,,O,27054.40,4079.31,4079.31,16970.47,16232.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",humana - medicare advantage,,O,3595.37,208.18,208.18,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49657,cpt,"REPAIR OF TRAPPED INCISIONAL HERNIA USING AN ENDOSCOPE, SECONDARY",humana - medicare advantage,,O,34209.16,7903.10,7903.10,10812.66,20525.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63267,cpt,"REMOVAL OF LOWER SPINE BONE AND GROWTH OTHER THAN A TUMOR, EXTRADURAL",humana - medicare advantage,,O,36152.79,5732.13,5732.13,14769.24,21691.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",humana - medicare advantage,,O,365.14,48.65,75.57,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,humana - medicare advantage,,O,41.19,1.80,31.66,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11422,cpt,"REMOVAL OF GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",humana - medicare advantage,,O,18352.47,1273.00,2243.72,2649.40,11011.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",humana - medicare advantage,,O,1997.14,273.93,436.85,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",humana - medicare advantage,,O,226.34,61.44,75.57,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36223,cpt,INSERTION OF CATHETER INTO INTRACRANIAL ARTERY ON ONE SIDE OF NECK FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,humana - medicare advantage,,O,33170.52,2564.86,4243.86,4542.11,19902.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72070,cpt,"X-RAY OF MIDDLE SPINE, 2 VIEWS",humana - medicare advantage,,O,322.63,39.71,98.41,256.49,193.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,humana - medicare advantage,,O,84.93,8.43,12.36,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43774,cpt,REMOVAL OF STOMACH REDUCTION DEVICE AND PORT BENEATH THE SKIN USING AN ENDOSCOPE,humana - medicare advantage,,O,29741.32,2727.97,2727.97,2727.97,17844.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",humana - medicare advantage,,O,513.19,16.80,16.80,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82310,cpt,"CALCIUM LEVEL, TOTAL",humana - medicare advantage,,O,38.80,5.06,5.06,11.12,23.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9264,cpt,"INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG",humana - medicare advantage,,O,46.26,10.29,10.29,20.93,27.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",humana - medicare advantage,,O,199.37,74.90,94.68,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28296,cpt,"CORRECTION OF BUNION, WITH ALIGNMENT CORRECTION OF MIDFOOT BONE (METATARSAL) TOWARDS TOE AREAS",humana - medicare advantage,,O,21379.42,2584.52,2584.52,2584.52,12827.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",humana - medicare advantage,,O,107.59,3.13,19.65,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",humana - medicare advantage,,O,3919.67,159.22,159.22,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0430,revCode,"OCCUPATIONAL THERAPY, GENERAL",humana - medicare advantage,,I,194.27,39.00,41.80,54.36,116.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",humana - medicare advantage,,O,112.55,10.48,10.48,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49505,cpt,REPAIR OF GROIN HERNIA (5 YEARS OR OLDER),humana - medicare advantage,,O,21433.72,3075.50,3075.50,3130.07,12860.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80164,cpt,"VALPROIC ACID LEVEL, TOTAL",humana - medicare advantage,,O,122.56,13.27,13.27,22.57,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86141,cpt,"MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION, HIGH SENSITIVITY",humana - medicare advantage,,O,83.78,12.69,12.69,17.55,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73580,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF KNEE JOINT,humana - medicare advantage,,O,836.43,323.17,325.07,325.07,501.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0104,cpt,COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY,humana - medicare advantage,,O,3830.48,1069.26,1069.26,1069.26,2298.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49329,cpt,OTHER PROCEDURE ON ABDOMEN USING AN ENDOSCOPE,humana - medicare advantage,,O,30927.63,7890.38,7890.38,28017.68,18556.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,644,ms-drg,ENDOCRINE DISORDERS WITH CC,humana - medicare advantage,,I,20353.94,6922.12,6922.12,23799.96,12212.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23615,cpt,"OPEN TREATMENT OF BROKEN UPPER ARM BONE, UPPER END",humana - medicare advantage,,O,57667.26,11309.20,11309.20,11309.20,34600.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,humana - medicare advantage,,O,40.11,4.18,4.18,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,humana - medicare advantage,,I,75778.57,12009.61,12295.83,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,483,ms-drg,MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES,humana - medicare advantage,,I,75391.14,14445.68,14445.68,14445.68,45234.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,humana - medicare advantage,,O,19198.81,2406.74,2568.77,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,987,ms-drg,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,humana - medicare advantage,,I,95039.41,20706.36,20706.36,27921.93,57023.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36475,cpt,DESTRUCTION OF FIRST INCOMPETENT VEIN OF ARM OR LEG USING RADIOFREQUENCY AND IMAGING GUIDANCE,humana - medicare advantage,,O,27732.57,3410.10,3410.10,10128.50,16639.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64636,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, EACH ADDITIONAL FACET JOINT",humana - medicare advantage,,O,7684.84,1563.06,1563.06,4212.43,4610.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36830,cpt,CREATION OF ARTERY-VEIN CONNECTION USING TUBE GRAFT FOR HEMODIALYSIS,humana - medicare advantage,,O,30956.95,4464.51,4464.51,4543.34,18574.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",humana - medicare advantage,,I,145.15,30.77,90.01,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47000,cpt,"NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN",humana - medicare advantage,,O,11195.22,1299.27,1304.33,6518.37,6717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36247,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL THIRD ORDER BRANCH",humana - medicare advantage,,O,26881.27,2581.62,2581.62,29201.92,16128.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,228,ms-drg,OTHER CARDIOTHORACIC PROCEDURES WITH MCC,humana - medicare advantage,,I,121254.63,30823.46,30823.46,30823.46,72752.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,humana - medicare advantage,,O,24173.14,2776.54,2782.44,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",humana - medicare advantage,,O,73.14,3.60,3.60,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27447,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE AND OUTSIDE AREA",humana - medicare advantage,,O,76738.27,10981.15,11308.80,59556.87,46042.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84244,cpt,RENIN (KIDNEY ENZYME) LEVEL,humana - medicare advantage,,O,145.10,21.55,21.55,27.49,87.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17261,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",humana - medicare advantage,,O,1535.94,159.87,159.87,761.92,921.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,humana - medicare advantage,,O,90.02,12.05,13.36,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",humana - medicare advantage,,O,3457.28,1078.00,1078.59,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",humana - medicare advantage,,O,270.00,64.89,236.57,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11402,cpt,"EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS",humana - medicare advantage,,O,6260.36,1304.93,1304.93,2628.67,3756.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78802,cpt,"NUCLEAR MEDICINE LOCALIZATION OF TUMOR OR INFLAMMATION OR STUDY OF DISTRIBUTION OF RADIOACTIVE TRACER IN WHOLE BODY, SINGLE DAY IMAGING",humana - medicare advantage,,O,3201.44,1155.28,1155.28,1155.28,1920.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,humana - medicare advantage,,O,71.96,9.99,12.98,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,humana - medicare advantage,,O,298.87,98.24,98.24,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73223,cpt,MRI SCAN OF ARM JOINT BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,3679.85,324.07,324.07,464.03,2207.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,humana - medicare advantage,,O,94.38,2.18,10.53,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",humana - medicare advantage,,O,2042.16,944.83,1162.00,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",humana - medicare advantage,,I,183.82,35.02,172.26,172.26,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,humana - medicare advantage,,O,145.10,29.21,40.45,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70220,cpt,"X-RAY OF PARANASAL SINUS, COMPLETE, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,362.65,72.01,72.01,271.99,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82530,cpt,"CORTISOL (HORMONE) MEASUREMENT, FREE",humana - medicare advantage,,O,184.03,14.59,16.41,24.76,110.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,humana - medicare advantage,,O,266.35,64.70,101.78,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",humana - medicare advantage,,O,238.30,63.70,94.65,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1442,cpt,"INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM",humana - medicare advantage,,O,4.99,0.72,0.72,269.36,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29822,cpt,LIMITED REMOVAL OF ABNORMAL SHOULDER JOINT TISSUE USING ENDOSCOPE,humana - medicare advantage,,O,27841.82,2507.32,2507.32,20881.37,16705.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,humana - medicare advantage,,O,2289.17,554.60,721.03,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,humana - medicare advantage,,I,5902.00,1055.41,1055.41,28002.03,3541.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,14060,cpt,"TISSUE TRANSFER REPAIR OF WOUND (10 SQ CENTIMETERS OR LESS) OF EYELIDS, NOSE, EARS, AND/OR LIPS",humana - medicare advantage,,O,4854.80,2032.61,2032.61,4854.80,2912.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33249,cpt,INSERTION OR REPLACEMENT OF SINGLE OR DUAL CHAMBER PACING DEFIBRILLATOR LEADS,humana - medicare advantage,,O,103183.41,27788.91,27788.91,50189.53,61910.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,humana - medicare advantage,,I,22023.98,6812.39,8430.16,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52260,cpt,DILATION OF THE BLADDER USING AN ENDOSCOPE UNDER GENERAL OR SPINAL ANESTHESIA,humana - medicare advantage,,O,14534.61,1612.75,1612.75,7644.43,8720.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29880,cpt,REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE,humana - medicare advantage,,O,21409.78,2586.84,2586.84,7284.82,12845.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,humana - medicare advantage,,O,1630.73,338.97,342.21,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85384,cpt,FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,humana - medicare advantage,,O,56.26,7.19,9.53,75.59,11.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82384,cpt,CATECHOLAMINES (ORGANIC NITROGEN) LEVEL,humana - medicare advantage,,O,195.83,25.25,25.25,146.87,117.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,humana - medicare advantage,,O,287.62,21.62,21.62,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86870,cpt,IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,humana - medicare advantage,,O,303.20,21.62,259.14,263.51,181.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37765,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, 10-20 INCISIONS",humana - medicare advantage,,O,23967.03,2586.52,2586.52,13483.00,14380.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23472,cpt,"PROSTHETIC REPAIR OF SHOULDER JOINT, TOTAL SHOULDER",humana - medicare advantage,,O,76075.73,11006.86,11309.20,25947.42,45645.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,348.89,56.80,76.26,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",humana - medicare advantage,,O,826.60,242.61,243.60,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",humana - medicare advantage,,O,318.12,56.64,181.39,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52353,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) USING AN ENDOSCOPE,humana - medicare advantage,,O,27424.44,3917.75,3917.75,3917.75,16454.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",humana - medicare advantage,,O,281.36,90.50,94.68,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93668,cpt,PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION PER SESSION,humana - medicare advantage,,O,148.80,49.55,49.55,64.11,89.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87106,cpt,"FUNGAL CULTURE, YEAST",humana - medicare advantage,,O,112.65,7.28,10.11,16.71,67.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17003,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 2-14 GROWTHS",humana - medicare advantage,,O,1040.92,159.38,1315.38,1315.38,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,640,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",humana - medicare advantage,,I,24682.45,5356.97,8426.29,14419.00,14809.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52352,cpt,REMOVAL OR MANIPULATION OF STONE IN URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE,humana - medicare advantage,,O,22874.73,2781.70,2783.04,5448.70,13724.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,humana - medicare advantage,,O,76.04,10.15,10.15,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84586,cpt,VASOACTIVE INTESTINAL PEPTIDE (INTESTINAL HORMONE) LEVEL,humana - medicare advantage,,O,88.33,34.62,34.62,34.62,53.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",humana - medicare advantage,,O,267.61,61.44,76.23,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",humana - medicare advantage,,O,422.68,79.92,242.61,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13152,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF EYELIDS, NOSE, EARS, AND/OR LIPS",humana - medicare advantage,,O,6410.73,2032.61,2032.61,2032.61,3846.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,436,ms-drg,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,humana - medicare advantage,,I,18592.52,7211.81,7211.81,7211.81,11155.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",humana - medicare advantage,,O,13.80,2.61,3.11,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,humana - medicare advantage,,O,1952.12,344.86,377.64,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L1833,cpt,"KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED, OFF-THE SHELF",humana - medicare advantage,,O,922.91,282.22,481.89,922.91,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83516,cpt,"ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, MULTIPLE STEP METHOD",humana - medicare advantage,,O,55.44,9.63,11.30,41.58,13.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,100,ms-drg,SEIZURES WITH MCC,humana - medicare advantage,,I,27764.15,6132.00,6132.00,14577.74,16658.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",humana - medicare advantage,,O,151.46,8.03,13.12,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9601,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG-ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; EACH ADDITIONAL BRANCH OF A MAJOR CORONARY ARTERY (LIST SEPARATELY IN ADDITION TO",humana - medicare advantage,,O,100902.96,11709.83,11709.83,11709.83,60541.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,862,ms-drg,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,humana - medicare advantage,,I,41021.29,8957.01,12097.49,15812.54,24612.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",humana - medicare advantage,,O,127.54,21.16,21.19,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,humana - medicare advantage,,O,31.24,2.94,8.40,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,humana - medicare advantage,,O,76.68,7.98,11.16,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",humana - medicare advantage,,O,66.26,9.83,9.84,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26735,cpt,TREATMENT OF BROKEN FINGER AT MIDPORTION OR PART NEAR HAND,humana - medicare advantage,,O,24074.48,2589.15,2589.15,2589.15,14444.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85303,cpt,PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT,humana - medicare advantage,,O,264.26,13.57,13.70,264.26,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",humana - medicare advantage,,O,15729.98,1862.99,1862.99,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",humana - medicare advantage,,I,238.84,62.82,234.06,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0269,cpt,"PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE, POST SURGICAL OR INTERVENTIONAL PROCEDURE (E.G., ANGIOSEAL PLUG, VASCULAR PLUG)",humana - medicare advantage,,O,62806.84,6858.72,6858.72,11808.74,37684.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),humana - medicare advantage,,O,41.28,5.08,5.09,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22514,cpt,INJECTION OF BONE CEMENT INTO BODY OF LOWER SPINE BONE ACCESSED THROUGH THE SKIN USING IMAGING GUIDANCE,humana - medicare advantage,,O,37406.27,5736.03,5736.03,18976.00,22443.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43248,cpt,INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,humana - medicare advantage,,O,3996.24,1081.46,1082.06,3758.90,2397.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,humana - medicare advantage,,O,1159.26,202.49,203.19,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11426,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF SCALP, NECK, HANDS, FEET, OR GENITALS, MORE THAN 4.0 CM",humana - medicare advantage,,O,19573.33,2243.72,2243.72,5406.77,11744.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,271,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,humana - medicare advantage,,I,91403.84,19680.56,19680.56,24984.60,54842.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45350,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (SIGMOIDOSCOPE),humana - medicare advantage,,O,3810.64,935.38,935.38,3292.25,2286.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,humana - medicare advantage,,O,70.06,8.01,8.01,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10005,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, FIRST GROWTH",humana - medicare advantage,,O,2576.47,558.51,558.51,1932.35,1545.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80162,cpt,"DIGOXIN LEVEL, TOTAL",humana - medicare advantage,,O,101.33,13.02,13.15,13.33,15.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,humana - medicare advantage,,O,567.74,115.42,288.14,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36905,cpt,"EXCISION OF BLOOD CLOT AND/OR INFUSION TO DISSOLVE BLOOD CLOT IN DIALYSIS CIRCUIT AND BALLOON DILATION OF DIALYSIS SEGMENT, , ACCESSED THROUGH THE SKIN, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION",humana - medicare advantage,,O,37372.90,9050.94,9050.94,10133.54,22423.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,humana - medicare advantage,,I,316.37,68.94,633.75,633.75,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23412,cpt,"REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROCEDURE, CHRONIC OR OLD",humana - medicare advantage,,O,42342.66,5745.08,5745.08,16913.72,25405.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85549,cpt,WHITE BLOOD CELL ENZYME ACTIVITY MEASUREMENT,humana - medicare advantage,,O,46.88,18.37,18.37,18.37,28.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,272,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,humana - medicare advantage,,I,125452.44,16564.29,16564.29,17584.66,75271.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86617,cpt,CONFIRMATION TEST FOR ANTIBODY TO BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),humana - medicare advantage,,O,35.39,15.26,15.26,29.04,21.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21014,cpt,REMOVAL OF (2 CENTIMETERS OR GREATER) MUSCLE GROWTH OF FACE AND SCALP,humana - medicare advantage,,O,18703.97,2243.72,2243.72,4391.53,11222.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64718,cpt,RELEASE AND/OR RELOCATION OF ULNAR NERVE AT ELBOW,humana - medicare advantage,,O,18467.33,1563.58,1563.58,14075.51,11080.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5116,cpt,"INJECTION, TRASTUZUMAB-QYYP, BIOSIMILAR, (TRAZIMERA), 10 MG",humana - medicare advantage,,O,249.43,27.71,32.67,187.07,149.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0342,revCode,"NUCLEAR MEDICINE, THERAPEUTIC",humana - medicare advantage,,O,2703.71,220.75,220.75,225.27,1622.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0121,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK,humana - medicare advantage,,O,3195.82,717.96,719.92,1255.30,1917.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,humana - medicare advantage,,I,1386.23,364.58,1364.01,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",humana - medicare advantage,,O,350.39,39.08,60.74,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",humana - medicare advantage,,E,1724.51,232.62,660.44,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28270,cpt,INCISION OF JOINT CAPSULE OF FOOT AND TOE,humana - medicare advantage,,O,43492.65,2630.53,5736.03,22181.74,26095.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,humana - medicare advantage,,O,1343.10,94.48,94.48,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",humana - medicare advantage,,O,376.41,61.44,94.39,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,264,ms-drg,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,humana - medicare advantage,,I,66325.29,19500.19,19500.19,19500.19,39795.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,humana - medicare advantage,,O,188.17,19.53,58.69,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64418,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO SUPRASCAPULAR NERVE OF SHOULDER,humana - medicare advantage,,O,18628.25,2580.62,2580.62,2580.62,11176.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,698,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,humana - medicare advantage,,I,27219.24,6918.41,10361.19,18262.00,16331.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,humana - medicare advantage,,O,306.38,103.42,115.54,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,humana - medicare advantage,,O,3055.12,203.12,208.18,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,335,ms-drg,PERITONEAL ADHESIOLYSIS WITH MCC,humana - medicare advantage,,I,66776.47,23051.33,23385.25,23385.25,40065.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93291,cpt,"EVALUATION OF HEART RHYTHM MONITOR SYSTEM IMPLANTED UNDER SKIN WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",humana - medicare advantage,,O,139.10,21.65,21.71,22.06,83.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,humana - medicare advantage,,O,862.88,61.44,94.39,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",humana - medicare advantage,,O,220.61,25.26,46.04,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,humana - medicare advantage,,O,784.37,233.55,236.49,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),humana - medicare advantage,,O,65.11,4.25,8.24,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,humana - medicare advantage,,O,105.03,8.42,35.49,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11424,cpt,"REMOVAL OF GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",humana - medicare advantage,,O,15617.60,1304.33,1304.33,9370.59,9370.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",humana - medicare advantage,,O,38.92,2.65,2.65,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",humana - medicare advantage,,O,90.84,3.51,20.81,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91112,cpt,TRANSIT AND PRESSURE MEASUREMENT OF STOMACH THROUGH COLON WITH WIRELESS CAPSULE,humana - medicare advantage,,O,1776.38,206.04,721.13,1332.29,1065.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",humana - medicare advantage,,O,212.36,14.48,43.43,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,337,ms-drg,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,humana - medicare advantage,,I,42487.64,10142.47,10142.47,11374.57,25492.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85598,cpt,PHOSPHOLIPID TEST,humana - medicare advantage,,O,299.66,17.62,17.62,17.62,179.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64415,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO BRACHIAL NERVE BUNDLE OF ARM,humana - medicare advantage,,O,33058.65,2631.25,11631.36,11631.36,19835.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73720,cpt,MRI SCAN OF LEG BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,3055.12,325.59,332.34,1041.43,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,humana - medicare advantage,,O,547.73,91.89,283.75,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",humana - medicare advantage,,O,96.29,11.40,27.45,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,371,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,humana - medicare advantage,,I,34493.37,11008.95,11627.46,12164.75,20696.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36226,cpt,INSERTION OF CATHETER INTO CHEST ARTERY FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,humana - medicare advantage,,O,38021.84,2564.86,4229.97,4229.97,22813.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",humana - medicare advantage,,O,70.01,13.01,22.61,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29445,cpt,"APPLICATION OF WALKING CAST COVERING FOOT, ANKLE, AND LOWER LEG",humana - medicare advantage,,O,1973.35,429.22,429.22,429.22,1184.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92978,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL OR GRAFT WITH REVIEW BY RADIOLOGIST, INITIAL VESSEL",humana - medicare advantage,,O,81139.05,9201.74,9201.74,27750.61,48683.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",humana - medicare advantage,,O,4184.57,938.10,938.10,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,humana - medicare advantage,,O,252.59,54.84,58.45,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64520,cpt,INJECTION OF ANESTHETIC AGENT INTO MIDDLE OR LOWER SPINE SYMPATHETIC NERVE,humana - medicare advantage,,O,4485.85,1113.24,1113.24,9603.36,2691.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52356,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) WITH STENT USING AN ENDOSCOPE,humana - medicare advantage,,O,26186.13,3916.85,4079.31,10931.90,15711.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",humana - medicare advantage,,O,238.30,71.54,94.68,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",humana - medicare advantage,,O,356.40,83.75,94.58,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80202,cpt,VANCOMYCIN (ANTIBIOTIC) LEVEL,humana - medicare advantage,,O,92.78,13.27,13.27,27.34,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,217,ms-drg,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC,humana - medicare advantage,,I,256254.88,37892.62,37892.62,37892.62,153752.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9047,cpt,"INFUSION, ALBUMIN (HUMAN), 25%, 50 ML",humana - medicare advantage,,O,105.55,1.06,51.72,204.13,63.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",humana - medicare advantage,,O,101.45,14.76,20.48,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82308,cpt,CALCITONIN (HORMONE) LEVEL,humana - medicare advantage,,O,405.84,26.25,26.25,70.36,243.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",humana - medicare advantage,,O,50.72,5.89,5.90,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,humana - medicare advantage,,O,31.88,2.63,4.29,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13132,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, UNDERARMS, GENITALS, HANDS, AND/OR FEET",humana - medicare advantage,,O,5466.42,783.95,2243.72,2243.72,3279.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",humana - medicare advantage,,O,62.51,14.38,36.70,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,humana - medicare advantage,,O,2599.91,94.47,94.48,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27648,cpt,INJECTION FOR X-RAY IMAGING OF ANKLE,humana - medicare advantage,,O,3420.36,490.39,490.39,490.39,2052.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,4852.19,224.32,324.17,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78070,cpt,NUCLEAR MEDICINE STUDY OF PARATHYROID,humana - medicare advantage,,O,1393.12,337.82,342.21,777.36,835.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64479,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",humana - medicare advantage,,O,7223.75,739.73,1110.34,2764.46,4334.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,humana - medicare advantage,,O,1869.58,206.26,206.26,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73220,cpt,MRI SCAN OF ARM BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,3055.12,320.47,320.47,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,humana - medicare advantage,,O,203.82,49.80,50.00,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21554,cpt,REMOVAL OF (5 CENTIMETERS OR GREATER) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,humana - medicare advantage,,O,20809.89,2244.32,2244.32,11082.03,12485.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,humana - medicare advantage,,O,101.33,21.90,29.01,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46270,cpt,"REPAIR OF ABNORMAL ANAL DRAINAGE TRACT, UNDER THE SKIN",humana - medicare advantage,,O,19826.90,2231.78,2231.78,2231.78,11896.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,humana - medicare advantage,,I,19710.37,4922.26,6849.11,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,humana - medicare advantage,,I,48.06,11.46,33.03,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",humana - medicare advantage,,O,52.60,8.84,8.84,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70490,cpt,CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST,humana - medicare advantage,,O,1343.10,94.48,94.48,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",humana - medicare advantage,,O,60.16,6.38,6.38,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73201,cpt,CT SCAN OF ARM WITH CONTRAST,humana - medicare advantage,,O,1570.82,324.17,324.17,324.17,942.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",humana - medicare advantage,,O,238.84,35.53,75.26,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31624,cpt,IRRIGATION AND SUCTION OF LUNG AIRWAYS TO OBTAIN CELLS USING AN ENDOSCOPE,humana - medicare advantage,,O,17901.60,2941.10,2941.10,3763.71,10740.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36581,cpt,"REPLACEMENT OF CENTRAL VENOUS CATHETER, TUNNELED WITHOUT PORT OR PUMP",humana - medicare advantage,,O,20102.84,2586.52,2586.52,5848.59,12061.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19286,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, ADDITIONAL LESION",humana - medicare advantage,,O,49381.77,4912.34,4912.34,4912.34,29629.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84305,cpt,SOMATOMEDIN (GROWTH FACTOR) LEVEL,humana - medicare advantage,,O,256.01,20.83,20.83,34.48,153.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",humana - medicare advantage,,I,316.91,22.36,258.58,258.58,190.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29824,cpt,PARTIAL REMOVAL OF COLLAR BONE AT SHOULDER USING AN ENDOSCOPE,humana - medicare advantage,,O,30695.12,2631.25,4160.58,17497.02,18417.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,humana - medicare advantage,,O,252.59,4.78,21.48,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70250,cpt,"X-RAY OF SKULL, LESS THAN 4 VIEWS",humana - medicare advantage,,O,292.62,94.39,94.39,94.39,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0585,cpt,"INJECTION, ONABOTULINUMTOXINA, 1 UNIT",humana - medicare advantage,,O,8.76,7.93,7.93,7.93,5.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63030,cpt,PARTIAL REMOVAL OF BONE WITH RELEASE OF SPINAL CORD OR SPINAL NERVES OF 1 INTERSPACE IN LOWER SPINE,humana - medicare advantage,,O,29485.64,5732.13,5732.13,22114.23,17691.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29825,cpt,RELEASE OR REMOVAL OF SHOULDER SCAR TISSUE USING AN ENDOSCOPE,humana - medicare advantage,,O,29814.55,2596.65,5613.10,14706.90,17888.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",humana - medicare advantage,,O,285.11,61.44,75.92,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64624,cpt,DESTRUCTION OF GENICULAR NERVE BRANCHES OF KNEE BY INJECTION USING IMAGING GUIDANCE,humana - medicare advantage,,O,5206.83,1562.39,1562.39,2589.93,3124.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,humana - medicare advantage,,O,183.82,20.77,22.00,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,humana - medicare advantage,,O,290.12,59.69,115.54,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,339,ms-drg,APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC,humana - medicare advantage,,I,44017.42,10670.20,10670.20,10670.20,26410.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0180,cpt,"INJECTION, AGALSIDASE BETA, 1 MG",humana - medicare advantage,,O,492.35,203.70,203.70,203.70,295.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28232,cpt,"INCISION TO LENGTHEN TOE TENDON, OPEN PROCEDURE",humana - medicare advantage,,O,17839.27,2584.52,2584.52,2631.16,10703.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,humana - medicare advantage,,O,138.03,20.16,20.81,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19082,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, EACH ADDITIONAL GROWTH",humana - medicare advantage,,O,11530.70,2243.72,2243.72,4516.07,6918.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22999,cpt,OTHER PROCEDURE ON ABDOMINAL MUSCLE OR BONE,humana - medicare advantage,,O,31812.66,6318.16,7903.10,7903.10,19087.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,humana - medicare advantage,,O,143.17,18.59,18.66,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,humana - medicare advantage,,O,348.63,85.16,85.16,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",humana - medicare advantage,,I,190.07,49.10,186.27,190.07,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84110,cpt,URINE PORPHOBILINOGEN (METABOLISM SUBSTANCE) LEVEL,humana - medicare advantage,,O,61.96,8.27,8.27,8.27,37.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52204,cpt,BIOPSY OF THE BLADDER USING AN ENDOSCOPE,humana - medicare advantage,,O,16937.27,1612.75,1612.75,8967.03,10162.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,humana - medicare advantage,,O,440.18,84.89,203.29,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90732,cpt,"VACCINE FOR PNEUMOCOCCAL POLYSACCHARIDE FOR INJECTION BENEATH THE SKIN OR INTO MUSCLE, PATIENT 2 YEARS OR OLDER",humana - medicare advantage,,O,171.31,98.30,98.30,98.30,102.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85306,cpt,PROTEIN S (CLOTTING INHIBITOR) MEASUREMENT,humana - medicare advantage,,O,187.57,15.02,15.13,187.57,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73702,cpt,CT SCAN OF LEG BEFORE AND AFTER CONTRAST INJECTION,humana - medicare advantage,,O,2362.30,156.43,161.61,482.16,1417.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0275,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES PACEMAKER,humana - medicare advantage,,O,17504.50,5978.85,9158.16,9158.16,10502.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",humana - medicare advantage,,O,192.85,42.50,91.33,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,humana - medicare advantage,,O,5902.67,923.22,1155.68,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,149.83,34.39,34.39,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93284,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, MULTIPLE LEAD DEFIBRILLATOR SYSTEM",humana - medicare advantage,,O,349.06,30.94,30.94,33.69,209.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,humana - medicare advantage,,O,187.57,14.84,100.59,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11622,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",humana - medicare advantage,,O,18159.00,159.22,159.22,2453.97,10895.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64488,cpt,INJECTION OF LOCAL ANESTHETIC FOR ABDOMINAL WALL PAIN CONTROL ON BOTH SIDES USING IMAGING GUIDANCE,humana - medicare advantage,,O,37973.20,7902.70,7902.70,7902.70,22783.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37607,cpt,TYING OR BANDING OF SURGICALLY CREATED ARTERY-VEIN CONNECTION,humana - medicare advantage,,O,17782.73,2551.81,2580.62,2580.62,10669.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3489,cpt,"INJECTION, ZOLEDRONIC ACID, 1 MG",humana - medicare advantage,,O,147.55,10.36,45.35,110.66,88.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,humana - medicare advantage,,O,203.82,49.80,50.00,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28810,cpt,AMPUTATION OF TOE AND MIDFOOT BONE,humana - medicare advantage,,O,19213.79,2584.52,2584.52,2584.83,11528.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,humana - medicare advantage,,O,101.33,11.74,23.60,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36820,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, FOREARM VEIN",humana - medicare advantage,,O,23302.11,4452.47,4452.47,4452.47,13981.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,humana - medicare advantage,,O,53.76,5.92,5.94,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70470,cpt,CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,2708.71,159.41,159.41,450.85,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,14301,cpt,TISSUE TRANSFER REPAIR OF WOUND (30.1 TO 60.0 SQ CENTIMETERS),humana - medicare advantage,,O,17483.76,2823.95,2823.95,2823.95,10490.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21012,cpt,REMOVAL OF (2 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF FACE AND SCALP,humana - medicare advantage,,O,17016.95,1262.82,1262.82,4330.56,10210.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",humana - medicare advantage,,O,85.03,16.92,85.03,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,humana - medicare advantage,,O,60.03,7.19,11.74,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",humana - medicare advantage,,O,212.59,22.86,26.96,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97605,cpt,"NEGATIVE PRESSURE WOUND THERAPY, SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS, PER SESSION",humana - medicare advantage,,O,1881.44,329.77,413.73,540.81,1128.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77075,cpt,X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY,humana - medicare advantage,,O,735.32,61.44,97.23,97.23,441.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",humana - medicare advantage,,O,4496.04,1078.59,1078.59,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,humana - medicare advantage,,O,108.53,13.66,14.28,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,humana - medicare advantage,,O,3055.12,206.42,206.42,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,92.99,21.05,34.39,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",humana - medicare advantage,,O,31.88,3.63,3.63,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,humana - medicare advantage,,O,50.72,6.35,6.35,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,humana - medicare advantage,,I,5986.20,1090.17,3120.34,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,humana - medicare advantage,,I,65131.57,7666.11,15711.73,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93281,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT MULTIPLE LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",humana - medicare advantage,,O,257.60,30.44,30.46,136.53,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,564,ms-drg,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,humana - medicare advantage,,I,22485.44,9608.59,9608.59,9608.59,13491.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,humana - medicare advantage,,O,402.67,93.28,93.28,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",humana - medicare advantage,,O,715.30,48.27,94.39,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",humana - medicare advantage,,O,437.43,101.00,101.00,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,373,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,humana - medicare advantage,,I,28552.84,5080.75,5080.75,7657.82,17131.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",humana - medicare advantage,,O,35.00,2.32,2.32,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19499,cpt,OTHER PROCEDURE ON BREAST,humana - medicare advantage,,O,36082.70,3882.54,3882.54,5007.08,21649.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,humana - medicare advantage,,O,119.15,21.42,22.01,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,humana - medicare advantage,,O,3008.85,207.30,469.17,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",humana - medicare advantage,,O,1406.87,198.35,327.84,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,humana - medicare advantage,,O,178.08,50.28,50.28,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",humana - medicare advantage,,O,632.77,59.44,156.44,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96409,cpt,ADMINISTRATION OF CHEMOTHERAPY INTO VEIN USING PUSH TECHNIQUE,humana - medicare advantage,,O,448.94,102.13,179.68,361.50,269.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9602,cpt,"PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH DRUG ELUTING INTRACORONARY STENT, WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",humana - medicare advantage,,O,89872.77,14944.85,14944.85,15180.19,53923.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,humana - medicare advantage,,O,401.42,94.39,94.39,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",humana - medicare advantage,,O,226.34,61.44,76.80,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,humana - medicare advantage,,O,83.78,3.34,3.40,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38525,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, OPEN PROCEDURE",humana - medicare advantage,,O,34276.96,4931.97,4931.97,12984.24,20566.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93454,cpt,INSERTION OF CATHETER FOR IMAGING OF HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,humana - medicare advantage,,O,40037.22,2564.66,2564.66,18046.03,24022.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86593,cpt,SYPHILIS TEST,humana - medicare advantage,,O,50.01,2.27,4.31,6.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36590,cpt,REMOVAL OF PERIPHERAL VENOUS CATHETER FOR INFUSION,humana - medicare advantage,,O,1905.16,1937.39,1937.39,1937.39,1143.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,humana - medicare advantage,,O,38.92,4.65,4.65,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,humana - medicare advantage,,O,123.87,5.34,8.72,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,16020,cpt,DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5% TOTAL BODY SURFACE),humana - medicare advantage,,O,738.64,157.08,157.08,553.98,443.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84446,cpt,VITAMIN E LEVEL,humana - medicare advantage,,O,83.76,7.84,13.90,66.59,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13101,cpt,REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF TRUNK,humana - medicare advantage,,O,17422.96,473.85,1304.93,5652.50,10453.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,659,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,humana - medicare advantage,,I,49964.58,11203.29,11203.29,17521.95,29978.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86341,cpt,ISLET CELL (PANCREAS) ANTIBODY MEASUREMENT,humana - medicare advantage,,O,139.21,23.10,23.10,23.67,83.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74250,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST AND MULTIPLE SERIAL FILMS,humana - medicare advantage,,O,530.23,158.38,158.38,397.67,318.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,863,ms-drg,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,humana - medicare advantage,,I,11597.19,6882.46,6882.46,10082.73,6958.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,humana - medicare advantage,,O,43.18,10.79,16.96,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",humana - medicare advantage,,O,140.38,11.21,21.32,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33207,cpt,INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER AND LOWER CHAMBER ELECTRODES,humana - medicare advantage,,O,40018.14,9221.29,9221.29,9407.44,24010.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5101,cpt,"INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MICROGRAM",humana - medicare advantage,,O,1.96,0.20,0.20,0.53,1.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19303,cpt,SIMPLE COMPLETE REMOVAL OF BREAST,humana - medicare advantage,,O,32479.31,5148.44,5154.34,5253.51,19487.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",humana - medicare advantage,,O,327.67,47.93,303.94,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,humana - medicare advantage,,O,175.06,87.53,106.43,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29881,cpt,REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE,humana - medicare advantage,,O,21489.40,2516.47,2516.47,7609.83,3025.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",humana - medicare advantage,,O,826.60,239.39,242.61,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",humana - medicare advantage,,O,441.23,35.97,49.79,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86162,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), TOTAL HEMOLYTIC",humana - medicare advantage,,O,151.31,19.99,19.99,19.99,90.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",humana - medicare advantage,,O,31.24,4.67,5.19,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11308,cpt,"SHAVING OF OVER 2.0 CENTIMETERS SKIN GROWTH OF SCALP, NECK, HANDS, FEET, OR GENITALS",humana - medicare advantage,,O,1965.00,161.17,161.17,161.17,1179.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75716,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMAGING OF ARTERIES OF BOTH ARMS OR LEGS,humana - medicare advantage,,O,7596.99,64.33,2581.62,5697.74,4558.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15002,cpt,"PREPARATION OF SKIN GRAFT SITE OF TRUNK, ARMS, OR LEGS, 100.0 SQ CM OR 1% BODY AREA FOR INFANTS AND CHILDREN, OR LESS",humana - medicare advantage,,O,24062.24,1752.61,1752.61,1752.61,14437.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,humana - medicare advantage,,O,116.31,18.99,18.99,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",humana - medicare advantage,,O,200.00,27.06,38.03,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",humana - medicare advantage,,O,1029.19,93.54,93.59,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",humana - medicare advantage,,O,41.28,4.92,5.02,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",humana - medicare advantage,,O,41.28,3.01,4.92,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86337,cpt,INSULIN ANTIBODY MEASUREMENT,humana - medicare advantage,,O,104.49,20.98,20.98,26.76,62.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",humana - medicare advantage,,O,357.64,32.78,76.26,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,humana - medicare advantage,,O,52.60,6.75,6.75,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",humana - medicare advantage,,O,117.54,25.46,58.45,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,155,ms-drg,"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",humana - medicare advantage,,I,26229.54,6053.79,6053.79,7743.63,15737.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55700,cpt,BIOPSY OF PROSTATE GLAND,humana - medicare advantage,,O,15825.28,1612.35,1612.35,4133.17,1936.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,176,ms-drg,PULMONARY EMBOLISM WITHOUT MCC,humana - medicare advantage,,I,19404.23,4326.04,5720.53,23340.67,11642.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,254,ms-drg,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,humana - medicare advantage,,I,43574.21,11908.23,11908.23,22388.66,26144.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,humana - medicare advantage,,I,16808.50,4145.69,8371.18,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",humana - medicare advantage,,O,345.14,75.82,179.68,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27829,cpt,OPEN TREATMENT OF LIGAMENT TEAR AT ANKLE JOINT,humana - medicare advantage,,O,42413.56,5753.52,5753.52,11156.14,25448.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,humana - medicare advantage,,O,5444.73,938.10,938.10,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",humana - medicare advantage,,O,266.35,51.50,76.19,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",humana - medicare advantage,,O,365.24,8.63,14.09,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",humana - medicare advantage,,O,519.10,54.18,83.40,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,208,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,humana - medicare advantage,,I,75679.94,16342.73,16342.73,23209.18,45407.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,856,ms-drg,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,humana - medicare advantage,,I,62065.22,50287.00,117603.82,117603.82,37239.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,882,ms-drg,NEUROSES EXCEPT DEPRESSIVE,humana - medicare advantage,,I,14589.21,3863.55,5612.78,11557.84,8753.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86039,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, TITER",humana - medicare advantage,,O,294.94,10.94,10.94,168.12,176.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,580,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",humana - medicare advantage,,I,52656.26,7319.59,11133.67,18388.00,31593.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24071,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF UPPER ARM OR ELBOW,humana - medicare advantage,,O,20596.09,2107.80,2107.80,4391.53,12357.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5106,cpt,"INJECTION, EPOETIN ALFA-EPBX, BIOSIMILAR, (RETACRIT) (FOR NON-ESRD USE), 1000 UNITS",humana - medicare advantage,,O,34.20,7.63,7.63,16.35,20.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17281,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",humana - medicare advantage,,O,2044.74,311.97,311.97,545.53,1226.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,humana - medicare advantage,,O,122.03,31.49,122.71,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64493,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SINGLE LEVEL",humana - medicare advantage,,O,4480.53,1107.35,1112.92,2566.99,2688.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42999,cpt,"OTHER PROCEDURE ON THROAT, ADENOIDS, OR TONSILS",humana - medicare advantage,,O,21539.34,2899.66,2899.66,2899.66,12923.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,humana - medicare advantage,,O,256.35,58.45,58.45,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73650,cpt,"X-RAY OF HEEL, MINIMUM OF 2 VIEWS",humana - medicare advantage,,O,254.50,44.02,76.53,149.69,152.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0114,revCode,ROOM AND BOARD PRIVATE (ONE BED) PSYCHIATRIC,humana - medicare advantage,,I,2332.29,629.26,2200.28,3095.92,1399.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",humana - medicare advantage,,O,60.03,13.90,13.90,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38792,cpt,INJECTION OF RADIOACTIVE MATERIAL FOR X-RAY IDENTIFICATION OF LYMPH NODE,humana - medicare advantage,,O,48181.56,4936.05,4936.05,5007.08,28908.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11200,cpt,REMOVAL OF UP TO AND INCLUDING 15 SKIN TAGS,humana - medicare advantage,,O,1771.26,2107.80,2107.80,2107.80,1062.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",humana - medicare advantage,,O,267.61,48.10,74.38,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,humana - medicare advantage,,O,40.11,4.65,4.65,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83605,cpt,LACTIC ACID LEVEL,humana - medicare advantage,,O,71.96,5.48,11.34,53.97,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11642,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",humana - medicare advantage,,O,3061.00,710.75,1300.35,2453.97,1836.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,humana - medicare advantage,,O,287.62,77.37,77.37,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0521,revCode,FREESTANDING CLINIC CLINIC VISIT BY MEMBER TORHC/FQHC,humana - medicare advantage,,O,290.00,111.87,240.49,255.96,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,812,ms-drg,RED BLOOD CELL DISORDERS WITHOUT MCC,humana - medicare advantage,,I,17513.39,3290.25,6057.14,22466.97,10508.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78816,cpt,NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY,humana - medicare advantage,,O,8009.86,1290.20,1295.90,2705.32,4805.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33228,cpt,REMOVAL AND REPLACEMENT OF DUAL LEAD PERMANENT PACEMAKER PULSE GENERATOR,humana - medicare advantage,,O,35778.64,8954.12,9324.25,9324.25,21467.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80198,cpt,THEOPHYLLINE LEVEL,humana - medicare advantage,,O,99.09,13.86,13.86,13.86,59.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,humana - medicare advantage,,O,42.58,6.02,6.02,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,480,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,humana - medicare advantage,,I,96538.51,18056.23,18056.23,18056.23,57923.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26160,cpt,REMOVAL OF GROWTH OF TENDON FINGER OR HAND,humana - medicare advantage,,O,19482.74,1247.77,1247.77,5351.19,11689.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,246,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,humana - medicare advantage,,I,112798.01,18912.25,19579.58,59595.14,67678.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2350,cpt,"INJECTION, OCRELIZUMAB, 1 MG",humana - medicare advantage,,O,156.72,36.34,58.60,117.73,94.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93923,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, COMPLETE",humana - medicare advantage,,O,445.18,123.80,125.34,125.34,267.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90653,cpt,"VACCINE FOR INFLUENZA FOR INJECTION INTO MUSCLE, INACTIVATED",humana - medicare advantage,,O,244.29,56.98,56.98,56.98,146.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",humana - medicare advantage,,O,245.09,44.06,75.57,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,humana - medicare advantage,,O,188.17,66.99,104.70,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88104,cpt,"CELL EXAMINATION OF BODY FLUID, SMEARS",humana - medicare advantage,,O,102.63,29.42,29.42,29.42,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84300,cpt,URINE SODIUM LEVEL,humana - medicare advantage,,O,37.50,3.04,4.96,5.08,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",humana - medicare advantage,,O,19538.26,2569.95,2586.52,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92920,cpt,"BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORONARY ARTERY OR BRANCH (ACCESSED THROUGH THE SKIN), EACH ADDITIONAL ARTERY OR BRANCH",humana - medicare advantage,,O,56646.63,4554.88,11562.87,22653.36,33987.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,humana - medicare advantage,,O,73.83,11.51,14.78,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,humana - medicare advantage,,O,69.59,8.01,19.31,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,humana - medicare advantage,,O,107.35,17.69,19.63,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,humana - medicare advantage,,I,108746.38,30644.47,30644.47,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",humana - medicare advantage,,O,16.23,1.83,17.20,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",humana - medicare advantage,,O,65.11,8.45,8.45,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,486,ms-drg,KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC,humana - medicare advantage,,I,64005.75,13116.91,13116.91,13116.91,38403.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0118,revCode,ROOM AND BOARD PRIVATE (ONE BED) REHABILITATION,humana - medicare advantage,,I,969.17,949.79,949.79,949.79,581.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84484,cpt,"TROPONIN (PROTEIN) ANALYSIS, QUANTITATIVE",humana - medicare advantage,,O,176.37,12.22,12.22,186.95,14.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,humana - medicare advantage,,O,50.01,3.11,5.08,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",humana - medicare advantage,,O,45.06,8.66,17.57,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",humana - medicare advantage,,O,112.07,9.78,15.97,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",humana - medicare advantage,,O,183.82,24.23,27.91,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,4054.33,324.17,324.17,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93283,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, DUAL LEAD DEFIBRILLATOR SYSTEM",humana - medicare advantage,,O,288.87,30.93,32.32,32.32,173.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,humana - medicare advantage,,I,84.46,20.40,81.60,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,humana - medicare advantage,,O,89.65,18.15,18.15,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),humana - medicare advantage,,O,132.12,15.79,21.89,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",humana - medicare advantage,,O,209.99,16.56,18.03,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",humana - medicare advantage,,O,250.10,18.15,18.15,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,humana - medicare advantage,,O,132.54,29.82,55.19,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",humana - medicare advantage,,O,365.14,61.44,75.89,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73202,cpt,CT SCAN OF ARM BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,2143.46,161.61,161.61,161.61,1286.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,humana - medicare advantage,,O,183.82,19.97,21.24,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74240,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST,humana - medicare advantage,,O,513.01,159.41,159.63,543.79,307.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17263,cpt,"DESTRUCTION OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",humana - medicare advantage,,O,1535.94,159.87,159.87,159.87,921.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28820,cpt,AMPUTATION OF TOE AT JOINT BETWEEN THE FOREFOOT AND TOES,humana - medicare advantage,,O,16545.00,2584.52,2584.52,2630.53,9927.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,humana - medicare advantage,,E,880.03,214.07,214.17,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,humana - medicare advantage,,O,2149.71,310.75,310.75,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,219,ms-drg,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC,humana - medicare advantage,,I,273706.78,50398.98,50398.98,50398.98,164224.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,233,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,humana - medicare advantage,,I,285898.27,47239.96,47239.96,86794.01,171538.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",humana - medicare advantage,,I,2599.91,780.60,1874.51,1949.93,1559.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21933,cpt,"REMOVAL OF GROWTH OF MUSCLE OF BACK OR LOWER SIDES, 5.0 CM OR MORE",humana - medicare advantage,,O,19820.30,2226.69,2243.72,2283.41,11892.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,humana - medicare advantage,,O,811.59,92.97,93.99,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80197,cpt,TACROLIMUS LEVEL,humana - medicare advantage,,O,674.82,13.49,13.49,57.77,16.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",humana - medicare advantage,,O,89.65,10.18,12.93,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,151.64,21.05,34.39,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",humana - medicare advantage,,O,94.14,7.61,7.61,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73701,cpt,CT SCAN OF LEG WITH CONTRAST MATERIAL,humana - medicare advantage,,O,1630.73,156.23,159.02,159.02,978.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),humana - medicare advantage,,O,3857.66,938.20,1407.16,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),humana - medicare advantage,,O,91.30,14.31,18.92,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,humana - medicare advantage,,O,520.22,353.23,353.36,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20680,cpt,REMOVAL OF DEEP IMPLANT FROM BONE,humana - medicare advantage,,O,22681.09,2246.95,2246.95,12436.52,13608.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",humana - medicare advantage,,O,3395.81,1103.79,1108.34,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,humana - medicare advantage,,O,71.96,15.59,15.59,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43244,cpt,TYING OF DILATED VEINS OF STOMACH AND/OR ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,humana - medicare advantage,,O,5449.41,1441.59,1514.61,1539.44,3269.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,2707.46,156.22,159.41,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",humana - medicare advantage,,O,281.00,8.75,812.73,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,humana - medicare advantage,,O,28.83,5.59,11.81,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62304,cpt,X-RAY OF LOWER SPINAL CANAL WITH RADIOLOGICAL SUPERVISION AND INTERPRETATION,humana - medicare advantage,,O,7871.44,966.75,966.75,966.75,4722.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",humana - medicare advantage,,O,377.65,61.44,94.39,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,humana - medicare advantage,,O,148.64,17.37,18.45,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,699,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,humana - medicare advantage,,I,19519.09,6879.34,6879.34,9803.04,11711.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,humana - medicare advantage,,O,135.66,26.63,49.84,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",humana - medicare advantage,,O,622.77,61.44,93.28,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",humana - medicare advantage,,O,4116.84,594.86,1278.48,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29581,cpt,APPLICATION OF VEIN WOUND COMPRESSION SYSTEM LOWER LEG BELOW KNEE INCLUDING ANKLE AND FOOT,humana - medicare advantage,,O,1305.86,230.97,230.97,926.72,783.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,humana - medicare advantage,,O,1446.95,312.71,324.08,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,humana - medicare advantage,,I,14759.59,3312.91,4648.34,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,673,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,humana - medicare advantage,,I,69347.05,21366.97,21366.97,39818.00,41608.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,60100,cpt,"NEEDLE BIOPSY OF THYROID, ACCESSED THROUGH THE SKIN",humana - medicare advantage,,O,16801.93,568.09,568.09,568.09,10081.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,humana - medicare advantage,,O,69.59,9.12,9.23,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,humana - medicare advantage,,O,79.04,16.60,16.60,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",humana - medicare advantage,,O,83.33,15.97,26.08,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87185,cpt,"DETECTION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL)",humana - medicare advantage,,O,16.95,2.54,2.54,2.54,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,40530,cpt,PARTIAL REMOVAL OF LIP,humana - medicare advantage,,O,17632.10,2470.49,2470.49,2470.49,10579.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45172,cpt,REMOVAL OF RECTAL GROWTH THROUGH THE ANUS WITH REMOVAL OF A PORTION OF THE MUSCLE,humana - medicare advantage,,O,21801.42,2237.24,2237.24,2237.24,13080.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63047,cpt,"PARTIAL REMOVAL OF MIDDLE SPINE BONE WITH RELEASE OF SPINAL CORD AND/OR NERVES, LOWER BACK (LUMBAR) AREA",humana - medicare advantage,,O,38040.40,5647.81,5647.81,13162.95,22824.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,humana - medicare advantage,,I,163.02,40.45,737.50,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70540,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK WITHOUT CONTRAST",humana - medicare advantage,,O,1869.58,208.18,461.58,639.63,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17280,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS OR LESS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",humana - medicare advantage,,O,1675.86,159.23,349.82,410.05,1005.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",humana - medicare advantage,,O,103.81,18.28,18.28,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),humana - medicare advantage,,O,50.01,5.20,14.10,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37242,cpt,"OCCLUSION OF ARTERY (OTHER THAN HEMORRHAGE OR TUMOR) WITH RADIOLOGICAL SUPERVISION AND INTERPRETATION, ROADMAPPING, AND IMAGING GUIDANCE",humana - medicare advantage,,O,62597.01,8908.03,8908.03,8908.03,37558.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,501,ms-drg,SOFT TISSUE PROCEDURES WITH CC,humana - medicare advantage,,I,78496.87,11464.77,11464.77,19965.84,47098.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,humana - medicare advantage,,O,69.59,7.80,16.13,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",humana - medicare advantage,,O,63.63,6.74,6.78,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80185,cpt,"PHENYTOIN LEVEL, TOTAL",humana - medicare advantage,,O,108.53,12.98,12.98,17.58,15.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",humana - medicare advantage,,O,44.82,3.29,9.39,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64635,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, SINGLE FACET JOINT",humana - medicare advantage,,O,7687.98,1563.06,1563.06,2892.60,4612.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",humana - medicare advantage,,O,140.04,24.64,24.64,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",humana - medicare advantage,,O,71.96,7.91,7.91,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,humana - medicare advantage,,O,113.25,11.78,13.98,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,humana - medicare advantage,,I,36086.42,12423.48,12482.79,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",humana - medicare advantage,,O,1091.80,160.12,160.65,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36222,cpt,INSERTION OF CATHETER INTO EXTRACRANIAL ARTERY ON ONE SIDE OF NECK FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,humana - medicare advantage,,O,21909.38,2564.66,2564.66,2564.66,13145.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,humana - medicare advantage,,O,2112.19,159.41,159.41,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",humana - medicare advantage,,O,70.06,8.29,8.29,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13151,cpt,"REPAIR OF WOUND (1.1 TO 2.5 CENTIMETERS) OF EYELIDS, NOSE, EARS, AND/OR LIPS",humana - medicare advantage,,O,10438.38,2470.49,2470.49,2470.49,6263.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,908,ms-drg,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,humana - medicare advantage,,I,61086.11,11576.87,13293.20,20349.19,36651.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,304,ms-drg,HYPERTENSION WITH MCC,humana - medicare advantage,,I,24017.13,7342.26,7342.26,12391.04,14410.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11623,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",humana - medicare advantage,,O,4960.80,1253.04,1253.04,2217.32,2976.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77021,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF MRI GUIDANCE FOR INSERTION OF NEEDLE,humana - medicare advantage,,O,11389.85,1273.00,1304.33,6117.24,6833.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",humana - medicare advantage,,O,245.09,61.44,75.57,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,humana - medicare advantage,,O,30.08,5.04,5.04,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54161,cpt,"REMOVAL OF FORESKIN, PATIENT OLDER THAN 28 DAYS OF AGE",humana - medicare advantage,,O,17685.68,1612.75,1612.75,1639.64,10611.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,humana - medicare advantage,,O,1753.28,96.00,96.00,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82465,cpt,CHOLESTEROL LEVEL,humana - medicare advantage,,O,37.50,4.26,4.26,4.37,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",humana - medicare advantage,,O,114.43,3.13,19.65,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",humana - medicare advantage,,O,90.84,9.28,9.28,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49422,cpt,REMOVAL OF ABDOMINAL CAVITY CATHETER,humana - medicare advantage,,O,18151.83,2586.52,2586.52,4543.19,10891.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,humana - medicare advantage,,O,30.49,2.32,2.32,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26418,cpt,REPAIR OF FINGER TENDON ON THE TOP SIDE OF THE HAND (EXTENSOR) WITHOUT A GRAFT,humana - medicare advantage,,O,26605.46,2589.15,2589.15,2589.15,15963.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,200,ms-drg,PNEUMOTHORAX WITH CC,humana - medicare advantage,,I,20169.50,7259.72,7259.72,12541.14,12101.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,humana - medicare advantage,,O,87.53,4.18,4.18,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,humana - medicare advantage,,I,32181.45,11429.58,11445.99,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52224,cpt,DESTRUCTION OF (LESS THAN 0.5 CENTIMETERS) GROWTHS OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,humana - medicare advantage,,O,16231.14,2776.54,2782.44,2782.44,9738.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,982,ms-drg,EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,humana - medicare advantage,,I,47387.36,16063.92,16063.92,16063.92,28432.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74150,cpt,CT SCAN OF ABDOMEN WITHOUT CONTRAST,humana - medicare advantage,,O,1344.34,95.70,95.70,766.27,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,418,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,humana - medicare advantage,,I,55035.81,10049.90,10461.52,14375.97,33021.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31267,cpt,"REMOVAL OF NASAL SINUS TISSUE USING AN ENDOSCOPE, MAXILLARY SINUS",humana - medicare advantage,,O,30770.23,5366.25,5366.25,5366.25,18462.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45338,cpt,"PLACEMENT OF DRAINAGE CATHETER OF BILIARY DUCT, ACCESSED THROUGH THE SKIN WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",humana - medicare advantage,,O,4723.92,938.10,938.10,1922.90,2834.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37230,cpt,"INSERTION OF STENTS INTO ARTERY IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",humana - medicare advantage,,O,81353.63,14941.36,14941.36,29201.92,48812.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19285,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",humana - medicare advantage,,O,31940.44,2805.32,2805.32,7734.30,19164.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,humana - medicare advantage,,O,1952.12,144.93,159.41,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10160,cpt,"ASPIRATION OF ABSCESS, BLOOD ACCUMULATION, BLISTER, OR CYST",humana - medicare advantage,,O,906.43,307.72,307.72,307.72,543.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",humana - medicare advantage,,O,218.83,30.93,33.69,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),humana - medicare advantage,,O,283.14,16.69,16.69,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37225,cpt,"REMOVAL OF PLAQUE IN ARTERIES IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",humana - medicare advantage,,O,100206.21,14241.67,14241.67,14241.67,60123.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31526,cpt,DIAGNOSTIC EXAMINATION OF VOICE BOX USING AN ENDOSCOPE WITH OPERATING MICROSCOPE OR TELESCOPE,humana - medicare advantage,,O,17731.22,1390.45,1390.45,1390.45,10638.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22853,cpt,INSERTION OF DEVICE INTO INTERVERTEBRAL DISC SPACE OF SPINE AND FUSION OF VERTEBRAE,humana - medicare advantage,,O,79400.06,11349.44,11349.44,22181.74,47640.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28124,cpt,PARTIAL REMOVAL OF TOE BONE,humana - medicare advantage,,O,17782.12,2562.21,2581.58,2581.58,10669.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33274,cpt,INSERTION OR REPLACEMENT OF PERMANENT LEADLESS PACEMAKER INTO LOWER RIGHT CHAMBER OF HEART VIA CATHETER USING IMAGING GUIDANCE,humana - medicare advantage,,O,58435.25,14913.94,14913.94,15183.80,35061.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,humana - medicare advantage,,O,3580.43,810.94,812.73,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",humana - medicare advantage,,O,338.89,30.54,33.15,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,2112.19,159.37,161.61,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,44388,cpt,DIAGNOSTIC EXAMINATION OF LARGE BOWEL USING AN ENDOSCOPE INSERTED THROUGH SURGICALLY CREATED OPENING INTO LARGE BOWEL FROM BODY WALL (COLOSTOMY),humana - medicare advantage,,O,3212.71,710.83,710.83,1994.96,1927.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,689,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,humana - medicare advantage,,I,21131.83,6249.42,7144.57,7144.57,12679.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,813,ms-drg,COAGULATION DISORDERS,humana - medicare advantage,,I,39775.27,10298.94,10298.94,10298.94,23865.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83825,cpt,MERCURY LEVEL,humana - medicare advantage,,O,132.12,15.93,15.93,27.18,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49652,cpt,REPAIR OF HERNIA USING AN ENDOSCOPE,humana - medicare advantage,,O,32035.83,4504.70,4504.70,4577.95,19221.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,humana - medicare advantage,,O,100.03,11.53,11.53,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,205,ms-drg,OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,humana - medicare advantage,,I,31114.01,8093.16,8093.16,8093.16,18668.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",humana - medicare advantage,,O,101.45,11.20,11.20,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45331,cpt,BIOPSY OF THE LOWER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY),humana - medicare advantage,,O,4384.17,710.14,1008.99,3810.64,2630.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72120,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS 2 OR 3 VIEWS,humana - medicare advantage,,O,377.65,92.59,92.59,92.59,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",humana - medicare advantage,,O,650.28,61.44,94.39,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57461,cpt,CONE BIOPSY OF CERVIX AND VAGINA USING AN ENDOSCOPE WITH LOOP ELECTRODE,humana - medicare advantage,,O,20672.65,1553.11,2459.35,2459.35,12403.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,15830,cpt,REMOVAL OF EXCESSIVE SKIN AND TISSUE BENEATH THE SKIN OF ABDOMEN,humana - medicare advantage,,O,44474.55,4912.44,4912.44,4912.44,26684.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",humana - medicare advantage,,O,70.78,13.97,24.96,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29826,cpt,SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE,humana - medicare advantage,,O,33765.02,2631.25,5735.83,16721.96,6904.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,964,ms-drg,OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,humana - medicare advantage,,I,28362.97,9902.39,9902.39,9902.39,17017.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,164,ms-drg,MAJOR CHEST PROCEDURES WITH CC,humana - medicare advantage,,I,103938.91,16060.55,16511.07,25897.15,62363.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43233,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, 3.0 CM OR MORE",humana - medicare advantage,,O,5214.04,1514.61,1514.61,3018.61,3128.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9517,cpt,"IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE",humana - medicare advantage,,O,100.04,19.80,23.29,23.29,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,humana - medicare advantage,,O,3055.12,202.94,206.42,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9041,cpt,"INJECTION, BORTEZOMIB (VELCADE), 0.1 MG",humana - medicare advantage,,O,20.57,3.00,32.42,39.05,12.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,humana - medicare advantage,,O,383.02,34.82,324.08,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9017,cpt,"FRESH FROZEN PLASMA (SINGLE DONOR), FROZEN WITHIN 8 HOURS OF COLLECTION, EACH UNIT",humana - medicare advantage,,O,464.83,82.71,82.71,82.71,278.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46250,cpt,REMOVAL OF MULTIPLE EXTERNAL HEMORRHOIDS,humana - medicare advantage,,O,17632.50,2210.23,2231.78,5521.37,10579.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,humana - medicare advantage,,O,770.33,202.50,203.12,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,377,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH MCC,humana - medicare advantage,,I,46517.09,11486.77,11486.77,18787.25,27910.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",humana - medicare advantage,,O,3191.43,324.07,324.07,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,humana - medicare advantage,,O,1343.10,94.47,94.48,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",humana - medicare advantage,,O,801.60,189.21,189.54,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64494,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SECOND LEVEL",humana - medicare advantage,,O,4519.81,1107.35,1112.92,2566.99,2711.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37799,cpt,OTHER PROCEDURE ON BLOOD VESSEL,humana - medicare advantage,,O,25554.94,3410.10,3410.10,13483.00,15332.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49324,cpt,INSERTION OF ABDOMINAL CAVITY CATHETER USING AN ENDOSCOPE,humana - medicare advantage,,O,22261.75,4488.40,4522.38,8563.22,13357.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26055,cpt,INCISION OF TENDON COVERING OF FINGER,humana - medicare advantage,,O,17730.63,1248.60,1248.60,4980.73,10638.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,4054.33,327.84,327.84,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26115,cpt,REMOVAL (LESS THAN 1.5 CENTIMETERS) TISSUE BENEATH THE SKIN GROWTH OF HAND OR FINGER,humana - medicare advantage,,O,17865.43,1304.33,1304.33,1304.33,10719.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97124,cpt,"THERAPEUTIC MASSAGE TO 1 OR MORE AREAS, EACH 15 MINUTES",humana - medicare advantage,,O,107.40,27.68,27.68,28.24,64.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,humana - medicare advantage,,O,42.58,4.32,7.06,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,humana - medicare advantage,,O,414.89,93.99,93.99,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94010,cpt,MEASUREMENT AND GRAPHIC RECORDING OF TOTAL AND TIMED EXHALED AIR CAPACITY,humana - medicare advantage,,O,222.58,50.61,125.98,126.32,133.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78014,cpt,NUCLEAR MEDICINE STUDY OF THYROID AND THYROID FUNCTION,humana - medicare advantage,,O,1304.33,342.21,342.21,883.36,782.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27130,cpt,REPLACEMENT OF THIGH BONE AND HIP JOINT WITH PROSTHESIS,humana - medicare advantage,,O,78286.44,11309.20,11309.20,11418.64,46971.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L4360,cpt,"WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A S",humana - medicare advantage,,O,632.08,279.88,279.88,279.88,379.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64484,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",humana - medicare advantage,,O,7561.13,743.72,743.72,2728.97,4536.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",humana - medicare advantage,,O,183.82,20.21,20.21,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52235,cpt,DESTRUCTION AND/OR REMOVAL OF (2.0 TO 5.0 CENTIMETERS) MEDIUM GROWTHS OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,humana - medicare advantage,,O,20734.14,2781.70,2782.44,4447.47,12440.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,humana - medicare advantage,,O,27089.15,2439.68,2581.57,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,humana - medicare advantage,,O,412.67,92.59,94.39,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,humana - medicare advantage,,O,521.47,92.78,94.39,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22551,cpt,"FUSION OF SPINE BONES WITH REMOVAL OF DISC AT UPPER SPINAL COLUMN, ANTERIOR APPROACH, COMPLEX",humana - medicare advantage,,O,65424.14,11349.44,11349.44,22181.74,39254.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73090,cpt,"X-RAY OF FOREARM, 2 VIEWS",humana - medicare advantage,,O,245.09,38.03,76.80,183.82,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,humana - medicare advantage,,O,184.32,70.33,104.22,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80235,cpt,MEASUREMENT OF LACOSAMIDE,humana - medicare advantage,,O,67.78,24.40,26.57,26.57,40.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46221,cpt,REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING,humana - medicare advantage,,O,3889.72,1284.30,1301.01,8613.19,2333.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",humana - medicare advantage,,O,502.71,78.63,244.41,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",humana - medicare advantage,,O,41.28,5.10,5.13,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17262,cpt,"DESTRUCTION OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",humana - medicare advantage,,O,507.74,161.17,161.17,493.37,304.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83930,cpt,BLOOD OSMOLALITY (CONCENTRATION) MEASUREMENT,humana - medicare advantage,,O,119.15,6.48,6.48,6.64,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,494,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC",humana - medicare advantage,,I,76484.16,12271.65,12271.65,20756.53,45890.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",humana - medicare advantage,,I,34416.83,12509.59,12509.59,12509.59,20650.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",humana - medicare advantage,,O,377.65,43.63,94.39,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",humana - medicare advantage,,O,8992.46,1299.03,1304.93,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87902,cpt,ANALYSIS TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS,humana - medicare advantage,,O,824.65,76.19,252.30,437.97,302.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5107,cpt,"INJECTION, BEVACIZUMAB-AWWB, BIOSIMILAR, (MVASI), 10 MG",humana - medicare advantage,,O,251.18,28.11,28.11,474.05,150.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",humana - medicare advantage,,O,315.99,85.00,194.77,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,humana - medicare advantage,,O,167.56,25.68,26.07,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36907,cpt,"BALLOON DILATION OF DIALYSIS SEGMENT, ACCESSED THROUGH THE SKIN, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",humana - medicare advantage,,O,22996.23,2589.90,2591.16,10133.54,13797.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",humana - medicare advantage,,O,65.11,10.15,14.41,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80051,cpt,"BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM, CHLORIDE, CARBON DIOXIDE)",humana - medicare advantage,,O,65.11,6.87,6.87,48.83,39.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",humana - medicare advantage,,O,36.32,3.59,4.39,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",humana - medicare advantage,,O,754.07,158.88,203.19,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70200,cpt,"X-RAY OF EYE SOCKET, MINIMUM OF 4 VIEWS",humana - medicare advantage,,O,452.01,94.48,94.48,94.48,271.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",humana - medicare advantage,,O,422.68,79.93,242.61,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,867,ms-drg,OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,humana - medicare advantage,,I,43523.87,15939.97,15939.97,15939.97,26114.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73060,cpt,"X-RAY OF UPPER ARM, MINIMUM OF 2 VIEWS",humana - medicare advantage,,O,245.09,22.66,76.26,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",humana - medicare advantage,,O,246.35,17.59,19.99,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",humana - medicare advantage,,O,176.32,30.07,30.18,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,humana - medicare advantage,,I,976.85,256.92,849.91,976.85,586.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28285,cpt,CORRECTION OF TOE JOINT DEFORMITY,humana - medicare advantage,,O,17411.66,2596.33,5736.03,13419.43,10447.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12020,cpt,SIMPLE CLOSURE OF SURFACE WOUND REOPENING,humana - medicare advantage,,O,19920.86,1128.94,1128.94,1128.94,11952.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19281,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MAMMOGRAPHIC GUIDANCE, FIRST LESION",humana - medicare advantage,,O,21298.80,131.53,2805.32,5148.44,12779.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,humana - medicare advantage,,O,560.24,92.59,94.39,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",humana - medicare advantage,,O,1858.47,98.50,98.50,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86317,cpt,"DETECTION OF INFECTIOUS AGENT ANTIBODY, QUANTITATIVE",humana - medicare advantage,,O,148.64,8.99,14.69,29.14,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,humana - medicare advantage,,O,3238.42,206.67,208.18,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22552,cpt,"FUSION OF SPINE BONES WITH REMOVAL OF DISC IN UPPER SPINAL COLUMN BELOW SECOND VERTEBRA OF NECK , ANTERIOR APPROACH",humana - medicare advantage,,O,83429.70,11349.44,11349.44,22181.74,50057.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,humana - medicare advantage,,O,67.58,5.08,5.08,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37224,cpt,"BALLOON DILATION OF ARTERIES IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",humana - medicare advantage,,O,41978.34,4519.00,4519.00,18046.03,25187.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64615,cpt,INJECTION OF CHEMICAL FOR DESTRUCTION OF FACIAL AND NECK NERVE MUSCLES ON BOTH SIDES OF FACE,humana - medicare advantage,,O,2323.66,1585.20,1585.20,1585.20,1394.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36902,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT AND BALLOON DILATION OF DIALYSIS SEGMENT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",humana - medicare advantage,,O,17042.54,4518.00,4518.00,17456.98,10225.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,humana - medicare advantage,,O,6554.34,441.62,1496.91,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73020,cpt,"X-RAY OF SHOULDER, 1 VIEW",humana - medicare advantage,,O,240.10,40.75,76.26,100.71,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1892,cpt,"INTRODUCER/SHEATH, GUIDING, INTRACARDIAC ELECTROPHYSIOLOGICAL, FIXED-CURVE, PEEL-AWAY",humana - medicare advantage,,O,1586.87,297.12,1440.00,1440.00,952.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,579,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",humana - medicare advantage,,I,79681.30,19975.13,19975.13,100840.81,47808.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,humana - medicare advantage,,I,16493.28,2797.28,5822.84,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,288,ms-drg,ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,humana - medicare advantage,,I,108475.75,16926.52,16926.52,16926.52,65085.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36410,cpt,"INSERTION OF NEEDLE INTO VEIN, PATIENT 3 YEARS OR OLDER",humana - medicare advantage,,O,4861.11,182.60,4504.70,4504.70,2916.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,193,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,humana - medicare advantage,,I,28507.68,8334.78,8582.27,17274.09,17104.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,humana - medicare advantage,,O,792.84,92.74,94.39,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72128,cpt,CT SCAN OF MIDDLE SPINE WITHOUT CONTRAST,humana - medicare advantage,,O,1753.28,199.66,199.66,400.81,1051.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72190,cpt,"X-RAY OF PELVIS, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,411.42,69.58,93.59,213.76,246.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45381,cpt,"INJECTIONS BENEATH LINING OF LARGE BOWEL, USING A FLEXIBLE ENDOSCOPE",humana - medicare advantage,,O,6984.17,1407.16,1407.16,3276.29,4190.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,humana - medicare advantage,,O,1893.35,157.27,301.25,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66982,cpt,COMPLEX REMOVAL OF CATARACT WITH INSERTION OF PROSTHETIC LENS,humana - medicare advantage,,O,16910.08,1876.58,1876.58,4894.22,10146.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43280,cpt,STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE,humana - medicare advantage,,O,36571.06,7902.70,7902.70,26906.78,21942.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",humana - medicare advantage,,O,108.49,21.05,34.39,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,humana - medicare advantage,,O,348.63,85.16,85.51,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,humana - medicare advantage,,O,10678.57,95.85,2581.62,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11900,cpt,"INJECTION INTO SKIN GROWTH, 1-7 GROWTHS",humana - medicare advantage,,O,1269.35,159.63,159.63,1489.62,761.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,humana - medicare advantage,,O,67.58,8.51,8.51,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52287,cpt,EXAMINATION WITH INJECTIONS OF CHEMICAL FOR DESTRUCTION OF BLADDER USING AN ENDOSCOPE,humana - medicare advantage,,O,17088.84,1612.75,1612.75,1612.75,10253.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45382,cpt,CONTROL OF BLEEDING OF UPPER LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,humana - medicare advantage,,O,9610.88,1407.16,1407.16,1714.28,5766.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45330,cpt,DIAGNOSTIC EXAMINATION OF THE LOWER PORTION OF THE LARGE BOWEL USING AN ENDOSCOPE,humana - medicare advantage,,O,3245.25,719.92,1082.98,2991.30,1947.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",humana - medicare advantage,,O,38.92,3.91,3.93,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20931,cpt,STRUCTURAL DONOR BONE GRAFT FOR SPINE SURGERY,humana - medicare advantage,,O,62145.07,11349.44,11349.44,11533.98,37287.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",humana - medicare advantage,,O,100.04,20.74,58.45,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80307,cpt,"TESTING FOR PRESENCE OF DRUG, BY CHEMISTRY ANALYZERS",humana - medicare advantage,,O,197.60,49.05,60.90,77.68,118.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47562,cpt,REMOVAL OF GALLBLADDER USING AN ENDOSCOPE,humana - medicare advantage,,O,25184.23,4521.08,4521.08,9136.32,5405.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,240,ms-drg,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,humana - medicare advantage,,I,48148.78,17032.79,17032.79,31073.16,28889.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,humana - medicare advantage,,O,1479.41,92.59,94.48,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49651,cpt,REPOSITIONING OF RECURRENT GROIN HERNIA USING AN ENDOSCOPE,humana - medicare advantage,,O,26236.25,7878.05,7878.05,21444.53,15741.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5110,cpt,"INJECTION, FILGRASTIM-AAFI, BIOSIMILAR, (NIVESTYM), 1 MICROGRAM",humana - medicare advantage,,O,2.63,0.29,0.29,0.82,1.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,humana - medicare advantage,,O,899.10,136.27,339.93,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,humana - medicare advantage,,O,513.11,156.86,156.86,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43249,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, LESS THAN 3.0 CM",humana - medicare advantage,,O,5156.78,1469.46,1511.66,4819.09,3094.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,humana - medicare advantage,,O,106.28,8.57,8.59,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,870,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,humana - medicare advantage,,I,192936.51,41518.66,41518.66,55725.83,115761.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,606,ms-drg,MINOR SKIN DISORDERS WITH MCC,humana - medicare advantage,,I,13473.89,10804.19,10804.19,10804.19,8084.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45384,cpt,"REMOVAL OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL BY HOT BIOPSY FORCEPS, USING A FLEXIBLE ENDOSCOPE",humana - medicare advantage,,O,4528.30,938.20,1165.67,4749.21,2716.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,348.89,61.44,76.26,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),humana - medicare advantage,,O,166.34,27.39,27.44,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,287,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",humana - medicare advantage,,I,42121.79,7205.02,7458.60,13887.33,25273.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28292,cpt,CORRECTION OF BUNION WITH REMOVAL OF THE BASE OF THE GREAT TOE,humana - medicare advantage,,O,33825.97,4160.28,4160.28,20996.90,20295.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19330,cpt,REMOVAL OF RUPTURED BREAST IMPLANT AND IMPLANT MATERIAL,humana - medicare advantage,,O,31200.09,2727.97,2727.97,2727.97,18720.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,humana - medicare advantage,,O,50.00,8.06,12.69,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,252,ms-drg,OTHER VASCULAR PROCEDURES WITH MCC,humana - medicare advantage,,I,66686.69,20797.71,20797.71,38100.00,40012.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36819,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, UPPER ARM, BASILIC VEIN",humana - medicare advantage,,O,28569.86,4455.22,4455.22,8737.59,17141.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,humana - medicare advantage,,O,7543.40,1294.20,1296.10,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,humana - medicare advantage,,O,237.59,106.92,178.95,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70360,cpt,X-RAY OF SOFT TISSUE OF NECK,humana - medicare advantage,,O,240.10,61.44,76.26,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64495,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, THIRD AND ANY ADDITIONAL LEVEL(S)",humana - medicare advantage,,O,4552.63,1111.87,1113.12,2202.56,2731.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28750,cpt,FUSION OF GREAT TOE AT THE JOINT WITH THE FOOT,humana - medicare advantage,,O,33226.41,5666.83,5736.03,11244.87,19935.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11421,cpt,"REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",humana - medicare advantage,,O,21237.03,738.55,2244.02,2689.89,12742.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97164,cpt,"RE-EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",humana - medicare advantage,,O,133.30,44.40,64.95,75.98,79.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,humana - medicare advantage,,O,842.86,94.39,94.39,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",humana - medicare advantage,,O,635.27,137.73,310.75,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11044,cpt,REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS,humana - medicare advantage,,O,6092.03,1247.54,1302.18,23397.56,3655.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93660,cpt,EVALUATION OF HEART FUNCTION USING TILT TABLE,humana - medicare advantage,,O,1208.02,288.64,419.78,821.83,724.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,348.89,53.55,76.26,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",humana - medicare advantage,,O,85.05,7.99,8.84,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",humana - medicare advantage,,O,231.34,36.97,50.36,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64445,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO SCIATIC NERVE OF LOWER BACK AND LEG,humana - medicare advantage,,O,42861.08,5736.03,5736.03,10198.40,25716.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",humana - medicare advantage,,O,1138.00,159.38,161.17,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",humana - medicare advantage,,O,51.68,6.81,224.42,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,3055.12,320.47,324.13,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,410.17,61.80,94.48,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58670,cpt,DESTRUCTION OF FALLOPIAN TUBES USING AN ENDOSCOPE,humana - medicare advantage,,O,21604.39,4491.89,4491.89,9350.46,12962.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",humana - medicare advantage,,O,68064.84,9197.64,9197.64,27750.61,40838.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",humana - medicare advantage,,O,468.95,93.59,93.59,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84145,cpt,PROCALCITONIN (HORMONE) LEVEL,humana - medicare advantage,,O,97.91,26.68,26.78,32.12,32.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",humana - medicare advantage,,O,267.61,46.08,76.26,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1785,cpt,"PACEMAKER, DUAL CHAMBER, RATE-RESPONSIVE (IMPLANTABLE)",humana - medicare advantage,,O,18044.92,9158.16,9158.16,9158.16,10826.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37766,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, GREATER THAN 20 INCISIONS",humana - medicare advantage,,O,24542.50,3410.10,3410.10,5064.25,14725.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",humana - medicare advantage,,O,520.22,353.36,353.36,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",humana - medicare advantage,,O,1724.51,97.60,665.06,959.65,801.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50200,cpt,"NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN",humana - medicare advantage,,O,9979.95,1172.33,1299.03,3057.19,5987.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87517,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS B VIRUS, QUANTIFICATION",humana - medicare advantage,,O,205.27,42.71,42.71,57.99,123.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",humana - medicare advantage,,O,1252.50,103.81,132.11,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,492,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",humana - medicare advantage,,I,67922.69,18654.89,21515.90,21515.90,40753.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36558,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, TUNNELED",humana - medicare advantage,,O,20661.93,2586.12,2586.12,6323.15,12397.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62321,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK USING IMAGING GUIDANCE,humana - medicare advantage,,O,2267.14,558.18,564.08,1776.12,1360.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),humana - medicare advantage,,O,126.23,10.13,100.59,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,humana - medicare advantage,,O,60.16,11.87,11.87,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,humana - medicare advantage,,O,3055.12,202.81,206.42,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",humana - medicare advantage,,O,135.66,14.84,18.02,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73040,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF SHOULDER JOINT,humana - medicare advantage,,O,1406.87,212.42,325.07,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,humana - medicare advantage,,O,3055.12,204.02,461.58,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78709,cpt,"NUCLEAR MEDICINE STUDY OF KIDNEY WITH ASSESSMENT OF BLOOD FLOW AND FUNCTION, WITH OR WITHOUT DRUGS, MULTIPLE STUDIES",humana - medicare advantage,,O,1411.87,444.24,444.24,1009.00,847.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",humana - medicare advantage,,I,944.41,228.70,660.82,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",humana - medicare advantage,,O,98.78,7.87,7.87,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",humana - medicare advantage,,O,411.42,47.57,94.39,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",humana - medicare advantage,,I,16029.09,4785.97,5118.20,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,humana - medicare advantage,,O,187.57,13.08,101.62,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27570,cpt,MANIPULATION OF KNEE JOINT UNDER ANESTHESIA,humana - medicare advantage,,O,13902.50,1248.60,1248.60,10424.46,8341.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71111,cpt,"X-RAY OF BOTH SIDES OF THE RIBS INCLUDING THE CHEST, MINIMUM OF 4 VIEWS",humana - medicare advantage,,O,377.65,61.44,94.39,188.83,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,humana - medicare advantage,,O,252.59,75.92,75.92,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82436,cpt,URINE CHLORIDE LEVEL,humana - medicare advantage,,O,45.33,5.63,5.63,5.63,27.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,humana - medicare advantage,,O,55.44,9.79,11.42,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,humana - medicare advantage,,O,19028.38,1098.56,1098.56,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,humana - medicare advantage,,O,2152.21,335.59,342.21,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,327,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",humana - medicare advantage,,I,49416.36,16344.34,16344.34,23136.42,29649.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99281,cpt,"EMERGENCY DEPARTMENT VISIT, SELF LIMITED OR MINOR PROBLEM",humana - medicare advantage,,E,206.32,65.63,530.49,531.77,123.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21501,cpt,INCISION AND DRAINAGE OF ABSCESS OR BLOOD ACCUMULATION IN SOFT TISSUES OF NECK OR CHEST,humana - medicare advantage,,O,16735.57,2243.72,2243.72,2243.72,10041.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",humana - medicare advantage,,O,50.01,4.43,4.43,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9025,cpt,"INJECTION, AZACITIDINE, 1 MG",humana - medicare advantage,,O,14.99,0.42,0.66,6.63,8.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,humana - medicare advantage,,O,1958.01,473.85,505.32,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",humana - medicare advantage,,O,85.39,17.80,22.57,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19081,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, FIRST GROWTH",humana - medicare advantage,,O,6548.62,1273.00,1774.33,5582.75,3929.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,329,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,humana - medicare advantage,,I,114604.99,18176.89,28755.27,42391.95,68762.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,humana - medicare advantage,,O,351.40,81.48,81.48,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,humana - medicare advantage,,O,4054.33,319.17,324.17,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49083,cpt,DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE,humana - medicare advantage,,O,3277.05,723.30,824.47,2260.51,1966.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,humana - medicare advantage,,O,236.36,11.30,11.42,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,14061,cpt,"TISSUE TRANSFER REPAIR OF WOUND (10.1 TO 30.0 SQ CENTIMETERS) OF EYELIDS, NOSE, EARS, AND/OR LIPS",humana - medicare advantage,,O,17991.94,1500.98,1500.98,1500.98,10795.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",humana - medicare advantage,,I,1952.12,434.32,434.32,1952.12,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71101,cpt,"X-RAY OF RIBS ON ONE SIDE OF BODY INCLUDING THE CHEST, MINIMUM OF 3 VIEWS",humana - medicare advantage,,O,377.65,61.44,94.39,228.17,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27654,cpt,SECONDARY REPAIR OF RUPTURED ACHILLES TENDON,humana - medicare advantage,,O,32249.15,5736.03,5736.03,16282.30,19349.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54150,cpt,REMOVAL OF FORESKIN OF USING CLAMP OR DEVICE,humana - medicare advantage,,O,18204.46,1602.91,1602.91,2226.17,10922.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,humana - medicare advantage,,O,231.34,36.98,50.36,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,humana - medicare advantage,,O,3055.12,204.95,206.42,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84133,cpt,URINE POTASSIUM LEVEL,humana - medicare advantage,,O,38.92,2.84,4.64,4.64,23.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,humana - medicare advantage,,I,14826.55,4677.51,5920.45,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,178,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,humana - medicare advantage,,I,19678.73,7277.47,8960.58,14434.95,11807.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,300,ms-drg,PERIPHERAL VASCULAR DISORDERS WITH CC,humana - medicare advantage,,I,16027.98,6756.27,6756.27,12036.47,9616.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,humana - medicare advantage,,O,213.87,28.75,46.68,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84432,cpt,THYROGLOBULIN (THYROID RELATED HORMONE) LEVEL,humana - medicare advantage,,O,93.19,15.90,15.90,24.00,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36246,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL SECOND ORDER BRANCH",humana - medicare advantage,,O,24259.05,2582.02,2582.02,19004.00,14555.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87076,cpt,BACTERIAL CULTURE FOR ANAEROBIC ISOLATES,humana - medicare advantage,,O,96.38,8.00,8.00,72.29,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83497,cpt,HYDROXYINDOLACETIC ACID (PRODUCT OF METABOLISM) LEVEL,humana - medicare advantage,,O,212.36,12.64,12.64,31.86,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,humana - medicare advantage,,O,3683.73,275.00,275.00,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74022,cpt,COMPLETE X-RAY STUDY OF ABDOMEN WITH SINGLE X-RAY OF CHEST,humana - medicare advantage,,O,550.24,73.32,97.71,98.50,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45335,cpt,"INJECTIONS BENEATH LINING OF LOWER LARGE BOWEL, USING A FLEXIBLE ENDOSCOPE",humana - medicare advantage,,O,4385.73,1079.88,1079.88,1079.88,2631.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9311,cpt,"INJECTION, RITUXIMAB 10 MG AND HYALURONIDASE",humana - medicare advantage,,O,175.06,36.40,37.27,5983.60,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9040,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",humana - medicare advantage,,O,756.23,259.12,262.14,756.23,453.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",humana - medicare advantage,,O,120.33,16.46,16.46,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,79005,cpt,ORAL ADMINISTRATION OF RADIOACTIVE MATERIAL THERAPY AGENT,humana - medicare advantage,,O,2703.71,220.75,220.75,225.27,1622.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",humana - medicare advantage,,O,20.05,1.78,2.96,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82088,cpt,ALDOSTERONE HORMONE LEVEL,humana - medicare advantage,,O,209.99,28.44,39.98,40.99,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27792,cpt,OPEN TREATMENT OF THE OUTSIDE PROMINENCE OF BONE OF THE LEG (FIBULA) IN THE REGION OF THE ANKLE,humana - medicare advantage,,O,32639.18,5674.67,5674.67,9712.30,19583.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,humana - medicare advantage,,I,74793.54,13792.29,13792.29,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",humana - medicare advantage,,O,362.65,61.08,75.57,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,humana - medicare advantage,,O,1753.28,94.47,94.48,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93312,cpt,INSERTION OF PROBE IN ESOPHAGUS FOR HEART ULTRASOUND EXAMINATION INCLUDING INTERPRETATION AND REPORT,humana - medicare advantage,,O,1858.32,408.83,430.60,1435.55,1114.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,humana - medicare advantage,,O,3055.12,204.02,206.42,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,humana - medicare advantage,,O,152.18,14.75,14.75,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,372,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,humana - medicare advantage,,I,21464.09,6956.42,6956.42,12516.32,12878.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77372,cpt,"RADIATION THERAPY DELIVERY, STEREOTACTIC RADIOSURGERY (SRS) FOR CRANIAL GROWTHS, PER SESSION, USING A LINEAR ACCELERATOR",humana - medicare advantage,,O,23204.58,6663.20,6663.20,10102.14,13922.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70260,cpt,"X-RAY OF SKULL, COMPLETE, MINIMUM OF 4 VIEWS",humana - medicare advantage,,O,538.98,61.44,94.39,94.48,323.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33225,cpt,INSERTION OF LEFT LOWER HEART ELECTRODE FOR PACEMAKER OR DEFIBRILLATOR,humana - medicare advantage,,O,44936.34,16251.07,16251.07,17558.91,26961.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",humana - medicare advantage,,O,2069.24,93.35,98.50,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80178,cpt,LITHIUM LEVEL,humana - medicare advantage,,O,56.26,6.48,6.48,42.20,7.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93931,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE ARM OR LIMITED,humana - medicare advantage,,O,646.53,92.68,97.18,216.32,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,humana - medicare advantage,,O,8198.69,1161.40,1161.40,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74220,cpt,X-RAY OF ESOPHAGUS WITH SINGLE CONTRAST,humana - medicare advantage,,O,585.25,65.33,157.22,360.68,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,809,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,humana - medicare advantage,,I,46992.19,7372.16,7833.65,9364.35,28195.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0296,cpt,COUNSELING VISIT TO DISCUSS NEED FOR LUNG CANCER SCREENING USING LOW DOSE CT SCAN (LDCT) (SERVICE IS FOR ELIGIBILITY DETERMINATION AND SHARED DECISION MAKING),humana - medicare advantage,,O,351.40,65.71,65.71,65.71,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",humana - medicare advantage,,O,734.07,19.80,23.29,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L4386,cpt,"WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PA",humana - medicare advantage,,O,646.53,179.87,179.87,222.75,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74174,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST,humana - medicare advantage,,O,1840.81,323.17,324.12,1326.08,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73615,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ANKLE JOINT,humana - medicare advantage,,O,1235.54,332.01,332.01,332.01,741.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11046,cpt,"REMOVAL OF MUSCLE AND/OR TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",humana - medicare advantage,,O,3414.96,473.85,504.27,1078.95,2048.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",humana - medicare advantage,,O,267.61,58.94,76.19,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0105,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK,humana - medicare advantage,,O,3209.39,717.96,719.92,719.92,1925.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,humana - medicare advantage,,O,6833.06,1646.56,2237.82,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",humana - medicare advantage,,O,183.82,20.70,21.69,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,humana - medicare advantage,,O,60.16,9.91,11.85,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,humana - medicare advantage,,O,1620.71,439.39,439.39,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87798,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, AMPLIFIED PROBE TECHNIQUE",humana - medicare advantage,,O,228.87,16.13,34.53,35.23,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,humana - medicare advantage,,O,195.07,21.19,21.19,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,humana - medicare advantage,,O,345.14,124.25,179.68,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12042,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF NECK, HANDS, FEET, AND/OR GENITALS",humana - medicare advantage,,O,14792.08,1273.00,1304.33,2549.24,8875.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25545,cpt,"OPEN TREATMENT OF THE SHAFT OF THE FOREARM BONE ON THE SMALL FINGER SIDE OF THE FOREARM, ULNA BONE",humana - medicare advantage,,O,27851.38,5755.15,5755.15,5755.15,16710.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",humana medicare adv,,O,107.59,3.13,80.69,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",humana medicare adv,,O,348.89,53.55,61.44,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,humana medicare adv,,O,101.33,21.90,76.00,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,humana medicare adv,,I,22023.98,6812.39,9336.17,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,humana medicare adv,,O,502.71,78.63,78.63,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,humana medicare adv,,O,351.40,81.48,191.37,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,humana medicare adv,,O,41.28,5.78,30.96,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",humana medicare adv,,I,225.50,61.14,61.14,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",humana medicare adv,,I,944.41,228.70,318.03,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",humana medicare adv,,O,83.33,15.97,57.88,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,humana medicare adv,,O,3055.12,203.12,517.17,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",humana medicare adv,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,humana medicare adv,,O,694.00,180.07,331.00,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",humana medicare adv,,O,231.34,36.97,62.04,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",humana medicare adv,,O,192.85,42.50,85.00,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",humana medicare adv,,I,190.07,49.10,58.60,190.07,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,humana medicare adv,,O,101.33,11.74,76.00,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,humana medicare adv,,O,188.17,66.99,160.80,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,humana medicare adv,,I,48.06,11.46,11.46,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",humana medicare adv,,O,1858.47,98.50,339.67,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",humana medicare adv,,O,73.14,3.60,14.21,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,humana medicare adv,,O,41.26,8.55,8.55,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",humana medicare adv,,O,108.49,21.05,75.35,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,humana medicare adv,,O,73.83,11.51,14.35,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",humana medicare adv,,O,107.59,3.13,80.69,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,humana medicare adv,,O,754.07,203.12,754.07,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",humana medicare adv,,O,90.84,3.51,3.51,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,humana medicare adv,,O,67.58,8.51,38.52,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",humana medicare adv,,I,1997.14,545.14,615.69,19187.06,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",humana medicare adv,,O,52.60,8.84,39.45,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,medica,,O,30.08,5.04,11.48,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),humana medicare adv,,O,91.30,14.31,91.30,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",humana medicare adv,,O,91.30,6.24,20.51,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,humana medicare adv,,I,1274.16,335.11,392.81,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,humana medicare adv,,I,1386.23,364.58,427.36,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",humana medicare adv,,O,502.71,78.63,78.63,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",humana medicare adv,,O,154.76,24.25,24.84,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",humana medicare adv,,O,345.14,75.82,185.08,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",humana medicare adv,,O,116.79,7.81,22.69,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,humana medicare adv,,O,41.19,1.80,4.08,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,humana medicare adv,,I,4152.82,995.38,1533.85,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",humana medicare adv,,O,71.96,7.91,100.29,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,humana medicare adv,,O,351.40,51.44,124.36,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,humana medicare adv,,O,345.14,124.25,185.08,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,humana medicare adv,,O,122.03,31.49,35.79,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",humana medicare adv,,O,218.83,30.93,218.83,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",humana medicare adv,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",humana medicare adv,,O,734.07,19.80,276.33,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,humana medicare adv,,I,26508.25,6362.98,11358.13,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",humana medicare adv,,O,10827.72,2513.53,5000.91,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,humana medicare adv,,O,287.62,21.62,298.87,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,humana medicare adv,,O,647.78,94.48,485.84,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",humana medicare adv,,O,647.78,98.50,485.84,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",humana medicare adv,,O,365.14,61.44,76.80,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,humana medicare adv,,O,5902.67,923.22,923.22,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",humana medicare adv,,O,120.33,16.46,90.25,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",humana medicare adv,,I,145.15,30.77,53.52,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",humana medicare adv,,I,238.84,62.82,108.30,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",humana medicare adv,,O,734.07,114.82,114.82,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",humana medicare adv,,O,5902.67,335.59,1465.07,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,humana medicare adv,,O,1205.09,132.64,5796.19,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,humana medicare adv,,O,31.24,2.94,11.71,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",humana medicare adv,,O,56.26,6.34,49.23,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,humana medicare adv,,O,383.02,34.82,329.69,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",humana medicare adv,,O,754.07,158.88,754.07,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",humana medicare adv,,O,331.50,12.98,248.63,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",humana medicare adv,,O,50.01,4.43,7.31,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,humana medicare adv,,O,195.07,21.19,94.21,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,humana medicare adv,,I,6.27,0.90,1.55,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",humana medicare adv,,O,151.46,8.03,84.41,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",humana medicare adv,,O,230.63,78.33,113.02,159.67,138.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",humana medicare adv,,O,85.05,7.99,21.40,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",humana medicare adv,,O,1997.14,273.93,738.11,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,humana medicare adv,,O,298.87,98.24,298.87,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,humana medicare adv,,O,9.11,0.50,5.25,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,humana medicare adv,,O,76.68,5.83,17.21,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0430,revCode,"OCCUPATIONAL THERAPY, GENERAL",humana medicare adv,,I,194.27,39.00,54.36,54.36,116.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",humana medicare adv,,O,315.99,85.00,85.00,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",humana medicare adv,,O,13.80,2.61,18.98,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",humana medicare adv,,O,94.14,7.61,12.99,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",humana medicare adv,,O,369.82,61.44,63.59,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",humana medicare adv,,O,114.43,3.13,85.82,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",humana medicare adv,,O,252.47,43.75,67.71,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,humana medicare adv,,O,3683.73,275.00,860.51,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",humana medicare adv,,I,231.34,60.43,85.45,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,humana medicare adv,,I,316.37,68.94,110.64,633.75,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,humana medicare adv,,O,106.28,8.57,79.71,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,humana medicare adv,,O,90.02,12.05,63.70,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,humana medicare adv,,O,3055.12,202.94,517.17,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",humana medicare adv medicare advantage,,O,715.30,48.27,92.97,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",humana medicare adv medicare advantage,,O,369.82,61.44,92.97,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,liability insurance medicare advantage,,O,41.19,1.80,21.90,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",liability insurance medicare advantage,,O,100.04,20.74,55.19,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",liability insurance medicare advantage,,O,70.01,13.01,21.90,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,liability insurance medicare advantage,,O,188.17,19.53,55.19,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,medica,,O,3055.12,204.02,1165.83,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),medica,,O,132.12,15.79,47.56,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",medica,,O,502.71,78.63,180.98,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",medica,,O,50.72,7.45,18.26,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,medica,,O,402.67,93.28,273.82,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,medica,,O,2149.71,310.75,773.90,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,medica,,O,122.03,31.49,56.37,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",medica,,O,8.17,0.89,0.89,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,16020,cpt,DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5% TOTAL BODY SURFACE),medica,,O,738.64,157.08,205.45,553.98,443.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,medica,,O,101.45,15.87,36.52,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,medica,,I,12315.58,3063.82,6432.75,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,medica,,O,3055.12,205.61,1099.84,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82552,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, ISOENZYMES",medica,,O,66.05,9.38,25.20,25.20,39.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",medica,,O,4.22,1.00,28.26,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9965,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 100-199 MG/ML IODINE CONCENTRATION, PER ML",medica,,O,7.98,1.70,3.04,6.34,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",medica,,O,114.43,3.13,12.03,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,medica,,O,647.78,92.64,233.20,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",medica,,O,230.63,78.33,78.33,159.67,138.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,medica,,O,130.11,30.48,39.26,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3301,cpt,"INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISE SPECIFIED, 10 MG",medica,,O,21.30,1.21,7.67,9.59,12.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",medica,,O,85.05,7.99,18.94,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,medica,,O,80.09,5.66,5.66,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1756,cpt,"INJECTION, IRON SUCROSE, 1 MG",medica,,O,2.08,0.23,0.75,0.94,1.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",medica,,O,647.78,98.50,233.20,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",medica,,O,183.82,20.70,66.18,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,medica,,O,113.25,11.78,40.77,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88312,cpt,SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,medica,,O,63.70,17.04,46.63,63.70,38.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,medica,,O,42.51,2.00,14.44,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",medica,,O,1680.75,111.66,111.66,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",medica,,O,91.43,5.96,32.91,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,medica,,O,351.40,51.44,96.89,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",medica,,O,83.33,15.97,15.97,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",medica,,O,734.07,114.82,264.27,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",medica,,O,223.91,73.72,80.61,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1887,cpt,"CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)",medica,,O,357.97,72.03,72.03,218.49,214.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",medica,,O,127.54,21.16,45.91,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",medica,,O,82.61,19.42,29.74,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,medica,,O,3238.42,206.67,1099.84,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,medica,,O,647.78,92.97,233.20,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",medica,,O,1015.48,95.84,182.79,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1769,cpt,GUIDE WIRE,medica,,O,338.79,40.02,163.41,304.82,203.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",medica,,O,50.02,5.00,18.01,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,medica,,O,28365.62,4521.08,8904.76,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",medica,,O,377.65,61.44,135.95,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,medica,,O,184.32,70.33,70.33,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",medica,,O,345.14,36.70,124.25,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84300,cpt,URINE SODIUM LEVEL,medica,,O,37.50,3.04,3.04,5.08,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",medica,,O,2069.24,93.35,702.76,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,medica,,I,26926.14,6286.85,8935.64,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43249,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, LESS THAN 3.0 CM",medica,,O,5156.78,1469.46,1831.60,4819.09,3094.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),medica,,O,91.30,14.31,32.87,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36416,cpt,PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,medica,,O,11.79,2.31,4.50,11.79,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",medica,,O,96.29,17.55,62.75,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,medica,,O,383.02,34.82,359.70,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,medica,,O,9.11,0.50,3.14,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",medica,,O,0.59,0.15,0.59,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,medica,,O,4318.19,810.94,1647.82,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,medica,,O,3580.43,810.94,1647.82,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",medica,,O,38.92,2.65,14.01,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",medica,,O,132.12,25.53,91.27,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,medica,,O,73.83,11.51,17.82,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",medica,,O,20.05,1.78,7.22,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",medica,,O,147.58,21.05,21.05,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,medica,,O,792.84,92.74,302.55,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1030,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG",medica,,O,87.39,9.18,31.46,65.54,52.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,medica,,O,752.83,92.79,271.02,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,medica,,O,345.14,124.25,124.25,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82390,cpt,CERULOPLASMIN (PROTEIN) LEVEL,medica,,O,71.96,2.18,26.69,26.69,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,medica,,O,95.55,14.26,34.40,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",medica,,O,39.88,13.23,14.43,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,medica,,O,60.16,9.91,21.66,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,medica,,O,178.08,50.28,51.33,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",medica,,O,650.28,61.44,234.10,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",medica,,O,348.89,46.07,125.60,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,medica,,O,5444.73,938.10,3284.31,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,medica,,O,101.33,11.74,36.48,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",medica,,O,162.48,33.29,58.49,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,medica,,O,908.09,156.44,250.86,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,561,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",medica,,I,28538.09,6566.77,8964.00,13087.98,17122.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",medica,,O,212.36,14.48,76.45,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",medica,,O,56.26,6.34,20.25,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",medica,,O,52.60,8.84,18.94,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,medica,,O,1481.91,158.58,533.49,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47000,cpt,"NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN",medica,,O,11195.22,1299.27,3057.19,6518.37,6717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7070,cpt,"INFUSION, D5W, 1000 CC",medica,,O,157.80,23.30,56.81,56.81,94.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,medica,,O,50.01,3.11,3.11,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,medica,,O,513.11,156.86,184.72,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",medica,,O,1138.00,159.38,214.84,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,medica,,O,419.99,136.22,151.20,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,medica,,O,31.24,2.94,10.61,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,medica,,O,42.58,6.02,15.33,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",medica,,O,36.32,4.04,13.08,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",medica,,O,50.72,5.89,19.35,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",medica,,O,369.82,61.44,135.95,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",medica,,O,281.00,8.75,95.44,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,medica,,O,71.96,7.48,25.91,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",medica,,O,52.60,5.67,5.67,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",medica,,E,1724.51,232.62,620.82,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),medica,,O,126.23,10.13,46.81,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77002,cpt,FLUOROSCOPIC GUIDANCE FOR INSERTION OF NEEDLE,medica,,O,1932.70,187.94,695.77,1101.64,1159.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",medica,,O,107.59,3.13,12.03,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",medica,,O,93.77,21.35,121.55,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84166,cpt,"PROTEIN MEASUREMENT, BODY FLUID",medica,,O,61.34,6.87,30.15,30.15,20.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",medica,,O,91.30,6.24,32.87,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",medica,,O,13.78,1.69,4.96,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),medica,,O,166.34,27.39,59.88,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",medica,,O,350.39,39.08,126.14,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,medica,,O,27089.15,2439.68,9663.07,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,medica,,O,1952.12,344.86,723.85,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",medica,,O,147.58,21.05,21.05,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,medica,,O,76.68,5.83,5.83,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33249,cpt,INSERTION OR REPLACEMENT OF SINGLE OR DUAL CHAMBER PACING DEFIBRILLATOR LEADS,medica,,O,103183.41,27788.91,50189.53,50189.53,61910.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,medica,,O,1893.35,157.27,773.90,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,medica,,O,351.40,81.48,126.50,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,medica,,O,42.58,4.32,4.32,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",medica,,O,116.79,7.81,42.04,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,medica,,O,1479.41,92.59,564.54,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",medica,,O,5902.67,335.59,2124.96,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,medica,,O,1590.91,567.62,570.62,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,medica,,O,287.62,77.37,103.54,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",medica,,O,345.14,75.82,116.29,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",medica,,O,108.88,10.16,10.16,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",medica,,O,318.12,56.64,133.13,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,medica,,O,40.11,4.18,14.44,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,medica,,O,41.28,5.78,14.86,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",medica,,O,622.77,61.44,423.49,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",medica,,O,1645.73,583.80,592.46,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,medica,,O,67.58,5.08,24.33,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",medica,,O,826.60,242.61,297.58,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,medica,,O,41.26,8.55,21.02,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",medica,,O,112.07,9.78,9.78,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,medica,,O,51.39,9.33,18.50,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84133,cpt,URINE POTASSIUM LEVEL,medica,,O,38.92,2.84,2.84,4.64,23.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",medica,,O,65.11,10.15,16.13,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",medica,,O,3595.37,208.18,1294.33,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",medica,,O,348.89,56.80,125.60,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,medica,,O,188.17,19.53,170.97,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",medica,,O,50.02,5.17,18.01,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,medica,,O,5902.67,923.22,2124.96,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",medica,,O,93.19,13.33,33.55,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",medica,,O,1091.80,160.12,214.84,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,medica,,O,56.62,7.92,8.08,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",medica,,O,1997.14,430.17,718.97,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",medica,,O,1858.47,98.50,769.62,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,medica,,I,36086.42,12423.48,15286.73,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",medica,,O,19.52,4.40,7.03,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,medica,,O,41.19,1.80,23.56,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,medica,,O,770.33,202.50,277.32,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,medica,,O,65.11,6.57,23.44,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,medica,,O,45.13,4.38,15.33,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,medica,,O,60.03,7.19,7.19,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",medica,,O,547.73,117.10,357.42,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,medica,,O,22.60,4.56,9.70,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",medica,,O,65.06,17.18,23.43,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,medica,,O,123.87,5.34,5.34,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",medica,,O,441.23,35.97,158.84,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",medica,,O,246.35,17.59,88.69,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,medica,,O,93.19,5.27,35.56,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,medica,,O,2707.46,156.22,974.69,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,medica,,O,26791.18,4521.08,9866.22,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",medica,,O,35.00,2.32,14.23,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",medica,,O,7.91,1.68,2.85,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,medica,,O,842.86,94.39,294.85,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",medica,,O,101.45,25.33,36.52,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",medica,,O,365.14,48.65,131.45,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",medica,,O,285.11,61.44,285.11,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,medica,,O,106.28,8.57,38.26,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",medica,,O,4.12,1.10,1.48,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",medica,,O,70.06,8.29,25.22,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,medica,,O,647.78,94.48,647.78,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",medica,,O,437.43,101.00,167.97,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",medica,,O,267.61,61.44,96.34,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",medica,,O,226.34,61.44,83.93,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1726,cpt,"CATHETER, BALLOON DILATATION, NON-VASCULAR",medica,,O,253.84,91.38,91.38,213.13,152.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",medica,,O,680.29,236.16,252.25,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",medica,,O,70.78,13.97,20.38,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,medica,,O,8198.69,1161.40,2951.53,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",medica,,O,377.65,43.63,135.95,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,medica,,O,231.34,36.98,83.28,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,medica,,O,101.33,21.90,36.48,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",medica,,O,8992.46,1299.03,2784.73,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",medica,,O,16.70,0.37,1.33,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",medica,,O,41.06,11.36,14.78,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94640,cpt,RESPIRATORY INHALED PRESSURE OR NONPRESSURE TREATMENT TO RELIEVE AIRWAY OBSTRUCTION OR FOR SPUTUM SPECIMEN,medica,,O,223.34,51.35,78.33,99.96,134.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",medica,,O,103.81,18.28,37.37,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",medica,,O,4496.04,1078.59,2756.55,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,medica,,O,60.16,11.87,21.66,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,medica,,O,195.07,21.19,70.23,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,medica,,O,3055.12,206.42,1132.84,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",medica,,O,90.84,9.28,32.70,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",medica,,O,365.24,8.63,8.63,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",medica,,O,1434.39,436.85,516.38,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",medica,,O,45.06,8.39,16.22,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,292,ms-drg,HEART FAILURE AND SHOCK WITH CC,medica,,I,17047.40,4692.10,7821.94,7821.94,10228.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,medica,,O,89.65,18.15,32.27,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,medica,,O,298.87,98.24,107.59,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,medica,,O,45.06,3.98,3.98,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",medica,,O,513.19,16.80,195.83,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82542,cpt,CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE,medica,,O,97.91,11.61,37.36,37.36,58.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,medica,,O,1952.12,144.93,723.85,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70552,cpt,MRI SCAN OF BRAIN WITH CONTRAST,medica,,O,3057.62,333.17,1166.79,1166.79,1834.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",medica,,O,267.61,46.08,96.34,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,medica,,O,42.58,3.22,15.33,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",medica,,O,365.14,61.44,131.45,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,medica,,O,3683.73,275.00,1042.07,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",medica,,O,190.94,53.23,66.80,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,medica,,O,521.47,92.78,193.36,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,medica,,O,116.31,18.99,41.87,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",medica,,O,357.64,32.78,128.75,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,medica,,O,784.37,233.55,1241.88,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),medica,,O,65.11,4.25,23.44,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",medica,,O,419.99,46.79,151.20,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",medica,,O,348.89,61.44,125.60,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,medica,,I,26508.25,6362.98,10814.87,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,medica,,O,31.88,2.63,2.63,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",medica,,O,231.34,36.97,83.28,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",medica,,O,252.47,44.06,90.89,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75716,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMAGING OF ARTERIES OF BOTH ARMS OR LEGS,medica,,O,7596.99,64.33,2580.11,5697.74,4558.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,medica,,O,67.58,3.47,3.47,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,medica,,O,53.76,5.92,19.35,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",medica,,O,41.28,3.01,3.01,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1776,cpt,JOINT DEVICE (IMPLANTABLE),medica,,O,3788.11,198.44,18412.83,18412.83,2272.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,987,ms-drg,NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,medica,,I,95039.41,20706.36,27456.85,27921.93,57023.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",medica,,O,88.24,14.05,31.37,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",medica,,O,94.14,7.61,31.98,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",medica,,O,36.32,3.59,13.86,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",medica,,O,38.92,3.91,14.01,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,336,ms-drg,PERITONEAL ADHESIOLYSIS WITH CC,medica,,I,67565.05,6006.27,18225.35,24239.00,40539.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,medica,,O,112.55,9.00,9.00,1270.41,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",medica,,O,107.59,3.13,12.03,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,442,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",medica,,I,23206.50,6521.42,8487.22,8487.22,13923.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",medica,,E,5953.08,743.91,1475.66,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,medica,,O,78.05,7.37,25.30,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,medica,,O,94.38,2.18,20.21,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",medica,,O,3191.43,324.07,3382.91,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80235,cpt,MEASUREMENT OF LACOSAMIDE,medica,,O,67.78,24.40,24.40,26.57,40.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",medica,,O,826.60,239.39,252.25,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",medica,,O,734.07,19.80,264.27,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50200,cpt,"NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN",medica,,O,9979.95,1172.33,3057.19,3057.19,5987.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1895,cpt,"LEAD, CARDIOVERTER-DEFIBRILLATOR, ENDOCARDIAL DUAL COIL (IMPLANTABLE)",medica,,O,63309.93,22791.57,22791.57,22791.57,37985.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",medica,,O,715.30,48.27,265.24,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",medica,,O,4184.57,938.10,2467.61,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,medica,,O,84.93,8.43,30.57,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",medica,,O,1.42,0.39,0.97,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",medica,,O,60.16,6.38,21.66,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6197,cpt,"ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING",medica,,O,25.00,9.00,9.00,39.75,15.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",medica,,O,36.32,6.91,13.08,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,medica,,O,176.37,11.81,63.49,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,medica,,O,6554.34,441.62,3570.06,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,medica,,O,10678.57,95.85,3844.29,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,medica,,O,152.18,14.75,54.78,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,medica,,O,101.45,12.63,36.52,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3370,cpt,"INJECTION, VANCOMYCIN HCL, 500 MG",medica,,O,70.84,21.28,66.54,66.54,42.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1722,cpt,"CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE)",medica,,O,65218.30,23478.59,23478.59,23478.59,39130.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,medica,,O,502.71,78.63,180.98,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",medica,,O,71.96,7.91,25.91,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,medica,,O,213.87,28.75,76.99,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,medica,,O,69.59,9.12,25.05,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),medica,,O,60.03,6.83,7.19,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",medica,,O,51.68,6.81,9.70,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",medica,,O,82.88,8.42,29.84,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),medica,,O,50.01,5.20,7.73,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",medica,,O,331.51,119.35,119.35,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,medica,,O,30.49,2.32,13.25,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,medica,,O,83.76,6.73,31.06,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",medica,,O,135.66,25.29,48.84,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",medica,,O,635.27,137.73,228.70,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",medica,,O,50.01,4.43,18.00,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",medica,,O,154.76,24.25,56.44,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,medica,,O,3055.12,203.12,1099.84,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",medica,,O,151.46,8.03,8.03,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,medica,,O,101.45,3.58,12.52,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",medica,,O,92.99,21.05,21.05,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,medica,,O,16541.64,1561.79,5199.06,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,medica,,O,265.10,8.75,95.44,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,medica,,I,18614.53,3748.00,8294.60,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86317,cpt,"DETECTION OF INFECTIOUS AGENT ANTIBODY, QUANTITATIVE",medica,,O,148.64,8.99,8.99,29.14,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,medica,,O,10678.57,58.46,3212.20,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",medica,,O,209.99,16.56,16.56,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,medica,,O,138.03,20.16,49.69,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",medica,,O,73.14,3.60,26.33,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,medica,,O,38.92,4.65,14.85,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,medica,,O,290.12,59.69,104.44,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",medica,,O,45.06,8.66,16.22,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",medica,,O,157.91,56.85,56.85,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",medica,,O,158.29,56.98,56.98,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",medica,,O,151.64,21.05,21.05,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",medica,,O,331.50,12.98,119.34,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,medica,,E,2880.28,490.23,676.20,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",medica,,O,252.47,43.75,76.45,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),medica,,O,53.08,5.52,19.11,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,medica,,O,3055.12,204.95,1165.83,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),medica,,O,29523.82,4577.80,9866.22,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,medica,,O,90.02,12.05,32.41,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),medica,,O,8588.52,489.94,548.96,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77372,cpt,"RADIATION THERAPY DELIVERY, STEREOTACTIC RADIOSURGERY (SRS) FOR CRANIAL GROWTHS, PER SESSION, USING A LINEAR ACCELERATOR",medica,,O,23204.58,6663.20,8353.65,10102.14,13922.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1781,cpt,MESH (IMPLANTABLE),medica,,O,2029.44,404.71,730.60,814.49,1217.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,medica,,O,252.59,75.92,90.93,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,medica,,O,754.07,203.12,271.47,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,medica,,O,183.82,19.97,66.18,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",medica,,O,650.28,61.44,248.14,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,medica,,O,1446.95,312.71,420.01,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,medica,,O,50.02,4.84,18.01,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,medica,,O,50.00,8.06,18.00,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,medica,,O,2289.17,554.60,554.60,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",medica,,O,290.00,66.00,181.62,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",medica,,O,13.80,2.61,4.97,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,medica,,O,1958.01,473.85,1390.59,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,medica,,O,323.88,75.26,116.60,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",medica,,O,373.90,92.59,134.84,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",medica,,O,250.10,18.15,90.04,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",medica,,O,130.95,13.50,47.14,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",medica,,O,10827.72,2513.53,2737.31,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",medica,,O,65.11,8.45,23.44,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,medica,,O,93.19,11.22,33.55,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",medica,,O,67.24,14.75,24.94,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,medica,,I,17457.81,5769.18,7641.23,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,medica,,O,3055.12,202.81,1099.84,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",medica,,O,120.33,16.46,43.32,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2350,cpt,"INJECTION, OCRELIZUMAB, 1 MG",medica,,O,156.72,36.34,56.51,117.73,94.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,medica,,O,1205.09,132.64,447.01,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",medica,,O,754.07,158.88,271.47,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7030,cpt,"INFUSION, NORMAL SALINE SOLUTION , 1000 CC",medica,,O,9.26,2.95,58.60,58.60,5.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,medica,,O,145.10,29.21,52.24,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,medica,,E,292.62,111.66,111.66,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,medica,,O,3595.37,280.86,1294.33,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),medica,,O,283.14,16.69,101.93,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3260,cpt,AMBULATORY SURGICAL BOOT EAC,medica,,O,340.14,93.68,122.45,134.53,204.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",medica,,O,245.09,44.06,245.09,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",medica,,O,4.27,1.25,4.85,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,medica,,O,3055.12,206.42,1099.84,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,389,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH CC,medica,,I,17143.70,5530.39,7376.56,18965.92,10286.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",medica,,O,1997.14,273.93,718.97,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,medica,,I,16915.97,4140.71,7394.93,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,medica,,O,50.01,5.20,7.83,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,medica,,O,694.00,180.07,298.45,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",medica,,O,3583.92,323.18,1960.02,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,medica,,O,287.62,21.62,74.73,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1580,cpt,"INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG",medica,,O,9.46,3.41,4.57,5.64,5.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,medica,,O,4054.33,319.17,1503.35,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,medica,,O,7543.40,1294.20,2715.62,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,medica,,O,401.42,94.39,144.51,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,medica,,E,880.03,214.07,309.36,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",medica,,O,327.67,47.93,77.42,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",medica,,O,108.49,21.05,21.05,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2060,cpt,"INJECTION, LORAZEPAM, 2 MG",medica,,O,78.01,14.44,28.18,77.43,46.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,medica,,O,67.58,8.51,24.33,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",medica,,I,16029.09,4785.97,7521.14,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2407,cpt,"INJECTION, ORITAVANCIN (ORBACTIV), 10 MG",medica,,O,63.57,22.88,22.88,22.88,38.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),medica,,O,50.01,5.20,18.00,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",medica,,O,47.53,8.48,12.88,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,medica,,O,80.09,1.66,28.83,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",medica,,O,16.23,1.83,6.19,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,medica,,O,87.53,4.18,31.51,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,other,,I,16493.28,2797.28,7300.19,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",medica,,O,184.32,70.33,70.33,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,medica,,O,119.15,21.42,28.12,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",medica,,O,117.54,25.46,369.00,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",medica,,O,47.53,3.60,32.45,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,mutual of omaha medicare advantage,,O,76.68,5.83,9.61,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",mutual of omaha medicare advantage,,O,91.30,6.24,10.45,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",mutual of omaha medicare advantage,,O,85.05,7.99,10.03,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,other,,O,178.08,50.28,56.44,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,other,,O,3055.12,204.95,229.00,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",other,,O,120.33,16.46,79.58,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,100,ms-drg,SEIZURES WITH MCC,other,,I,27764.15,6132.00,14577.74,14577.74,16658.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,other,,O,42.51,2.00,2.00,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",other,,O,19.52,4.40,14.19,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,201,ms-drg,PNEUMOTHORAX WITHOUT CC/MCC,other,,I,23260.48,2891.35,5908.44,8982.44,13956.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,other,,O,50.01,5.20,5.20,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",other,,O,513.19,16.80,78.76,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",other,,O,734.07,19.80,418.42,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",other,,O,70.78,13.97,44.17,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",other,,O,331.50,12.98,34.46,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,other,,I,48.06,11.46,31.44,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,other,,O,42.58,3.22,26.36,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,other,,I,26926.14,6286.85,7855.35,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,other,,O,502.71,78.63,286.54,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",other,,O,52.60,8.84,23.64,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2270,cpt,"INJECTION, MORPHINE SULFATE, UP TO 10 MG",other,,O,84.59,0.76,9.57,82.91,50.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,other,,O,41.28,5.78,16.05,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",other,,O,108.49,21.05,81.37,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",other,,O,0.59,0.15,13.96,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,other,,I,19710.37,4922.26,8225.46,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",other,,E,1724.51,232.62,746.49,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,394,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,other,,I,20150.20,5703.31,7268.99,10874.89,12090.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,other,,O,752.83,92.79,537.14,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,other,,O,351.40,81.48,263.55,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,200,ms-drg,PNEUMOTHORAX WITH CC,other,,I,20169.50,7259.72,8480.18,12541.14,12101.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99203,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30-44 MINUTES",other,,O,280.00,68.79,188.13,378.91,168.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,other,,O,53.76,5.92,33.54,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",other,,O,82.88,8.42,61.05,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,other,,O,1343.10,94.47,108.35,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,other,,O,9.11,0.50,24.01,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,other,,O,56.62,7.92,26.33,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2765,cpt,"INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG",other,,O,79.57,14.40,14.40,59.62,47.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),other,,O,50.01,5.20,5.20,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",other,,I,944.41,228.70,311.21,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,374,ms-drg,DIGESTIVE MALIGNANCY WITH MCC,other,,I,21410.93,11344.37,11344.37,12885.84,12846.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",other,,O,10827.72,2513.53,6233.72,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,other,,O,195.07,21.19,146.30,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,other,,O,4054.33,319.17,358.25,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",other,,O,117.54,58.77,124.59,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,other,,I,124.70,13.59,90.57,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),other,,O,50.01,5.20,5.20,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,other,,O,3055.12,204.02,229.00,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",other,,O,369.82,61.44,233.31,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,other,,I,1386.23,364.58,4197.87,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,other,,O,3055.12,206.42,229.00,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",other,,O,116.79,7.81,72.88,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",other,,O,83.33,15.97,62.50,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,other,,O,87.53,4.18,65.65,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,other,,O,647.78,92.64,325.40,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",other,,O,85.94,24.92,64.46,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",other,,O,36.32,4.04,4.04,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",other,,O,1724.51,97.60,97.60,959.65,801.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",other,,O,88.24,14.05,14.05,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",other,,O,151.46,8.03,112.54,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",other,,O,437.43,101.00,112.90,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",other,,O,7.91,1.68,13.32,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,other,,I,6.27,0.90,1.30,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,other,,I,78211.42,12813.14,13681.58,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,other,,O,69.59,9.12,30.18,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",other,,O,70.06,8.29,13.54,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",other,,O,162.48,33.29,64.38,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,other,,O,383.02,34.82,362.76,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",other,,O,5902.67,335.59,1300.54,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",other,,O,1680.75,111.66,619.31,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,other,,I,19597.90,4492.16,7072.48,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,other,,O,831.61,156.22,177.77,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",other,,O,88.56,20.43,66.42,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,other,,O,3055.12,202.81,229.00,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,other,,O,3595.37,280.86,280.86,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,203,ms-drg,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,other,,I,12110.61,3397.96,6846.28,8338.30,7266.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",other,,O,157.91,56.85,98.54,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,other,,O,5902.67,923.22,1300.54,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",other,,O,218.83,30.93,117.68,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,other,,O,90.02,12.05,34.77,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,other,,O,3055.12,203.12,229.00,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1876,cpt,"STENT, NON-COATED/NON-COVERED, WITH DELIVERY SYSTEM",other,,O,922.91,270.48,733.71,733.71,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,other,,O,24173.14,2776.54,19924.89,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,580,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",other,,I,52656.26,7319.59,7319.59,18388.00,31593.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",other,,O,91.30,6.24,56.97,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,other,,O,694.00,180.07,251.59,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,other,,I,5986.20,1090.17,73077.52,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",other,,O,56.26,6.34,9.75,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,other,,O,3055.12,204.02,228.03,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,other,,O,93.19,5.27,5.27,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9045,cpt,"INFUSION, ALBUMIN (HUMAN), 5%, 250 ML",other,,O,190.37,42.23,42.23,42.23,114.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,other,,I,108746.38,30644.47,73192.72,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",other,,O,1997.14,430.17,430.17,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",other,,O,50.72,5.89,7.48,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,other,,I,18651.11,4387.85,7114.16,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,331,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,other,,I,49456.93,5489.60,5489.60,19473.00,29674.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",other,,O,65.11,10.15,51.76,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),other,,O,53.08,5.52,5.52,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",other,,O,4.22,1.00,12.05,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,other,,O,1753.28,94.47,482.16,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",other,,O,39.88,13.23,13.49,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,other,,O,351.40,51.44,180.97,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",other,,O,4.27,1.25,14.91,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",other,,O,348.89,53.55,53.55,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",other,,O,468.95,93.59,229.19,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70542,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK WITH CONTRAST",other,,O,3055.12,366.49,366.49,366.49,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,other,,O,3055.12,202.50,229.00,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,other,,O,41.26,8.55,70.82,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",other,,O,65.06,17.18,42.04,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",other,,O,290.00,66.00,123.48,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",other,,O,754.07,158.88,158.88,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",other,,O,154.76,24.25,69.64,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",other,,O,502.71,78.63,286.54,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,other,,O,231.34,36.98,183.91,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,other,,O,521.47,92.78,325.40,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,352,ms-drg,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,other,,I,37987.72,5489.60,5489.60,8070.29,22792.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",other,,O,4.12,1.10,15.01,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),other,,O,132.12,15.79,82.44,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",other,,O,252.47,44.06,157.54,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),other,,O,8588.52,489.94,489.94,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,other,,O,2687.44,201.24,227.06,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74250,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST AND MULTIPLE SERIAL FILMS,other,,O,530.23,158.38,262.65,397.67,318.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,other,,O,3683.73,275.00,995.30,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,other,,O,101.33,11.74,45.54,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88312,cpt,SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,other,,O,63.70,17.04,39.75,63.70,38.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,other,,O,106.28,8.57,37.45,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",other,,O,231.34,36.97,183.91,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",other,,O,96.29,17.55,17.55,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",other,,O,3595.37,208.18,227.06,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,other,,O,323.88,75.26,257.48,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,other,,O,175.06,87.53,124.59,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",other,,O,1029.19,93.54,642.21,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,other,,O,3055.12,202.94,228.03,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,other,,O,122.03,31.49,57.42,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,other,,O,69.59,7.80,43.42,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,other,,O,31.24,2.94,18.40,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",other,,O,135.66,25.29,84.65,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),other,,O,126.23,10.13,10.13,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,other,,O,1753.28,96.00,99.22,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,other,,O,401.42,94.39,229.19,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",other,,O,85.05,7.99,34.46,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,other,,O,73.83,11.51,66.26,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,536,ms-drg,FRACTURES OF HIP AND PELVIS WITHOUT MCC,other,,I,16125.10,5605.93,6454.84,6454.84,9675.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",other,,O,93.19,13.33,58.15,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",other,,O,94.14,7.61,55.42,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",other,,O,365.14,48.65,259.07,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,other,,I,26508.25,6362.98,11457.85,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,other,,O,1479.41,92.59,103.93,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",other,,O,41.06,11.36,15.04,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,other,,O,1880.84,106.44,106.44,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",other,,O,67.24,14.75,45.68,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",other,,O,252.47,43.75,53.43,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",other,,O,82.61,19.42,55.47,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,other,,O,1893.35,157.27,157.27,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,326,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",other,,I,81034.64,14456.39,14456.39,35985.41,48620.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",other,,O,48.36,3.92,9.03,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",other,,I,238.84,62.82,208.13,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,other,,O,213.87,28.75,170.03,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,other,,O,76.68,5.83,60.96,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",other,,O,270.00,64.89,118.25,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,other,,O,31.88,2.63,18.77,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",other,,O,285.11,61.44,226.66,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",other,,O,41.28,3.01,27.31,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,other,,O,7543.40,1294.20,1448.18,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,other,,O,188.17,19.53,118.25,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,other,,O,80.09,1.66,8.33,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,other,,O,188.17,66.99,118.25,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,other,,I,65131.57,7666.11,7666.11,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",other,,O,1858.47,98.50,108.35,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",other,,O,47.53,8.48,22.26,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",other,,O,1997.14,273.93,273.93,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",other,,O,65.11,8.45,48.83,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",other,,O,734.07,114.82,418.42,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,other,,O,1159.26,202.49,204.85,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,other,,O,41.19,1.80,8.77,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,other,,O,2599.91,94.47,147.14,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,other,,O,65.11,6.57,40.63,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86774,cpt,ANALYSIS FOR ANTIBODY TO TETANUS BACTERIA (CLOSTRIDIUM TETANUS),other,,O,92.01,5.21,5.21,14.86,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,other,,O,1343.10,94.48,108.35,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,other,,O,3238.42,206.67,293.63,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",other,,I,225.50,61.14,115.77,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",other,,O,90.84,9.28,68.13,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,other,,O,83.76,6.73,6.73,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",other,,O,373.90,92.59,233.31,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86648,cpt,ANALYSIS FOR ANTIBODY TO DIPHTHERIA (BACTERIA),other,,O,92.01,5.21,5.21,15.27,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,other,,O,76.04,10.15,59.28,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,other,,O,113.25,11.78,11.78,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,other,,O,513.11,156.86,320.18,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",other,,O,71.96,7.91,13.44,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",other,,O,365.14,61.44,259.07,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1815,cpt,"INJECTION, INSULIN, PER 5 UNITS",other,,O,29.26,4.48,4.48,14.09,17.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,199,ms-drg,PNEUMOTHORAX WITH MCC,other,,I,24625.77,6870.06,13280.09,13280.09,14775.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",other,,I,145.15,30.77,192.10,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",other,,O,2069.24,93.35,108.35,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0521,revCode,FREESTANDING CLINIC CLINIC VISIT BY MEMBER TORHC/FQHC,other,,O,290.00,111.87,123.48,255.96,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,other,,I,36086.42,12423.48,14837.76,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,other,,O,3055.12,205.61,228.03,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",other,,O,132.12,25.53,25.53,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,other,,O,2289.17,554.60,742.47,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,other,,I,14759.59,3312.91,5096.00,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,other,,O,4852.19,224.32,224.32,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",other medicare advantage,,O,238.30,71.54,94.37,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",other medicare advantage,,O,1997.14,273.93,4430.42,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",other medicare advantage,,O,369.82,61.44,72.01,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",other medicare advantage,,O,85.05,7.99,10.35,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",other medicare advantage,,O,70.01,13.01,16.01,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,other medicare advantage,,O,65.11,6.57,6.57,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",other medicare advantage,,O,52.60,8.84,8.84,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",other medicare advantage,,O,238.30,63.70,94.37,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),other medicare advantage,,O,91.30,14.31,18.92,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",other medicare advantage,,O,183.82,20.70,21.47,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,other medicare advantage,,O,203.82,49.80,50.00,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,312,ms-drg,SYNCOPE AND COLLAPSE,other medicare advantage,,I,19356.82,5264.37,5595.70,7437.32,11614.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",other medicare advantage,,O,94.14,7.61,7.61,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,313,ms-drg,CHEST PAIN,other medicare advantage,,I,19828.75,4932.79,5131.89,5325.46,11897.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",other medicare advantage,,O,120.33,16.46,16.46,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",other medicare advantage,,O,151.46,8.03,13.12,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",other medicare advantage,,O,56.26,6.34,6.34,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,other medicare advantage,,I,32181.45,11429.58,12273.65,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,other medicare advantage,,O,113.25,11.78,14.27,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,other medicare advantage,,O,67.58,5.08,5.08,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",other medicare advantage,,O,85.05,7.99,8.53,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,other medicare advantage,,O,203.82,49.80,50.00,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",other medicare advantage,,O,91.30,6.24,10.35,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",other medicare advantage,,O,1997.14,273.93,430.17,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,other medicare advantage,,O,41.28,5.78,6.34,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,other medicare advantage,,O,53.76,5.92,5.92,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,other medicare advantage,,O,76.68,5.83,9.57,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",other medicare advantage,,O,245.09,44.06,72.01,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,other medicare advantage,,O,7543.40,1294.20,1295.47,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",other medicare advantage,,O,71.96,7.91,7.91,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",other medicare advantage,,O,100.04,20.74,22.08,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,other medicare advantage,,I,62688.63,11498.14,14099.01,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,193,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,other medicare advantage,,I,28507.68,8334.78,8659.78,17274.09,17104.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,other medicare advantage,,O,41.19,1.80,16.01,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,other medicare advantage,,O,31.24,2.94,2.94,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,other medicare advantage,,I,4152.82,995.38,2111.47,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",other medicare advantage,,O,285.11,61.44,75.57,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",other medicare advantage,,O,315.99,85.00,194.77,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,other medicare advantage,,I,17945.73,6102.59,7352.38,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,other medicare advantage,,O,56.62,7.92,7.92,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,698,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,other medicare advantage,,I,27219.24,6918.41,10560.76,18262.00,16331.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",other medicare advantage,,O,369.82,61.44,75.57,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",other medicare advantage,,O,10827.72,2513.53,2787.87,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",other medicare advantage,,O,47.53,8.48,8.48,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",other medicare advantage,,O,13.80,2.61,3.11,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,other medicare advantage,,O,383.02,34.82,162.47,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",other medicare advantage,,O,151.46,8.03,13.26,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,other medicare advantage,,O,106.28,8.57,8.57,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",other medicare advantage,,O,1997.14,430.17,430.17,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",other medicare advantage,,O,38.92,2.65,2.65,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,other medicare advantage,,I,26926.14,6286.85,6557.09,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",other medicare advantage,,O,246.35,17.59,20.07,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,336,ms-drg,PERITONEAL ADHESIOLYSIS WITH CC,other medicare advantage,,I,67565.05,6006.27,13629.93,24239.00,40539.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,other medicare advantage,,O,188.17,19.53,22.08,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,other medicare advantage,,O,183.82,20.77,20.77,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,other medicare advantage,,I,22023.98,6812.39,8427.99,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45331,cpt,BIOPSY OF THE LOWER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY),tricare,,O,4384.17,710.14,1101.91,3810.64,2630.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49324,cpt,INSERTION OF ABDOMINAL CAVITY CATHETER USING AN ENDOSCOPE,tricare,,O,22261.75,4488.40,4577.95,8563.22,13357.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,tricare,,O,266.35,64.70,102.33,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,308,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,tricare,,I,28408.75,7603.87,7603.87,14046.88,17045.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82575,cpt,CREATININE CLEARANCE MEASUREMENT TO TEST FOR KIDNEY FUNCTION,tricare,,O,80.22,9.31,9.50,20.42,11.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29881,cpt,REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE,tricare,,O,21489.40,2516.47,2631.25,7609.83,3025.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,tricare,,O,167.56,25.68,172.59,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,tricare,,O,298.87,98.24,101.80,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",tricare,,E,5953.08,743.91,743.91,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,204,ms-drg,RESPIRATORY SIGNS AND SYMPTOMS,tricare,,I,8937.95,4563.56,4563.56,4563.56,5362.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21556,cpt,REMOVAL OF (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,tricare,,O,18486.84,2243.72,2283.49,4391.53,11092.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,tricare,,O,646.53,93.49,98.50,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11623,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",tricare,,O,4960.80,1253.04,1273.00,2217.32,2976.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,tricare,,O,567.74,115.42,294.02,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82465,cpt,CHOLESTEROL LEVEL,tricare,,O,37.50,4.26,4.37,4.37,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1303,cpt,"INJECTION, RAVULIZUMAB-CWVZ, 10 MG",tricare,,O,762.92,173.77,221.67,221.67,457.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1454,cpt,"INJECTION, FOSNETUPITANT 235 MG AND PALONOSETRON 0.25 MG",tricare,,O,919.04,467.06,467.06,467.06,551.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52356,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) WITH STENT USING AN ENDOSCOPE,tricare,,O,26186.13,3916.85,3991.68,10931.90,15711.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49653,cpt,REPAIR OF TRAPPED HERNIA USING AN ENDOSCOPE,tricare,,O,27581.12,4577.80,4577.95,4577.95,16548.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,621,ms-drg,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,tricare,,I,48014.63,10223.98,12037.69,32094.15,28808.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,tricare,,O,3222.12,719.92,734.61,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62321,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK USING IMAGING GUIDANCE,tricare,,O,2267.14,558.18,569.57,1776.12,1360.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",tricare,,O,63.63,6.74,6.90,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86161,cpt,MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM PROTEINS),tricare,,O,30.00,9.98,12.05,15.00,18.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,246,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,tricare,,I,112798.01,18912.25,59595.14,59595.14,67678.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84166,cpt,"PROTEIN MEASUREMENT, BODY FLUID",tricare,,O,61.34,6.87,17.90,30.15,20.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9190,cpt,"INJECTION, FLUOROURACIL, 500 MG",tricare,,O,9.25,1.74,8.74,20.90,5.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0475,cpt,"INJECTION, BACLOFEN, 10 MG",tricare,,O,369.29,182.28,182.28,182.28,221.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19281,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MAMMOGRAPHIC GUIDANCE, FIRST LESION",tricare,,O,21298.80,131.53,3038.88,5148.44,12779.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72202,cpt,"X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE, 3 OR MORE VIEWS",tricare,,O,267.61,36.00,98.50,212.75,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,336,ms-drg,PERITONEAL ADHESIOLYSIS WITH CC,tricare,,I,67565.05,6006.27,6006.27,24239.00,40539.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17261,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",tricare,,O,1535.94,159.87,162.47,761.92,921.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,tricare,,O,31.88,2.63,4.40,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,201,ms-drg,PNEUMOTHORAX WITHOUT CC/MCC,tricare,,I,23260.48,2891.35,2891.35,8982.44,13956.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,tricare,,O,89.65,6.58,18.05,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,tricare,,O,306.38,103.42,117.90,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27618,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF LEG OR ANKLE,tricare,,O,17432.91,1273.00,1273.00,1273.00,10459.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,441,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",tricare,,I,27183.75,11619.11,12890.80,20379.28,16310.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",tricare,,O,41.06,11.36,41.06,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43246,cpt,INSERTION OF STOMACH TUBE USING A FLEXIBLE ENDOSCOPE,tricare,,O,4138.45,1539.50,1539.50,1539.50,2483.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20220,cpt,BIOPSY OF BONE USING NEEDLE OR TROCAR,tricare,,O,9567.06,1325.54,1325.54,2273.50,5740.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,tricare,,O,60.03,7.19,12.03,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1439,cpt,"INJECTION, FERRIC CARBOXYMALTOSE, 1 MG",tricare,,O,4.71,0.79,1.13,4.99,2.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84446,cpt,VITAMIN E LEVEL,tricare,,O,83.76,7.84,14.24,66.59,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11421,cpt,"REMOVAL OF GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",tricare,,O,21237.03,738.55,738.55,2689.89,12742.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,805,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,tricare,,I,14483.73,3890.14,3890.14,11041.35,8690.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29826,cpt,SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE,tricare,,O,33765.02,2631.25,2631.25,16721.96,6904.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92960,cpt,EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT,tricare,,O,854.12,508.26,508.26,905.36,512.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0640,cpt,"INJECTION, LEUCOVORIN CALCIUM, PER 50 MG",tricare,,O,24.48,4.06,19.99,38.80,14.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,809,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,tricare,,I,46992.19,7372.16,7372.16,9364.35,28195.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,tricare,,I,65131.57,7666.11,16664.40,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,tricare,,O,842.86,94.39,94.48,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86337,cpt,INSULIN ANTIBODY MEASUREMENT,tricare,,O,104.49,20.98,21.50,26.76,62.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64484,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",tricare,,O,7561.13,743.72,753.29,2728.97,4536.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28120,cpt,PARTIAL REMOVAL OF FOOT OR HEEL BONE FOR BONE INFECTION IN THE MID HINDFOOT AREA,tricare,,O,34724.90,2630.53,5847.07,11395.58,20834.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",tricare,,O,734.07,114.82,734.07,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",tricare,,O,3395.81,1103.79,1117.18,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0105,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK,tricare,,O,3209.39,717.96,717.99,719.92,1925.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,tricare,,O,36.32,4.67,4.78,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43247,cpt,"REMOVAL OF FOREIGN BODIES OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",tricare,,O,5841.02,1094.58,1094.58,2654.02,3504.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,tricare,,O,152.18,14.75,15.11,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84450,cpt,"LIVER ENZYME (SGOT), LEVEL",tricare,,O,40.11,5.08,5.20,8.75,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,tricare,,O,1630.73,338.97,341.05,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",tricare,,O,1893.35,485.97,506.04,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26615,cpt,OPEN TREATMENT OF FRACTURE OF BONE IN THE MIDPORTION OF THE HAND BETWEEN THE WRIST AND FINGERS,tricare,,O,27635.38,2631.25,2631.25,5060.32,16581.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",tricare,,O,96.29,17.55,35.23,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,tricare,,O,106.28,8.57,8.78,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",tricare,,O,1029.19,93.54,94.48,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93668,cpt,PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION PER SESSION,tricare,,O,148.80,49.55,50.36,64.11,89.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87798,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, AMPLIFIED PROBE TECHNIQUE",tricare,,O,228.87,16.13,35.23,35.23,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82040,cpt,ALBUMIN (PROTEIN) LEVEL,tricare,,O,37.50,4.85,4.97,33.12,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,tricare,,O,412.67,92.59,94.48,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",tricare,,O,318.54,72.28,88.03,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,tricare,,O,145.10,29.21,41.45,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70540,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK WITHOUT CONTRAST",tricare,,O,1869.58,208.18,208.18,639.63,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",tricare,,O,107.59,3.13,20.13,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49180,cpt,"NEEDLE BIOPSY OF ABDOMINAL CAVITY GROWTH, ACCESSED THROUGH THE SKIN",tricare,,O,11548.67,999.86,1273.00,1325.18,6929.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,tricare,,O,67.58,3.47,5.80,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,tricare,,O,3055.12,204.02,208.18,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",tricare,,O,212.36,14.48,134.71,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,tricare,,O,252.59,54.84,56.09,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86648,cpt,ANALYSIS FOR ANTIBODY TO DIPHTHERIA (BACTERIA),tricare,,O,92.01,5.21,15.27,15.27,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,tricare,,O,73.83,11.51,15.14,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94729,cpt,TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,tricare,,O,231.34,43.74,238.28,238.28,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86774,cpt,ANALYSIS FOR ANTIBODY TO TETANUS BACTERIA (CLOSTRIDIUM TETANUS),tricare,,O,92.01,5.21,14.86,14.86,55.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",tricare,,O,85.03,16.92,85.03,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",tricare,,O,154.76,24.25,154.76,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,tricare,,O,67.58,8.51,8.72,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",tricare,,O,238.84,35.53,76.80,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87425,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ROTAVIRUS,tricare,,O,84.93,10.39,12.03,51.31,50.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,51600,cpt,INJECTION PROCEDURE FOR X-RAY IMAGING OF THE BLADDER OR DURING VOIDING,tricare,,O,2968.32,207.30,207.30,1456.17,1780.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5120,cpt,"INJECTION, PEGFILGRASTIM-BMEZ, BIOSIMILAR, (ZIEXTENZO), 0.5 MG",tricare,,O,1004.49,80.06,80.06,411.12,602.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,tricare,,O,69.59,7.80,16.53,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",tricare,,O,73.14,3.60,3.69,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",tricare,,O,31.88,3.63,3.65,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9206,cpt,"INJECTION, IRINOTECAN, 20 MG",tricare,,O,16.23,4.11,16.23,36.90,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83516,cpt,"ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, MULTIPLE STEP METHOD",tricare,,O,55.44,9.63,11.58,41.58,13.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",tricare,,O,4116.84,594.86,1325.54,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",tricare,,O,70.06,8.29,8.49,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97032,cpt,"APPLICATION OF ELECTRICAL STIMULATION WITH THERAPIST PRESENT, EACH 15 MINUTES",tricare,,O,92.78,14.10,14.10,14.10,55.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21320,cpt,CLOSED TREATMENT OF BROKEN NOSE BONE WITH PLACEMENT OF STABILIZING DEVICE,tricare,,O,17629.16,2495.01,2495.01,5046.10,10577.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38900,cpt,IMAGING OF LYMPH NODES DURING SURGERY,tricare,,O,35811.33,5130.30,5130.30,9713.39,21486.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5103,cpt,"INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG",tricare,,O,109.30,19.12,30.95,109.12,65.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",tricare,,O,41.28,5.10,5.24,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",tricare,,O,373.90,92.59,94.48,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",tricare,,O,92.99,21.05,35.23,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,tricare,,O,414.89,93.99,94.48,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12035,cpt,"REPAIR OF WOUND (12.6 TO 20.0 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",tricare,,O,20510.28,2283.49,2283.49,5154.34,12306.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",tricare,,O,365.14,61.44,73.18,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",tricare,,O,441.23,35.97,50.36,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0121,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK,tricare,,O,3195.82,717.96,717.99,1255.30,1917.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0791,cpt,"INJECTION, CRIZANLIZUMAB-TMCA, 5 MG",tricare,,O,441.53,125.13,125.13,441.53,264.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83498,cpt,"HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVEL",tricare,,O,126.23,22.15,27.28,94.68,75.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",tricare,,O,47.53,3.60,3.69,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,tricare,,O,3055.12,206.42,206.42,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,tricare,,O,1880.84,106.44,159.41,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69200,cpt,REMOVAL OF FOREIGN BODY FROM EAR CANAL,tricare,,O,225.24,102.02,102.02,102.02,135.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",tricare,,O,422.68,79.92,247.56,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76800,cpt,ULTRASOUND SCAN OF SPINAL CANAL,tricare,,O,490.46,94.48,94.48,256.04,294.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,tricare,,O,4054.33,322.67,325.68,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,tricare,,O,50.72,6.35,6.51,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",tricare,,O,13.78,1.69,4.29,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9037,cpt,"PLATELETS, PHERESIS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",tricare,,O,3190.10,638.19,638.19,2179.70,1914.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3380,cpt,"INJECTION, VEDOLIZUMAB, 1 MG",tricare,,O,68.13,21.84,21.84,3747.37,40.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,779,ms-drg,ABORTION WITHOUT D&C,tricare,,I,5098.91,4359.27,4359.27,11608.00,3059.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,tricare,,O,76.68,5.83,9.75,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63035,cpt,"PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF UPPER OR LOWER SPINAL CORD OR NERVES AND/OR REMOVAL OF DISC, EACH ADDITIONAL INTERSPACE",tricare,,O,43130.78,5753.52,5847.07,5847.07,25878.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",tricare,,O,151.46,8.03,13.44,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23350,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOINT,tricare,,O,5340.22,795.73,980.47,4000.22,3204.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28485,cpt,OPEN TREATMENT OF FRACTURE OF THE MID PORTION OF THE FOOT,tricare,,O,27378.71,5847.07,5847.07,11179.03,16427.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21555,cpt,REMOVAL OF (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF NECK OR FRONT OF CHEST,tricare,,O,20108.46,2214.35,2214.35,5132.49,12065.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10005,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, FIRST GROWTH",tricare,,O,2576.47,558.51,563.01,1932.35,1545.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,tricare,,O,22.60,4.56,25.00,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,tricare,,O,1481.91,158.58,161.61,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,tricare,,O,1446.95,312.71,329.78,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,947,ms-drg,SIGNS AND SYMPTOMS WITH MCC,tricare,,I,68623.25,23067.35,23067.35,23067.35,41173.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",tricare,,O,89.65,10.18,13.24,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58300,cpt,PLACEMENT OF INTRA-UTERINE DEVICE (IUD) FOR PREGNANCY PREVENTION,tricare,,O,17850.39,2499.34,2499.34,7465.56,10710.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9395,cpt,"INJECTION, FULVESTRANT, 25 MG",tricare,,O,421.43,10.87,12.09,316.07,252.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19081,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, FIRST GROWTH",tricare,,O,6548.62,1273.00,1273.00,5582.75,3929.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77021,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF MRI GUIDANCE FOR INSERTION OF NEEDLE,tricare,,O,11389.85,1273.00,1273.00,6117.24,6833.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,tricare,,O,40.11,4.65,4.76,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37766,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, GREATER THAN 20 INCISIONS",tricare,,O,24542.50,3410.10,4543.34,5064.25,14725.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",tricare,,O,10827.72,2513.53,2633.29,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29880,cpt,REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE,tricare,,O,21409.78,2586.84,2631.25,7284.82,12845.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37765,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, 10-20 INCISIONS",tricare,,O,23967.03,2586.52,3452.23,13483.00,14380.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,tricare,,O,28.83,5.59,11.58,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,tricare,,I,14826.55,4677.51,4677.51,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",tricare,,O,90.84,3.51,20.90,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",tricare,,O,1040.92,159.87,162.47,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42831,cpt,"REMOVAL OF ADENOIDS PATIENT AGE 12 OR OVER, INITIAL PROCEDURE",tricare,,O,44292.83,2514.89,2514.89,2514.89,26575.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26055,cpt,INCISION OF TENDON COVERING OF FINGER,tricare,,O,17730.63,1248.60,1268.06,4980.73,10638.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32555,cpt,ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE,tricare,,O,2695.58,507.04,985.41,1831.81,1617.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,tricare,,O,76.04,10.15,10.36,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,tricare,,O,792.84,92.74,94.48,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,759,ms-drg,"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",tricare,,I,7547.33,2818.29,2818.29,8457.68,4528.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19499,cpt,OTHER PROCEDURE ON BREAST,tricare,,O,36082.70,3882.54,5007.08,5007.08,21649.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,tricare,,O,203.82,49.80,50.81,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63030,cpt,PARTIAL REMOVAL OF BONE WITH RELEASE OF SPINAL CORD OR SPINAL NERVES OF 1 INTERSPACE IN LOWER SPINE,tricare,,O,29485.64,5732.13,5847.07,22114.23,17691.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27823,cpt,OPEN TREATMENT OF PROMINENCES OF BOTH BONES OF THE LEG (TIBIA AND FIBULA) IN THE REGION OF THE ANKLE WITH HARDWARE FIXATION,tricare,,O,50033.07,11156.14,11156.14,11156.14,30019.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",tricare,,O,3457.28,1078.00,1094.58,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84590,cpt,VITAMIN A LEVEL,tricare,,O,29.03,11.66,11.66,15.88,17.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47562,cpt,REMOVAL OF GALLBLADDER USING AN ENDOSCOPE,tricare,,O,25184.23,4521.08,4577.95,9136.32,5405.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58999,cpt,OTHER PROCEDURE ON FEMALE GENITAL SYSTEM (NONOBSTETRICAL),tricare,,O,19481.18,157.46,157.46,157.46,11688.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58662,cpt,DESTRUCTION OR REMOVAL OF OVARY OR GROWTH OF PELVIS USING AN ENDOSCOPE,tricare,,O,30175.18,4607.33,4607.33,22301.14,18105.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77072,cpt,IMAGING FOR BONE AGE ASSESSMENT,tricare,,O,240.10,52.12,96.49,213.76,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,tricare,,O,1753.28,96.00,98.50,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57505,cpt,SCRAPING OF TISSUE OF CERVIX,tricare,,O,20523.11,2373.77,2373.77,2373.77,12313.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,493,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",tricare,,I,69921.76,14158.62,22740.93,24367.50,41953.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",tricare,,O,101.45,25.33,25.92,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",tricare,,O,183.82,20.21,28.13,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",tricare,,O,105.03,12.96,36.21,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,tricare,,I,108746.38,30644.47,35633.19,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29888,cpt,REPAIR OF ANTERIOR CRUCIATE LIGAMENT OF KNEE WITH ASSISTANCE OF AN ENDOSCOPE,tricare,,O,54316.68,5757.05,5757.05,14778.63,32590.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88262,cpt,"CHROMOSOME ANALYSIS FOR GENETIC DEFECTS, COUNT 15-20 CELLS",tricare,,O,313.73,126.00,126.00,126.00,188.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,419,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,tricare,,I,40465.41,9645.93,9753.85,26459.17,24279.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,tricare,,O,6554.34,441.62,1157.05,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",tricare,,O,348.89,56.80,76.80,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74022,cpt,COMPLETE X-RAY STUDY OF ABDOMEN WITH SINGLE X-RAY OF CHEST,tricare,,O,550.24,73.32,98.50,98.50,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63047,cpt,"PARTIAL REMOVAL OF MIDDLE SPINE BONE WITH RELEASE OF SPINAL CORD AND/OR NERVES, LOWER BACK (LUMBAR) AREA",tricare,,O,38040.40,5647.81,5667.02,13162.95,22824.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,tricare,,I,19710.37,4922.26,6035.62,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55250,cpt,REMOVAL OF SPERM DUCT,tricare,,O,18031.55,1639.64,1639.64,5663.50,10818.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",tricare,,O,419.99,46.79,445.18,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28072,cpt,REMOVAL OF JOINT LINING AT FIRST JOINT OF TOE,tricare,,O,32217.62,2562.21,2562.21,2562.21,19330.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93291,cpt,"EVALUATION OF HEART RHYTHM MONITOR SYSTEM IMPLANTED UNDER SKIN WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",tricare,,O,139.10,21.65,22.06,22.06,83.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,tricare,,O,1893.35,157.27,490.88,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29822,cpt,LIMITED REMOVAL OF ABNORMAL SHOULDER JOINT TISSUE USING ENDOSCOPE,tricare,,O,27841.82,2507.32,2631.25,20881.37,16705.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,216,ms-drg,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC,tricare,,I,542202.99,89387.47,91922.66,91922.66,325321.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46255,cpt,REMOVAL OF SINGLE EXTERNAL AND INTERNAL HEMORRHOID GROUP,tricare,,O,20835.51,2210.31,2210.31,2210.31,12501.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,tricare,,O,3238.42,206.67,266.93,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,tricare,,O,119.15,21.42,22.32,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59870,cpt,ASPIRATION OF ABNORMAL PREGNANCY CONTENTS WITH SCRAPING OF UTERINE WALL,tricare,,O,20134.64,2373.77,2373.77,2373.77,12080.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10140,cpt,DRAINAGE OF BLOOD OR FLUID ACCUMULATION,tricare,,O,18672.07,1309.64,1893.95,5930.73,11203.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",tricare,,O,270.00,64.89,188.17,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,369,ms-drg,MAJOR ESOPHAGEAL DISORDERS WITH CC,tricare,,I,18183.53,5934.09,5934.09,7530.55,10910.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52332,cpt,INSERTION OF STENT IN URINARY DUCT (URETER) USING AN ENDOSCOPE,tricare,,O,20654.85,2781.70,2781.70,17672.06,12392.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84466,cpt,TRANSFERRIN (IRON BINDING PROTEIN) LEVEL,tricare,,O,67.24,12.81,12.81,50.41,40.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,tricare,,O,2152.21,335.59,343.58,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",tricare,,O,411.42,47.57,98.50,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,tricare,,O,252.59,75.92,76.80,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,794,ms-drg,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,tricare,,I,5174.39,2904.57,30750.68,30750.68,3104.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",tricare,,O,183.82,20.70,28.31,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",tricare,,O,192.85,42.50,108.18,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80162,cpt,"DIGOXIN LEVEL, TOTAL",tricare,,O,101.33,13.02,13.33,13.33,15.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",tricare,,O,281.00,8.75,8.75,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",tricare,,O,266.35,51.50,76.80,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,tricare,,O,50.00,8.06,13.00,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58558,cpt,BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE,tricare,,O,24068.17,2373.69,2499.34,19315.13,14440.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86317,cpt,"DETECTION OF INFECTIOUS AGENT ANTIBODY, QUANTITATIVE",tricare,,O,148.64,8.99,15.05,29.14,89.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,tricare,,O,3055.12,203.12,325.68,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,tricare,,I,27884.18,6142.25,6142.25,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73650,cpt,"X-RAY OF HEEL, MINIMUM OF 2 VIEWS",tricare,,O,254.50,44.02,76.80,149.69,152.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",tricare,,O,4.27,1.25,4.85,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,tricare,,O,35679.28,5647.61,5667.02,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",tricare,,O,135.66,25.29,25.92,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28124,cpt,PARTIAL REMOVAL OF TOE BONE,tricare,,O,17782.12,2562.21,2562.21,2581.58,10669.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,tricare,,O,401.42,94.39,94.48,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",tricare,,O,647.78,98.50,98.50,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,tricare,,O,188.17,66.99,106.84,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36569,cpt,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER FOR INFUSION (PICC), PATIENT 5 YEARS OR OLDER",tricare,,O,2853.53,1292.67,1293.74,2529.35,1712.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,tricare,,O,5444.73,938.10,1304.24,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59812,cpt,TREATMENT OF INCOMPLETE ABORTION,tricare,,O,19183.63,2499.34,2499.34,4101.22,11510.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,299,ms-drg,PERIPHERAL VASCULAR DISORDERS WITH MCC,tricare,,I,27935.28,7317.62,7317.62,16225.76,16761.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,tricare,,O,40.11,4.18,4.29,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83825,cpt,MERCURY LEVEL,tricare,,O,132.12,15.93,16.33,27.18,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",tricare,,O,176.32,30.07,34.99,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,337,ms-drg,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,tricare,,I,42487.64,10142.47,11374.57,11374.57,25492.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",tricare,,O,298.47,56.42,96.34,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57288,cpt,CREATION OF SLING AROUND BLADDER CANAL (URETHRA) TO CONTROL LEAKAGE,tricare,,O,34340.73,4097.25,4097.25,23328.10,20604.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,tricare,,O,1343.10,94.47,94.48,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",tricare,,O,112.07,9.78,16.37,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28308,cpt,INCISION TO STRAIGHTEN TOE BONE (OTHER THAN THE BIG TOE) AT THE MIDFOOT BONE (METATARSAL) LEVEL,tricare,,O,31569.82,5060.32,5847.07,5847.07,18941.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,812,ms-drg,RED BLOOD CELL DISORDERS WITHOUT MCC,tricare,,I,17513.39,3290.25,3290.25,22466.97,10508.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38792,cpt,INJECTION OF RADIOACTIVE MATERIAL FOR X-RAY IDENTIFICATION OF LYMPH NODE,tricare,,O,48181.56,4936.05,5007.08,5007.08,28908.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",tricare,,O,88.56,20.43,88.56,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,tricare,,O,213.87,28.75,47.83,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,tricare,,O,36.32,3.85,3.95,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",tricare,,O,365.24,8.63,14.44,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36475,cpt,DESTRUCTION OF FIRST INCOMPETENT VEIN OF ARM OR LEG USING RADIOFREQUENCY AND IMAGING GUIDANCE,tricare,,O,27732.57,3410.10,4314.46,10128.50,16639.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,tricare,,I,62688.63,11498.14,11498.14,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",tricare,,O,240.10,61.44,74.99,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",tricare,,O,315.99,85.00,199.55,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,195,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,tricare,,I,12306.54,4159.34,4159.34,8390.31,7383.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17282,cpt,"DESTRUCTION OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",tricare,,O,2553.54,312.72,312.72,545.53,1532.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64635,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, SINGLE FACET JOINT",tricare,,O,7687.98,1563.06,1588.94,2892.60,4612.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21931,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF BACK OR FLANK,tricare,,O,19815.20,1325.34,2283.49,5743.86,11889.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91037,cpt,MONITORING AND RECORDING OF ESOPHAGEAL FUNCTION THROUGH NASAL TUBE WITH ELECTRODE,tricare,,O,3401.95,370.13,370.13,2397.37,2041.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0875,cpt,"INJECTION, DALBAVANCIN, 5 MG",tricare,,O,23.28,14.41,15.32,1722.94,13.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,tricare,,O,3953.80,1077.08,1094.58,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,645,ms-drg,ENDOCRINE DISORDERS WITHOUT CC/MCC,tricare,,I,16355.76,4514.30,4514.30,8513.93,9813.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",tricare,,O,209.99,16.56,18.48,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,tricare,,O,3580.43,810.94,825.95,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,tricare,,O,521.47,92.78,94.48,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29828,cpt,RELEASE OF TENDON CONNECTING BICEPS MUSCLE AND SHOULDER USING AN ENDOSCOPE,tricare,,O,45470.39,5674.87,5847.07,16913.72,27282.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",tricare,,O,158.29,56.98,158.29,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0490,cpt,"INJECTION, BELIMUMAB, 10 MG",tricare,,O,122.82,50.21,50.21,50.21,73.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,tricare,,I,12315.58,3063.82,3063.82,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11771,cpt,EXTENSIVE REMOVAL OF CYST OF TAILBONE,tricare,,O,19648.60,2145.13,2283.49,5607.96,11789.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45330,cpt,DIAGNOSTIC EXAMINATION OF THE LOWER PORTION OF THE LARGE BOWEL USING AN ENDOSCOPE,tricare,,O,3245.25,719.92,734.61,2991.30,1947.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42400,cpt,NEEDLE BIOPSY OF SALIVARY GLAND,tricare,,O,3268.58,556.26,573.66,573.66,1961.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49659,cpt,HERNIA REPAIR PROCEDURE USING AN ENDOSCOPE,tricare,,O,26058.62,8032.81,8032.81,8673.29,15635.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,60220,cpt,TOTAL REMOVAL OF THYROID LOBE ON ONE SIDE OF THE NECK,tricare,,O,28172.09,4577.95,4577.95,4577.95,16903.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88300,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, LIMITED EXAMINATION",tricare,,O,93.19,26.27,93.19,93.19,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,tricare,,O,416.45,133.14,136.97,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46260,cpt,REMOVAL OF MULTIPLE INTERNAL AND EXTERNAL HEMORRHOID GROUPS,tricare,,O,18904.18,2231.78,2271.31,4726.84,11342.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,558,ms-drg,"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",tricare,,I,9766.23,3665.63,3665.63,9877.45,5859.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23333,cpt,"REMOVAL OF FOREIGN BODY OF SHOULDER JOINT, ACCESSED BENEATH THE TISSUE OR MUSCLE",tricare,,O,21460.43,2283.49,2283.49,2283.49,12876.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,tricare,,O,1343.10,94.48,94.48,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,tricare,,I,78211.42,12813.14,18808.24,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),tricare,,O,41.28,5.08,5.20,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52344,cpt,"ENDOSCOPE OF THE BLADDER, URETHRA AND URETER TO TREAT A STRICTURE OF URETER",tricare,,O,21482.72,2781.70,2781.70,2781.70,12889.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69436,cpt,INCISION OF EARDRUM WITH PLACEMENT OF EARDRUM TUBE UNDER GENERAL ANESTHESIA,tricare,,O,13970.08,1227.06,1227.06,9077.44,8382.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27696,cpt,REPAIR OF DISRUPTION OF BOTH COLLATERAL LIGAMENTS OF ANKLE,tricare,,O,39717.55,5757.05,5757.05,5757.05,23830.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1602,cpt,"INJECTION, GOLIMUMAB, 1 MG, FOR INTRAVENOUS USE",tricare,,O,97.38,13.85,13.85,13.85,58.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,tricare,,O,547.73,91.89,288.48,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42825,cpt,REMOVAL OF TONSILS PATIENT YOUNGER THAN AGE 12,tricare,,O,19458.57,4601.50,4601.50,5017.69,11675.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,tricare,,O,90.02,12.05,13.69,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,561,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",tricare,,I,28538.09,6566.77,13087.98,13087.98,17122.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",tricare,,O,365.14,48.65,73.18,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",tricare,,O,94.14,7.61,7.80,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93660,cpt,EVALUATION OF HEART FUNCTION USING TILT TABLE,tricare,,O,1208.02,288.64,427.33,821.83,724.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29825,cpt,RELEASE OR REMOVAL OF SHOULDER SCAR TISSUE USING AN ENDOSCOPE,tricare,,O,29814.55,2596.65,2631.25,14706.90,17888.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",tricare,,O,1434.39,436.85,437.16,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,620,ms-drg,O.R. PROCEDURES FOR OBESITY WITH CC,tricare,,I,51507.32,12021.01,13161.36,13161.36,30904.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,tricare,,O,183.82,20.77,28.31,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,tricare,,O,71.96,7.48,12.46,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",tricare,,O,252.47,44.06,44.32,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,tricare,,O,265.10,8.75,8.75,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",tricare,,O,40.11,3.87,3.97,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,tricare,,O,3055.12,206.42,208.18,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",tricare,,O,348.89,53.55,73.18,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25075,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN AT FOREARM AND/OR WRIST,tricare,,O,21681.99,2283.49,2283.49,2283.49,13009.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86665,cpt,"ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), VIRAL CAPSID",tricare,,O,266.62,18.21,18.21,24.87,159.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28270,cpt,INCISION OF JOINT CAPSULE OF FOOT AND TOE,tricare,,O,43492.65,2630.53,5847.07,22181.74,26095.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43280,cpt,STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE,tricare,,O,36571.06,7902.70,8058.37,26906.78,21942.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",tricare,,O,246.35,17.59,26.09,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",tricare,,O,140.04,24.64,35.14,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",tricare,,O,1680.75,111.66,573.66,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,tricare,,O,30.49,2.32,2.38,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,tricare,,O,2261.82,101.22,574.51,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",tricare,,O,13.80,2.61,3.18,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,560,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",tricare,,I,42178.02,11012.76,14159.37,18039.67,25306.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49560,cpt,"REPAIR OF INCISIONAL OR ABDOMINAL HERNIA, INITIAL OR PRIMARY, NOT TRAPPED",tricare,,O,26772.79,2878.53,2878.53,2878.53,16063.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58562,cpt,REMOVAL OF FOREIGN BODY IN UTERUS USING AN ENDOSCOPE,tricare,,O,17673.04,2373.77,2373.77,2373.77,10603.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,tricare,,O,83.78,3.34,5.39,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",tricare,,O,70.01,13.01,23.02,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,tricare,,O,93.19,5.27,44.32,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27380,cpt,"SUTURE OF TENDON BELOW KNEE, PRIMARY",tricare,,O,30213.09,5845.48,5847.07,5847.07,18127.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",tricare,,O,238.30,63.70,96.34,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,769,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,tricare,,I,24014.05,6896.44,6896.44,21393.60,14408.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",tricare,,O,0.59,0.15,0.59,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",tricare,,O,25.94,5.08,5.20,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,153,ms-drg,OTITIS MEDIA AND URI WITHOUT MCC,tricare,,I,11209.32,3336.34,3336.34,8451.77,6725.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",tricare,,O,135.66,14.84,18.47,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",tricare,,O,20.05,1.78,3.03,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,tricare,,O,3055.12,320.47,325.68,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",tricare,,O,39.88,13.23,39.82,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,tricare,,O,102.63,10.90,21.30,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,tricare,,O,396.41,290.00,306.38,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,tricare,,I,30232.58,9248.60,9495.62,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70480,cpt,CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,tricare,,O,1343.10,93.35,94.48,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),tricare,,O,53.08,5.52,12.93,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80183,cpt,OXCARBAZEPINE LEVEL,tricare,,O,71.96,13.30,13.30,13.30,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",tricare,,O,2069.24,93.35,98.50,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54161,cpt,"REMOVAL OF FORESKIN, PATIENT OLDER THAN 28 DAYS OF AGE",tricare,,O,17685.68,1612.75,1639.64,1639.64,10611.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",tricare,,O,267.61,48.10,74.99,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,tricare,,O,26791.18,4521.08,4607.33,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,tricare,,O,3055.12,205.61,206.42,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,30140,cpt,"REMOVAL OF NASAL AIR PASSAGE, UNDER THE LINING TISSUE",tricare,,O,40405.33,2514.21,2514.89,2514.89,24243.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,14001,cpt,TISSUE TRANSFER REPAIR OF WOUND (10.1 TO 30.0 SQ CENTIMETERS) OF THE TRUNK,tricare,,O,20248.01,2283.49,2283.49,2283.49,12148.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,335,ms-drg,PERITONEAL ADHESIOLYSIS WITH MCC,tricare,,I,66776.47,23051.33,23051.33,23385.25,40065.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,tricare,,O,3595.37,280.86,333.17,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",tricare,,O,502.71,78.63,247.56,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0461,cpt,"INJECTION, ATROPINE SULFATE, 0.01 MG",tricare,,O,1.15,0.19,2.49,11.00,0.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",tricare,,O,240.10,27.64,94.48,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,tricare,,O,30.08,3.63,3.65,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,650,ms-drg,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,tricare,,I,40805.00,20028.73,20028.73,20028.73,24483.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,tricare,,O,56.62,7.92,8.11,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80164,cpt,"VALPROIC ACID LEVEL, TOTAL",tricare,,O,122.56,13.27,13.60,22.57,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,tricare,,O,41.19,1.80,41.86,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36821,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, ANY SITE AS SEPARATE PROCEDURE",tricare,,O,21470.01,2569.92,2611.64,10309.61,12882.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12036,cpt,"REPAIR OF WOUND (20.1 TO 30.0 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",tricare,,O,20221.99,2283.49,2283.49,2283.49,12133.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86747,cpt,ANALYSIS FOR ANTIBODY TO PARVOVIRUS,tricare,,O,70.78,12.91,15.09,18.79,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",tricare,,O,50.01,4.43,4.54,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",tricare,,O,1997.14,430.17,444.75,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",tricare,,O,218.83,30.93,33.69,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49568,cpt,"PLACEMENT OF MESH TO REPAIR INCISIONAL OR ABDOMINAL HERNIA, OPEN PROCEDURE",tricare,,O,31419.56,2878.53,2878.53,2878.53,18851.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",tricare,,O,116.79,7.81,10.78,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19120,cpt,"REMOVAL OF 1 OR MORE BREAST GROWTH, OPEN PROCEDURE",tricare,,O,20656.67,251.77,2947.92,2947.92,3480.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,tricare,,O,330.33,24.94,25.55,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",tricare,,O,200.00,27.06,41.86,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19301,cpt,PARTIAL REMOVAL OF BREAST,tricare,,O,31896.98,2805.32,3038.88,12984.24,19138.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84300,cpt,URINE SODIUM LEVEL,tricare,,O,37.50,3.04,5.08,5.08,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",tricare,,O,1252.50,103.81,132.52,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,tricare,,O,80.09,5.66,9.48,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54150,cpt,REMOVAL OF FORESKIN OF USING CLAMP OR DEVICE,tricare,,O,18204.46,1602.91,1619.96,2226.17,10922.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,tricare,,O,1952.12,159.41,159.41,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,832,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,tricare,,I,13166.47,3172.81,3172.81,9094.35,7899.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",tricare,,O,101.45,14.76,20.90,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,01999,cpt,OTHER ANESTHESIA PROCEDURE,tricare,,O,22209.69,2631.25,2631.25,2631.25,13325.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,tricare,,O,1869.58,206.26,206.42,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22853,cpt,INSERTION OF DEVICE INTO INTERVERTEBRAL DISC SPACE OF SPINE AND FUSION OF VERTEBRAE,tricare,,O,79400.06,11349.44,11533.98,22181.74,47640.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",tricare,,O,117.61,12.87,12.92,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74220,cpt,X-RAY OF ESOPHAGUS WITH SINGLE CONTRAST,tricare,,O,585.25,65.33,159.41,360.68,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",tricare,,O,267.61,61.44,267.61,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,473,ms-drg,CERVICAL SPINAL FUSION WITHOUT CC/MCC,tricare,,I,73180.56,15169.99,15169.99,74397.72,43908.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,tricare,,O,138.03,20.16,21.32,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",tricare,,O,47.53,8.48,8.69,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,870,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,tricare,,I,192936.51,41518.66,55725.83,55725.83,115761.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",tricare,,O,199.37,74.90,96.34,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,tricare,,O,93.19,11.22,12.10,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20680,cpt,REMOVAL OF DEEP IMPLANT FROM BONE,tricare,,O,22681.09,2246.95,2331.44,12436.52,13608.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,tricare,,O,237.59,106.92,182.60,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,tricare,,O,45.13,4.38,45.13,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",tricare,,O,82.61,19.42,82.61,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0416,cpt,"SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONS, FOR PROSTATE NEEDLE BIOPSY, ANY METHOD",tricare,,O,252.47,252.47,252.47,252.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29821,cpt,REMOVAL OF ENTIRE SHOULDER JOINT LINING USING AN ENDOSCOPE,tricare,,O,23555.74,2562.21,2562.21,2562.21,14133.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",tricare,,O,1406.87,198.35,325.68,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,tricare,,O,560.24,92.59,94.48,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,tricare,,O,770.33,202.50,206.42,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89321,cpt,SEMEN ANALYSIS FOR SPERM PRESENCE,tricare,,O,70.78,12.05,12.10,72.90,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63048,cpt,"PARTIAL REMOVAL OF SPINE BONE WITH RELEASE OF SPINAL CORD AND/OR NERVES, EACH ADDITIONAL SEGMENT",tricare,,O,44366.77,5559.58,5667.02,13162.95,26620.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",tricare,,O,183.82,24.23,32.23,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",tricare,,O,5902.67,335.59,1173.25,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",tricare,,O,7.49,1.49,7.49,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9263,cpt,"INJECTION, OXALIPLATIN, 0.5 MG",tricare,,O,8.74,0.07,8.74,24.00,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",tricare,,O,245.09,61.44,74.99,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,tricare,,O,176.37,11.81,12.10,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86039,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, TITER",tricare,,O,294.94,10.94,11.21,168.12,176.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36558,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, TUNNELED",tricare,,O,20661.93,2586.12,2633.29,6323.15,12397.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,tricare,,O,143.17,18.59,19.04,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,tricare,,O,402.67,93.28,94.48,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83090,cpt,HOMOCYSTEINE (AMINO ACID) LEVEL,tricare,,O,48.76,14.61,17.99,22.40,29.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96409,cpt,ADMINISTRATION OF CHEMOTHERAPY INTO VEIN USING PUSH TECHNIQUE,tricare,,O,448.94,102.13,185.09,361.50,269.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,tricare,,O,1753.28,94.47,98.50,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",tricare,,O,130.95,13.50,18.13,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29807,cpt,REPAIR OF SHOULDER SOCKET CARTILAGE USING AN ENDOSCOPE,tricare,,O,36519.46,5846.87,5847.07,5847.07,21911.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64636,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, EACH ADDITIONAL FACET JOINT",tricare,,O,7684.84,1563.06,1588.94,4212.43,4610.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74170,cpt,CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,tricare,,O,2708.71,159.22,161.61,612.94,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,tricare,,O,862.88,61.44,94.48,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82330,cpt,"CALCIUM LEVEL, IONIZED",tricare,,O,89.65,13.41,13.74,21.16,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",tricare,,O,238.30,71.54,96.34,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86593,cpt,SYPHILIS TEST,tricare,,O,50.01,2.27,4.42,6.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,tricare,,O,38.92,4.65,4.77,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83020,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, ELECTROPHORESIS",tricare,,O,32.18,12.92,12.92,12.92,19.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),tricare,,O,126.23,10.13,102.64,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86335,cpt,"IMMUNOLOGIC ANALYSIS TECHNIQUE ON BODY FLUID, OTHER FLUIDS WITH CONCENTRATION",tricare,,O,212.36,23.13,29.47,29.47,34.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36470,cpt,INJECTION OF CHEMICAL AGENT INTO SINGLE INCOMPETENT VEIN,tricare,,O,25938.51,2586.52,2633.29,2633.29,15563.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",tricare,,O,19.52,4.40,19.54,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90714,cpt,"VACCINE FOR TETANUS AND DIPHTHERIA TOXOIDS INJECTION INTO MUSCLE, PATIENT 7 YEARS OR OLDER",tricare,,O,162.94,27.78,27.78,27.78,97.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57522,cpt,REMOVAL OR DESTRUCTION OF CERVIX WITH ELECTRICAL CAUTERY,tricare,,O,19085.48,2436.56,2436.56,5572.53,11451.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,224,ms-drg,"CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC",tricare,,I,234652.30,51828.60,51828.60,51828.60,140791.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64415,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO BRACHIAL NERVE BUNDLE OF ARM,tricare,,O,33058.65,2631.25,2631.25,11631.36,19835.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,343,ms-drg,APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,tricare,,I,31516.04,8434.81,8434.81,8434.81,18909.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",tricare,,O,50.72,5.89,6.03,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11104,cpt,PUNCH BIOPSY OF SINGLE SKIN LESION,tricare,,O,1520.45,308.97,312.72,312.72,912.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62368,cpt,ELECTRONIC ANALYSIS AND REPROGRAMMING OF SPINAL CANAL DRUG INFUSION PUMP,tricare,,O,2663.70,247.04,247.04,247.04,1598.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",tricare,,O,147.58,21.05,35.23,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,tricare,,O,908.09,156.44,159.63,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",tricare,,O,223.91,73.72,96.96,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",tricare,,O,754.07,158.88,206.42,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20605,cpt,ASPIRATION AND/OR INJECTION OF MEDIUM JOINT OR JOINT CAPSULE,tricare,,O,665.34,692.70,692.70,692.70,399.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0413,revCode,"RESPIRATORY SERVICES, HYPERBARIC OXYGEN THERAPY",tricare,,O,820.35,105.74,110.56,110.56,492.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82340,cpt,URINE CALCIUM LEVEL,tricare,,O,15.08,6.05,6.05,10.08,9.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49465,cpt,"CONTRAST INJECTIONS FOR X-RAY IMAGING THROUGH EXISTING TUBE IN STOMACH, SMALL BOWEL OR LARGE BOWEL, ACCESSED THROUGH SKIN",tricare,,O,1017.00,206.42,206.42,510.59,610.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",tricare,,O,83.33,15.97,26.72,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,tricare,,O,4852.19,224.32,325.68,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",tricare,,O,125.04,27.28,59.64,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81256,cpt,GENE ANALYSIS (HEMOCHROMATOSIS) COMMON VARIANTS,tricare,,O,355.11,121.73,355.11,355.11,213.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",tricare,,O,100.04,20.74,59.64,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",tricare,,O,44.82,3.29,9.62,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,tricare,,O,116.31,18.99,19.46,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,tricare,,O,811.59,92.97,98.50,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",tricare,,O,117.54,25.46,59.64,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",tricare,,O,60.16,6.38,6.54,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,51992,cpt,CREATION OF SLING AROUND BLADDER CANAL (URETHRA) TO CONTROL LEAKAGE USING AN ENDOSCOPE,tricare,,O,48934.48,8032.81,8032.81,8032.81,29360.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11444,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH, 3.1-4.0 CM",tricare,,O,17594.26,1325.54,1325.54,5499.42,10556.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23515,cpt,OPEN TREATMENT OF COLLAR BONE BROKEN,tricare,,O,44215.64,5667.02,5667.02,5845.48,26529.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,tricare,,O,3055.12,204.95,206.42,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70552,cpt,MRI SCAN OF BRAIN WITH CONTRAST,tricare,,O,3057.62,333.17,333.17,1166.79,1834.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,tricare,,O,83.76,14.03,14.38,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",tricare,,O,56.26,6.34,6.50,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,896,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",tricare,,I,34188.85,7909.34,7909.34,19332.34,20513.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",tricare,,O,245.09,44.06,74.99,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,tricare,,O,8198.69,1161.40,1185.10,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",tricare,,O,3583.92,323.18,329.78,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77047,cpt,MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST,tricare,,O,1605.13,202.29,208.18,1203.85,963.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",tricare,,O,16.70,0.37,1.33,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",tricare,,O,266.35,64.70,102.64,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,tricare,,O,440.18,84.89,206.42,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,tricare,,O,1952.12,344.86,393.83,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,tricare,,O,31.24,2.94,3.00,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77075,cpt,X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY,tricare,,O,735.32,61.44,96.49,97.23,441.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,482,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,tricare,,I,55990.08,11135.77,13923.28,19728.27,33594.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99078,cpt,PHYSICIAN EDUCATIONAL SERVICES PROVIDED IN A GROUP SETTING,tricare,,O,3706.73,3706.73,3706.73,3706.73,2224.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82731,cpt,FETAL FIBRONECTIN (PROTEIN) ANALYSIS,tricare,,O,565.34,62.32,64.67,424.01,108.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",tricare,,O,632.77,59.44,79.81,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10121,cpt,"REMOVAL OF FOREIGN BODY FROM TISSUE, ACCESSED BENEATH THE SKIN, COMPLEX",tricare,,O,15953.28,1273.00,1273.00,1273.00,9571.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64494,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SECOND LEVEL",tricare,,O,4519.81,1107.35,1129.94,2566.99,2711.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64495,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, THIRD AND ANY ADDITIONAL LEVEL(S)",tricare,,O,4552.63,1111.87,1129.94,2202.56,2731.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",tricare,,O,221.79,37.73,38.66,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,tricare,,O,122.03,31.49,125.04,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",tricare,,O,331.50,12.98,13.29,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,tricare,,E,880.03,214.07,216.60,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,tricare,,O,351.40,92.60,98.50,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54830,cpt,REMOVAL OF GROWTH OF SPERM DUCT,tricare,,O,17845.38,158.54,2781.70,10053.87,10707.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49083,cpt,DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE,tricare,,O,3277.05,723.30,732.08,2260.51,1966.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29875,cpt,PARTIAL REMOVAL OF KNEE JOINT LINING USING AN ENDOSCOPE,tricare,,O,21676.78,485.10,2631.25,5060.32,13006.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,tricare,,I,18614.53,3748.00,6289.84,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,tricare,,O,27089.15,2439.68,2619.36,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",tricare,,O,35.39,4.06,6.50,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9280,cpt,"INJECTION, MITOMYCIN, 5 MG",tricare,,O,530.87,48.02,48.02,48.02,318.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,tricare,,I,20034.03,4988.82,4988.82,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,tricare,,O,2687.44,201.24,206.42,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29882,cpt,REPAIR OF INSIDE OR OUTSIDE KNEE JOINT CARTILAGE (MENISCUS) USING AN ENDOSCOPE (ARTHROSCOPY),tricare,,O,28887.70,2631.25,2631.25,2631.25,17332.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",tricare,,O,52.60,8.84,9.06,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",tricare,,O,50.72,7.45,12.05,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85460,cpt,"FETAL HEMOGLOBIN OR RED BLOOD CELLS MEASUREMENT FOR ASSESSMENT OF FETAL-MATERNAL CIRCULATION, DIFFERENTIAL LYSIS",tricare,,O,251.28,7.76,7.76,199.76,150.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38505,cpt,NEEDLE BIOPSY OR REMOVAL OF SURFACE LYMPH NODES,tricare,,O,13047.69,1305.53,2214.35,3254.84,7828.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71120,cpt,"X-RAY OF BREAST BONE, MINIMUM OF 2 VIEWS",tricare,,O,252.44,21.72,76.80,173.76,151.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",tricare,,O,233.84,30.94,33.69,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12042,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF NECK, HANDS, FEET, AND/OR GENITALS",tricare,,O,14792.08,1273.00,1273.00,2549.24,8875.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,tricare,,O,41.26,8.55,38.76,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55520,cpt,REMOVAL OF SPERMATIC CORD GROWTH,tricare,,O,26306.56,4577.95,4577.95,4577.95,15783.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,tricare,,I,26926.14,6286.85,6286.85,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64718,cpt,RELEASE AND/OR RELOCATION OF ULNAR NERVE AT ELBOW,tricare,,O,18467.33,1563.58,1588.80,14075.51,11080.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q3014,cpt,TELEHEALTH ORIGINATING SITE FACILITY FEE,tricare,,O,73.85,28.64,28.64,28.64,44.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",tricare,,O,226.34,61.44,76.80,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",tricare,,O,217.58,10.34,10.34,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",tricare,,O,203.82,32.52,55.42,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25651,cpt,PLACEMENT OF STABILIZING DEVICE FOR BROKEN BASE OF FOREARM BONE ON SMALL FINGER SIDE AT WRIST,tricare,,O,21434.03,2631.25,2631.25,2631.25,12860.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92507,cpt,"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR HEARING PROCESSING DISORDER",tricare,,O,264.26,74.09,74.09,97.63,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",tricare,,O,65.11,8.45,8.66,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",tricare,,O,101.45,11.20,11.48,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17250,cpt,APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,tricare,,O,703.02,157.08,162.47,777.14,421.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,tricare,,O,73.83,12.70,14.65,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70260,cpt,"X-RAY OF SKULL, COMPLETE, MINIMUM OF 4 VIEWS",tricare,,O,538.98,61.44,94.48,94.48,323.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",tricare,,O,114.43,3.13,20.13,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20931,cpt,STRUCTURAL DONOR BONE GRAFT FOR SPINE SURGERY,tricare,,O,62145.07,11349.44,11533.98,11533.98,37287.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73722,cpt,MRI SCAN OF LEG JOINT WITH CONTRAST,tricare,,O,2176.21,654.79,654.79,654.79,1305.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70220,cpt,"X-RAY OF PARANASAL SINUS, COMPLETE, MINIMUM OF 3 VIEWS",tricare,,O,362.65,72.01,73.18,271.99,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29827,cpt,REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE,tricare,,O,38417.80,5736.03,5847.07,17014.63,23050.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,tricare,,O,303.87,29.81,59.64,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",tricare,,O,647.78,98.50,98.50,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",tricare,,O,298.47,66.35,301.44,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",tricare,,O,318.12,56.64,182.60,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,176,ms-drg,PULMONARY EMBOLISM WITHOUT MCC,tricare,,I,19404.23,4326.04,4326.04,23340.67,11642.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58570,cpt,"REMOVAL OF UTERUS THROUGH ABDOMEN USING AN ENDOSCOPE, 250.0 G OR LESS",tricare,,O,32349.41,8032.54,8058.37,10429.05,19409.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22551,cpt,"FUSION OF SPINE BONES WITH REMOVAL OF DISC AT UPPER SPINAL COLUMN, ANTERIOR APPROACH, COMPLEX",tricare,,O,65424.14,11349.44,11533.98,22181.74,39254.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86707,cpt,HEPATITIS BE ANTIBODY MEASUREMENT,tricare,,O,28.93,6.21,11.62,11.62,17.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",tricare,,O,85.94,24.92,94.43,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,tricare,,O,109.71,43.44,44.32,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0289,cpt,"ARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE BODY, FOREIGN BODY, DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY) AT THE TIME OF OTHER SURGICAL KNEE ARTHROSCOPY IN A DIFFERENT COMPARTME",tricare,,O,19953.91,2631.25,2631.25,2631.25,11972.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,tricare,,O,3683.73,275.00,3706.73,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,tricare,,O,1958.01,473.85,473.85,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27829,cpt,OPEN TREATMENT OF LIGAMENT TEAR AT ANKLE JOINT,tricare,,O,42413.56,5753.52,11156.14,11156.14,25448.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,141,ms-drg,MAJOR HEAD AND NECK PROCEDURES WITH CC,tricare,,I,5992.10,2942.15,2942.15,2942.15,3595.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,357,ms-drg,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,tricare,,I,28383.37,12337.67,12337.67,12337.67,17030.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,949,ms-drg,AFTERCARE WITH CC/MCC,tricare,,I,40031.13,15153.97,15268.28,15268.28,24018.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36589,cpt,REMOVAL OF CENTRAL VENOUS CATHETER FOR INFUSION,tricare,,O,1252.35,2586.12,2633.29,4542.11,751.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82175,cpt,ARSENIC LEVEL,tricare,,O,93.19,18.59,19.05,19.17,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,tricare,,O,899.10,136.27,342.32,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,203,ms-drg,BRONCHITIS AND ASTHMA WITHOUT CC/MCC,tricare,,I,12110.61,3397.96,3397.96,8338.30,7266.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82626,cpt,DEHYDROEPIANDROSTERONE (DHEA) HORMONE LEVEL,tricare,,O,156.90,25.37,25.37,27.08,94.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",tricare,,O,285.11,61.44,76.80,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",tricare,,O,31.24,4.67,5.32,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27570,cpt,MANIPULATION OF KNEE JOINT UNDER ANESTHESIA,tricare,,O,13902.50,1248.60,1268.06,10424.46,8341.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58563,cpt,EXAMINATION OF UTERUS WITH DESTRUCTION OF UTERINE LINING USING AN ENDOSCOPE,tricare,,O,30147.26,4351.66,6065.03,12495.98,18088.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,881,ms-drg,DEPRESSIVE NEUROSES,tricare,,I,13364.19,3316.55,3316.55,3316.55,8018.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93459,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND/OR GRAFTS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,tricare,,O,28921.96,2582.89,2615.16,5906.55,17353.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",tricare,,O,7.91,1.68,7.91,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93930,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH ARMS,tricare,,O,770.33,202.29,206.42,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82375,cpt,CARBOXYHEMOGLOBIN (PROTEIN) LEVEL,tricare,,O,116.29,15.40,119.78,119.78,14.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88230,cpt,TISSUE CULTURE TO IDENTIFY WHITE BLOOD CELL DISORDERS,tricare,,O,291.23,116.97,116.97,116.97,174.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,tricare,,O,989.19,218.69,218.70,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,819,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,tricare,,I,36084.11,6900.35,6900.35,6900.35,21650.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,tricare,,O,287.62,21.62,78.63,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72220,cpt,"X-RAY OF SACRUM AND TAILBONE, MINIMUM OF 2 VIEWS",tricare,,O,240.10,33.96,73.18,75.57,88.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",tricare,,O,715.30,48.27,98.50,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59820,cpt,TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER,tricare,,O,18205.61,2373.69,2373.77,13386.01,10923.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",tricare,,O,108.49,21.05,35.23,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,tricare,,O,647.78,94.48,94.48,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,tricare,,O,101.45,15.87,16.25,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52351,cpt,"DIAGNOSTIC EXAMINATION OF THE BLADDER, BLADDER CANAL (URETHRA), AND URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE",tricare,,O,17224.91,2833.20,2833.20,9916.07,10334.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",tricare,,O,122.56,1.48,10.22,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,tricare,,O,2112.19,159.41,277.72,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",tricare,,O,85.05,7.99,9.75,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74019,cpt,"X-RAY OF ABDOMEN, 2 VIEWS",tricare,,O,365.14,61.44,96.49,213.76,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76506,cpt,ULTRASOUND SCAN OF BRAIN,tricare,,O,512.72,94.48,94.48,94.48,307.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,tricare,,O,3055.12,202.94,208.18,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,tricare,,E,2880.28,490.23,490.23,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0171,cpt,"INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG",tricare,,O,5.83,0.81,3.70,3.70,3.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52281,cpt,DILATION OF BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,tricare,,O,15500.95,1609.63,1619.96,5605.90,9300.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,tricare,,O,190.07,28.97,195.77,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94010,cpt,MEASUREMENT AND GRAPHIC RECORDING OF TOTAL AND TIMED EXHALED AIR CAPACITY,tricare,,O,222.58,50.61,126.32,126.32,133.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29823,cpt,REMOVAL OF EXTENSIVE SHOULDER JOINT TISSUE USING AN ENDOSCOPE,tricare,,O,29196.97,2631.16,2631.25,5060.32,17518.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,tricare,,O,87.53,4.18,4.29,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57260,cpt,"PLASTIC REPAIR OF VAGINA AND TISSUE SEPARATING VAGINA, RECTUM, AND BLADDER",tricare,,O,42179.41,7936.42,8045.59,11664.05,25307.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",tricare,,O,38.92,2.65,2.71,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,tricare,,I,26508.25,6362.98,6362.98,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76604,cpt,ULTRASOUND SCAN OF CHEST,tricare,,O,652.17,94.47,98.50,216.32,391.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,tricare,,O,4054.33,327.84,762.88,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,tricare,,O,42.58,6.02,6.17,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,tricare,,I,36086.42,12423.48,12628.73,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,833,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,tricare,,I,8469.32,2209.00,2209.00,2209.00,5081.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",tricare,,O,149.83,34.39,35.23,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",tricare,,O,734.07,19.80,734.07,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),tricare,,O,50.01,5.20,14.45,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89320,cpt,"SEMEN EVALUATION VOLUME, SPERM COUNT, MOTILITY AND ANALYSIS",tricare,,O,135.66,12.31,12.36,65.59,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",tricare,,O,91.30,18.02,18.47,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33285,cpt,INSERTION OF HEART RHYTHM MONITOR UNDER SKIN,tricare,,O,24139.56,7215.56,7215.56,7215.56,14483.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9042,cpt,"INJECTION, BRENTUXIMAB VEDOTIN, 1 MG",tricare,,O,545.23,196.65,196.65,408.92,327.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49406,cpt,"FLUID COLLECTION DRAINAGE OF THE ABDOMINAL REGION BY CATHETER USING IMAGING GUIDANCE, ACCESSED THROUGH THE SKIN",tricare,,O,10801.65,1304.34,1325.54,2260.51,6480.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,tricare,,O,105.03,8.42,36.21,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43870,cpt,CLOSURE OF SURGICALLY CREATED OPENING FROM STOMACH TO SKIN (GASTROSTOMY),tricare,,O,10362.67,2882.32,2882.32,2882.32,6217.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49329,cpt,OTHER PROCEDURE ON ABDOMEN USING AN ENDOSCOPE,tricare,,O,30927.63,7890.38,8032.81,28017.68,18556.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",tricare,,O,100.03,11.76,37.42,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",tricare,,O,48.36,3.92,3.94,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,53230,cpt,REMOVAL OF POUCH OF FEMALE BLADDER CANAL (URETHRA),tricare,,O,16241.96,4156.54,4156.54,4156.54,9745.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12051,cpt,"REPAIR OF WOUND (2.5 CENTIMETERS OR LESS) OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MOUTH",tricare,,O,17191.55,1273.00,1273.00,12893.66,10314.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,803,ms-drg,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,tricare,,I,70286.99,15720.79,15720.79,15720.79,42172.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,tricare,,O,513.11,156.86,159.41,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",tricare,,O,312.63,61.44,74.99,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80051,cpt,"BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM, CHLORIDE, CARBON DIOXIDE)",tricare,,O,65.11,6.87,7.04,48.83,39.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",tricare,,O,54.32,13.67,14.90,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62320,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK,tricare,,O,1594.50,564.08,574.51,1436.46,956.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,tricare,,O,45.06,3.98,6.66,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87799,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, QUANTIFICATION",tricare,,O,264.26,35.66,43.02,174.31,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1561,cpt,"INJECTION, IMMUNE GLOBULIN, (GAMUNEX-C/GAMMAKED), NON-LYOPHILIZED (E.G., LIQUID), 500 MG",tricare,,O,181.32,15.19,44.67,57.73,108.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,tricare,,O,351.40,51.44,83.14,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1459,cpt,"INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG",tricare,,O,90.06,10.62,46.93,54.25,54.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",tricare,,O,252.47,43.75,93.19,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,tricare,,I,19597.90,4492.16,4492.16,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87481,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), AMPLIFIED PROBE TECHNIQUE",tricare,,O,53.88,23.24,35.23,35.23,32.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28092,cpt,REMOVAL OF GROWTH OF TENDON COVERING OR JOINT CAPSULE OF TOES,tricare,,O,14740.64,1268.06,1268.06,1268.06,8844.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,tricare,,O,95.55,14.26,14.61,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",tricare,,O,345.14,75.82,182.60,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,460,ms-drg,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,tricare,,I,119532.08,24196.90,24196.90,77295.91,71719.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",tricare,,O,377.65,61.44,94.48,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",tricare,,O,151.64,21.05,35.23,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,tricare,,O,65.11,6.57,6.73,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,699,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,tricare,,I,19519.09,6879.34,7178.26,9803.04,11711.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",tricare,,O,4.12,1.10,4.12,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,tricare,,O,101.33,11.74,24.18,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,742,ms-drg,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,tricare,,I,58157.58,12241.40,12241.40,14140.43,34894.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87209,cpt,SPECIAL STAIN FOR PARASITES,tricare,,O,45.95,18.05,18.05,18.05,27.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9041,cpt,"INJECTION, BORTEZOMIB (VELCADE), 0.1 MG",tricare,,O,20.57,3.00,39.05,39.05,12.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27422,cpt,"REPAIR OF DISLOCATING KNEE CAP, WITH REALIGNMENT",tricare,,O,71388.91,5847.07,5847.07,5847.07,42833.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70150,cpt,"X-RAY OF BONES OF FACE, MINIMUM OF 3 VIEWS",tricare,,O,495.21,61.44,98.50,371.41,297.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9045,cpt,"INJECTION, CARBOPLATIN, 50 MG",tricare,,O,17.50,2.78,17.50,45.93,10.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,tricare,,I,14759.59,3312.91,3312.91,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,329,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,tricare,,I,114604.99,18176.89,26725.11,42391.95,68762.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27641,cpt,PARTIAL REMOVAL OF OUTER LOWER LEG BONE,tricare,,O,44710.20,5667.02,5667.02,5667.02,26826.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",tricare,,O,52.60,5.67,9.48,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,tricare,,O,647.78,92.64,94.48,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87106,cpt,"FUNGAL CULTURE, YEAST",tricare,,O,112.65,7.28,10.36,16.71,67.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",tricare,,O,3191.43,324.07,325.68,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9311,cpt,"INJECTION, RITUXIMAB 10 MG AND HYALURONIDASE",tricare,,O,175.06,36.40,37.17,5983.60,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,tricare,,O,76.68,7.98,11.44,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,tricare,,O,419.99,136.22,445.18,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,tricare,,O,1753.28,94.47,98.50,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,315,ms-drg,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,tricare,,I,15856.64,6712.08,6712.08,7143.80,9513.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),tricare,,O,8588.52,489.94,15283.15,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85384,cpt,FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,tricare,,O,56.26,7.19,9.76,75.59,11.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",tricare,,O,90.84,9.28,9.51,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,tricare,,O,287.62,77.37,79.85,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,tricare,,O,236.36,11.30,11.58,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,tricare,,I,17945.73,6102.59,6102.59,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28740,cpt,FUSION OF FOOT IN THE MIDFOOT REGION,tricare,,O,45471.26,5845.48,5847.07,20996.90,27282.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52235,cpt,DESTRUCTION AND/OR REMOVAL OF (2.0 TO 5.0 CENTIMETERS) MEDIUM GROWTHS OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,tricare,,O,20734.14,2781.70,2781.70,4447.47,12440.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11602,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",tricare,,O,1956.76,463.46,469.08,469.08,1174.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,tricare,,O,2112.19,159.37,161.61,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28313,cpt,RECONSTRUCTION OF SOFT TISSUE ANGULAR DEFORMITY OF TOE,tricare,,O,36456.69,5060.32,5847.07,5847.07,21874.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,tricare,,O,78.05,7.37,7.55,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49321,cpt,BIOPSY OF ABDOMEN USING AN ENDOSCOPE,tricare,,O,21980.24,4607.33,4607.33,9249.88,13188.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87517,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS B VIRUS, QUANTIFICATION",tricare,,O,205.27,42.71,43.02,57.99,123.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9022,cpt,"INJECTION, ATEZOLIZUMAB, 10 MG",tricare,,O,156.30,38.92,82.27,82.27,93.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",tricare,,O,60.03,13.90,14.24,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",tricare,,O,250.10,18.15,18.60,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85260,cpt,CLOTTING FACTOR X (STUART-PROWER) MEASUREMENT,tricare,,O,84.93,17.97,17.97,17.97,50.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,103,ms-drg,HEADACHES WITHOUT MCC,tricare,,I,23496.03,6310.95,6310.95,8860.70,14097.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,tricare,,O,184.32,70.33,106.14,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",tricare,,O,267.61,46.08,76.80,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,100,ms-drg,SEIZURES WITH MCC,tricare,,I,27764.15,6132.00,11502.94,14577.74,16658.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28112,cpt,"REMOVAL OF BONES AT SECOND, THIRD, OR FOURTH TOE JOINTS",tricare,,O,17438.28,2562.21,2562.21,5466.53,10462.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22999,cpt,OTHER PROCEDURE ON ABDOMINAL MUSCLE OR BONE,tricare,,O,31812.66,6318.16,6318.16,7903.10,19087.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55535,cpt,REMOVAL OF SPERMATIC CORD VENOUS DILATION OR SUTURING OF SPERMATIC VEINS,tricare,,O,21438.59,3130.92,3130.92,3130.92,12863.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,tricare,,I,18651.11,4387.85,4387.85,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",tricare,,O,1015.48,95.84,162.47,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83930,cpt,BLOOD OSMOLALITY (CONCENTRATION) MEASUREMENT,tricare,,O,119.15,6.48,6.64,6.64,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",tricare,,O,226.34,61.44,73.18,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,770,ms-drg,"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",tricare,,I,28990.20,4877.95,4877.95,4877.95,17394.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87385,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HISTOPLASMA CAPSULATUM (PARASITE),tricare,,O,70.01,13.30,13.30,13.30,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11406,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF BODY, ARMS, OR LEGS, MORE THAN 4.0 CM",tricare,,O,17469.26,1304.93,2283.49,5506.99,10481.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",tricare,,O,348.89,46.07,76.80,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86645,cpt,ANALYSIS FOR ANTIBODY (IGM) TO CYTOMEGALOVIRUS (CMV),tricare,,O,71.96,16.92,16.92,19.96,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1720,cpt,"INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG",tricare,,O,110.77,110.77,110.77,110.77,66.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,518,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,tricare,,I,93937.71,18529.16,18529.16,18529.16,56362.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,304,ms-drg,HYPERTENSION WITH MCC,tricare,,I,24017.13,7342.26,7770.19,12391.04,14410.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",tricare,,O,36.32,4.04,4.31,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17003,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 2-14 GROWTHS",tricare,,O,1040.92,159.38,162.47,1315.38,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12001,cpt,"REPAIR OF WOUND (2.5 CENTIMETERS OR LESS) OF THE SCALP, NECK, UNDERARMS, TRUNK, ARMS AND/OR LEGS",tricare,,O,17703.03,159.63,159.63,227.83,10621.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",tricare,,O,348.89,61.44,74.99,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",tricare,,O,67.24,14.75,15.11,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",tricare,,O,547.73,117.10,294.02,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86644,cpt,ANALYSIS FOR ANTIBODY TO CYTOMEGALOVIRUS (CMV),tricare,,O,79.04,14.45,14.45,20.61,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",tricare,,O,62.51,14.38,37.45,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,tricare,,O,290.12,59.69,117.90,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",tricare,,O,103.81,18.28,18.66,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,tricare,,O,55.44,9.79,11.59,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50200,cpt,"NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN",tricare,,O,9979.95,1172.33,1325.54,3057.19,5987.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19085,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH MRI GUIDANCE, FIRST LESION",tricare,,O,11216.07,1273.00,1273.00,6117.24,6729.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,563,ms-drg,"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",tricare,,I,15868.22,5516.36,5516.36,9635.77,9520.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3241,cpt,"INJECTION, TEPROTUMUMAB-TRBW, 10 MG",tricare,,O,773.58,321.88,321.88,321.88,464.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",tricare,,O,126.23,16.29,19.43,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",tricare,,O,15729.98,1862.99,1908.86,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,tricare,,O,43.18,10.79,17.34,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73222,cpt,MRI SCAN OF ARM JOINT WITH CONTRAST,tricare,,O,3055.12,461.27,654.79,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",tricare,,O,680.29,236.16,247.56,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,tricare,,O,138.03,9.70,25.55,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",tricare,,I,18651.52,4921.84,4921.84,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L1833,cpt,"KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED, OFF-THE SHELF",tricare,,O,922.91,282.22,922.91,922.91,553.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,660,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,tricare,,I,37749.06,9520.18,9520.18,18013.27,22649.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,tricare,,O,784.37,233.55,240.34,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",tricare,,O,622.77,61.44,96.49,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1745,cpt,"INJECTION, INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG",tricare,,O,282.56,34.04,34.45,75.44,169.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82384,cpt,CATECHOLAMINES (ORGANIC NITROGEN) LEVEL,tricare,,O,195.83,25.25,25.35,146.87,117.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0517,cpt,"INJECTION, BENRALIZUMAB, 1 MG",tricare,,O,409.04,168.25,168.25,168.25,245.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86343,cpt,WHITE BLOOD CELL HISTAMINE (IMMUNE SYSTEM CHEMICAL) RELEASE TEST,tricare,,O,31.15,12.51,12.51,27.07,18.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",tricare,,O,41.28,3.01,5.04,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86141,cpt,"MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION, HIGH SENSITIVITY",tricare,,O,83.78,12.69,13.00,17.55,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,tricare,,O,4054.33,319.17,333.17,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",tricare,,O,468.95,93.59,94.48,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23552,cpt,TREATMENT OF DISLOCATED JOINT BETWEEN COLLAR BONE AND SHOULDER WITH TISSUE GRAFT,tricare,,O,45459.72,5847.07,5847.07,5847.07,27275.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",tricare,,O,410.17,61.80,98.50,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23120,cpt,PARTIAL REMOVAL OF COLLAR BONE,tricare,,O,44226.23,5846.87,5847.07,11569.09,26535.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91112,cpt,TRANSIT AND PRESSURE MEASUREMENT OF STOMACH THROUGH COLON WITH WIRELESS CAPSULE,tricare,,O,1776.38,206.04,729.72,1332.29,1065.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86635,cpt,ANALYSIS FOR ANTIBODY TO COCCIDIOIDES (BACTERIA),tricare,,O,93.19,11.47,11.52,11.52,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,tricare,,O,7543.40,1294.20,1316.53,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,tricare,,O,178.08,50.28,51.52,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",tricare,,O,82.88,8.42,83.42,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",tricare,,O,8.17,0.89,14.63,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25606,cpt,"INSERTION OF HARDWARE TO LOWER FOREARM BONE BROKEN OR GROWTH PLATE SEPARATION, ACCESSED THROUGH THE SKIN",tricare,,O,20764.14,2631.25,2631.25,15573.11,12458.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,268,ms-drg,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,tricare,,I,18273.76,15118.51,15118.51,44762.62,10964.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,tricare,,O,252.59,4.78,21.89,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1442,cpt,"INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM",tricare,,O,4.99,0.72,0.99,269.36,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,776,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,tricare,,I,14024.63,2935.28,2935.28,9541.48,8414.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,tricare,,O,84.93,8.09,21.18,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,tricare,,O,60.16,11.87,12.16,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,tricare,,O,70.06,8.01,8.20,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",tricare,,O,1724.51,97.60,678.63,959.65,801.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70470,cpt,CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST,tricare,,O,2708.71,159.41,160.51,450.85,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,tricare,,O,256.35,58.45,59.64,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,tricare,,O,252.59,55.19,56.09,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,572,ms-drg,SKIN DEBRIDEMENT WITHOUT CC/MCC,tricare,,I,33361.43,6852.07,6852.07,6852.07,20016.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,tricare,,O,3055.12,202.81,208.18,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,tricare,,O,148.64,17.37,18.87,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,tricare,,O,41.28,5.78,6.50,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11981,cpt,INSERTION OF DRUG DELIVERY IMPLANT INTO TISSUE,tricare,,O,40615.05,2631.16,4239.16,5776.91,24369.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,tricare,,O,694.00,180.07,694.00,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64520,cpt,INJECTION OF ANESTHETIC AGENT INTO MIDDLE OR LOWER SPINE SYMPATHETIC NERVE,tricare,,O,4485.85,1113.24,1129.94,9603.36,2691.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),tricare,,O,29523.82,4577.80,6318.16,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,785,ms-drg,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,tricare,,I,14108.83,5205.40,5205.40,10198.00,8465.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,tricare,,O,113.25,11.78,14.33,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",tricare,,O,36.32,6.91,13.80,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,tricare,,O,351.40,81.48,84.11,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,tricare,,I,74793.54,13792.29,16755.70,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2353,cpt,"INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG",tricare,,O,714.06,172.18,205.65,205.65,428.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21012,cpt,REMOVAL OF (2 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF FACE AND SCALP,tricare,,O,17016.95,1262.82,1325.54,4330.56,10210.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",tricare,,O,650.28,61.44,94.48,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11606,cpt,"REMOVAL OF MALIGNANT GROWTH (OVER 4.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",tricare,,O,19392.87,4577.95,4577.95,5620.25,11635.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",tricare,,O,4.99,0.54,0.56,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58301,cpt,REMOVAL OF INTRA-UTERINE DEVICE (IUD) FOR PREGNANCY PREVENTION,tricare,,O,19235.71,1553.11,3553.34,3553.34,11541.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43248,cpt,INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,tricare,,O,3996.24,1081.46,1616.98,3758.90,2397.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",tricare,,O,41.28,4.92,5.04,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",tricare,,O,148.64,16.43,16.84,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",tricare,,O,120.33,16.46,16.87,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",tricare,,O,1138.00,159.38,162.47,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99401,cpt,"PREVENTIVE MEDICINE COUNSELING, APPROXIMATELY 15 MINUTES",tricare,,O,175.06,23.49,23.49,64.76,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82088,cpt,ALDOSTERONE HORMONE LEVEL,tricare,,O,209.99,28.44,40.92,40.99,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,tricare,,O,101.45,12.63,14.66,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80202,cpt,VANCOMYCIN (ANTIBIOTIC) LEVEL,tricare,,O,92.78,13.27,13.60,27.34,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59320,cpt,SUTURE OF CERVIX DURING PREGNANCY THROUGH VAGINA,tricare,,O,19906.17,2499.34,2499.34,2499.34,11943.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24075,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF UPPER ARM OR ELBOW,tricare,,O,20908.57,1325.18,2283.49,6095.44,12545.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,tricare,,O,80.09,1.66,10.37,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33249,cpt,INSERTION OR REPLACEMENT OF SINGLE OR DUAL CHAMBER PACING DEFIBRILLATOR LEADS,tricare,,O,103183.41,27788.91,29718.64,50189.53,61910.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",tricare,,O,36.32,3.59,4.50,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,tricare,,O,520.22,353.23,360.43,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,tricare,,O,100.03,11.53,11.82,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,tricare,,O,3008.85,207.30,207.30,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73040,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF SHOULDER JOINT,tricare,,O,1406.87,212.42,325.68,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21930,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF BACK OR FLANK,tricare,,O,16182.73,5230.59,5230.59,5230.59,9709.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",tricare,,O,266.35,64.70,266.35,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,tricare,,O,42.58,3.22,3.29,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69100,cpt,BIOPSY OF EAR,tricare,,O,1703.42,191.41,191.41,191.41,1022.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23075,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF SHOULDER AREA,tricare,,O,17552.56,1325.54,1325.54,1325.54,10531.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38525,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, OPEN PROCEDURE",tricare,,O,34276.96,4931.97,5253.51,12984.24,20566.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",tricare,,O,1.42,0.39,1.42,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,tricare,,O,42.51,2.00,2.26,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",tricare,,O,91.30,6.24,10.60,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52204,cpt,BIOPSY OF THE BLADDER USING AN ENDOSCOPE,tricare,,O,16937.27,1612.75,1639.64,8967.03,10162.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52005,cpt,INSERTION OF CATHETER INTO URINARY DUCT (URETER) USING AN ENDOSCOPE THROUGH THE BLADDER AREA,tricare,,O,15929.97,1594.04,1639.64,8382.60,9557.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",tricare,,O,376.41,61.44,94.48,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58670,cpt,DESTRUCTION OF FALLOPIAN TUBES USING AN ENDOSCOPE,tricare,,O,21604.39,4491.89,4577.95,9350.46,12962.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,tricare,,O,71.96,15.59,15.98,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,tricare,,O,50.01,5.20,13.10,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33207,cpt,INSERTION OR REPLACEMENT OF PERMANENT PACEMAKER AND LOWER CHAMBER ELECTRODES,tricare,,O,40018.14,9221.29,9407.44,9407.44,24010.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82374,cpt,CARBON DIOXIDE (BICARBONATE) LEVEL,tricare,,O,36.32,4.90,4.90,4.90,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",tricare,,O,801.60,189.21,259.12,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0277,cpt,"HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL",tricare,,O,820.35,105.74,110.56,110.56,492.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5122,cpt,"INJECTION, PEGFILGRASTIM-APGF, BIOSIMILAR, (NYVEPRIA), 0.5 MG",tricare,,O,855.42,167.19,171.38,623.41,513.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",tricare,,O,3595.37,208.18,333.17,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,640,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",tricare,,I,24682.45,5356.97,8266.30,14419.00,14809.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11442,cpt,"REMOVAL OF GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",tricare,,O,5141.92,1273.00,1273.00,1273.00,3085.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,tricare,,O,4630.63,693.07,1562.36,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71047,cpt,"X-RAY OF CHEST, 3 VIEWS",tricare,,O,410.17,76.80,76.80,76.80,246.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,tricare,,O,187.57,13.08,102.64,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,tricare,,O,4318.19,810.94,825.95,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23076,cpt,REMOVAL (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF SHOULDER AREA,tricare,,O,19077.91,2283.49,2283.49,2283.49,11446.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73723,cpt,MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST,tricare,,O,3471.56,325.59,325.68,3471.56,2082.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22845,cpt,"INSERTION OF ANTERIOR SPINAL INSTRUMENTATION FOR SPINAL STABILIZATION, 2 TO 3 VERTEBRAL SEGMENTS",tricare,,O,65424.14,11349.44,11533.98,11533.98,39254.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,512,ms-drg,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",tricare,,I,52854.47,10536.39,14107.45,14107.45,31712.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",tricare,,O,71.96,7.91,8.10,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",tricare,,O,826.60,242.61,247.56,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,tricare,,O,123.87,5.34,8.94,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82787,cpt,"GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT, IMMUNOGLOBULIN SUBCLASSES",tricare,,O,20.05,8.05,8.05,13.19,12.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97164,cpt,"RE-EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",tricare,,O,133.30,44.40,66.02,75.98,79.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99070,cpt,SUPPLIES AND MATERIALS PROVIDED BY THE PHYSICIAN BEYOND THOSE USUALLY INCLUDED IN THE OFFICE VISIT OR SERVICE,tricare,,O,34.23,34.23,34.23,34.23,20.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),tricare,,O,166.34,27.39,28.05,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,520,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,tricare,,I,40151.49,11585.32,11585.32,31059.69,24090.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87511,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",tricare,,O,47.70,23.24,35.23,35.23,28.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25607,cpt,"TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST, ABOVE WRIST, WITH PLACEMENT OF STABILIZING DEVICE",tricare,,O,35608.49,5736.03,5757.05,11244.87,21365.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84432,cpt,THYROGLOBULIN (THYROID RELATED HORMONE) LEVEL,tricare,,O,93.19,15.90,16.13,24.00,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,743,ms-drg,UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,tricare,,I,37248.08,8967.71,8967.71,8967.71,22348.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,175,ms-drg,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,tricare,,I,23982.29,5734.35,7427.04,14746.99,14389.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11422,cpt,"REMOVAL OF GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",tricare,,O,18352.47,1273.00,1273.00,2649.40,11011.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84305,cpt,SOMATOMEDIN (GROWTH FACTOR) LEVEL,tricare,,O,256.01,20.83,21.35,34.48,153.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86870,cpt,IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,tricare,,O,303.20,21.62,263.51,263.51,181.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",tricare,,O,113.79,13.73,30.43,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",tricare,,O,112.55,10.48,13.63,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,tricare,,O,2599.91,94.47,94.48,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,tricare,,I,84785.32,12190.37,17687.03,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74250,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST AND MULTIPLE SERIAL FILMS,tricare,,O,530.23,158.38,159.41,397.67,318.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72127,cpt,CT SCAN OF UPPER SPINE BEFORE AND AFTER CONTRAST,tricare,,O,2789.97,161.61,161.61,161.61,1673.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54163,cpt,REPAIR OF INCOMPLETE REMOVAL OF PENILE FORESKIN,tricare,,O,10357.70,1639.64,1639.64,1639.64,6214.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,tricare,,O,107.35,17.69,19.71,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29824,cpt,PARTIAL REMOVAL OF COLLAR BONE AT SHOULDER USING AN ENDOSCOPE,tricare,,O,30695.12,2631.25,2631.25,17497.02,18417.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,tricare,,O,31160.78,7903.69,8058.37,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5112,cpt,"INJECTION, TRASTUZUMAB-DTTB, BIOSIMILAR, (ONTRUZANT), 10 MG",tricare,,O,297.75,13.43,49.85,2873.58,178.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",tricare,,O,513.19,16.80,17.21,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70160,cpt,"X-RAY OF BONES OF NOSE, MINIMUM OF 3 VIEWS",tricare,,O,327.63,61.44,74.99,245.72,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49652,cpt,REPAIR OF HERNIA USING AN ENDOSCOPE,tricare,,O,32035.83,4504.70,4577.95,4577.95,19221.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43249,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, LESS THAN 3.0 CM",tricare,,O,5156.78,1469.46,1504.51,4819.09,3094.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",tricare,,O,93.77,21.35,37.45,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",tricare,,O,16.51,4.75,4.77,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,310,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,tricare,,I,15215.00,3354.50,3354.50,6648.19,9129.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,tricare,,O,123.87,33.18,34.00,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",tricare,,O,101.45,14.76,20.90,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1950,cpt,"INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG",tricare,,O,4121.85,885.75,1474.18,1474.18,2473.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",tricare,,O,2526.13,486.47,506.04,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,tricare,,O,2707.46,156.22,159.41,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,tricare,,O,19028.38,1098.56,6573.29,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",tricare,,O,826.60,239.39,247.56,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",tricare,,O,2.49,0.02,2.03,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",tricare,,E,1724.51,232.62,676.28,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,472,ms-drg,CERVICAL SPINAL FUSION WITH CC,tricare,,I,76071.55,19386.21,19386.21,38213.93,45642.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",tricare,,O,107.59,3.13,20.13,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,tricare,,O,187.57,14.84,102.64,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,834,ms-drg,ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC,tricare,,I,38536.82,17649.40,17649.40,17649.40,23122.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36471,cpt,INJECTION OF CHEMICAL AGENT INTO MULTIPLE INCOMPETENT VEINS OF ONE LEG,tricare,,O,2606.20,1345.28,4314.46,4314.46,1563.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73525,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF HIP JOINT,tricare,,O,1211.78,322.42,325.68,327.84,727.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19084,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND, EACH ADDITIONAL GROWTH",tricare,,O,13165.69,1257.73,1273.00,2878.34,7899.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,tricare,,I,14560.83,3337.55,3337.55,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,69205,cpt,REMOVAL OF FOREIGN BODY FROM EAR CANAL UNDER ANESTHESIA,tricare,,O,13077.72,1325.54,1325.54,13123.66,7846.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,tricare,,O,9.11,0.50,8.62,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45384,cpt,"REMOVAL OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL BY HOT BIOPSY FORCEPS, USING A FLEXIBLE ENDOSCOPE",tricare,,O,4528.30,938.20,938.20,4749.21,2716.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46221,cpt,REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING,tricare,,O,3889.72,1284.30,1324.55,8613.19,2333.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",tricare,,O,65.11,10.15,14.76,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,tricare,,O,345.14,124.25,182.60,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,tricare,,O,502.71,78.63,247.56,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,831,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,tricare,,I,29659.97,5961.46,5961.46,8870.45,17795.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,tricare,,O,135.66,26.63,51.07,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,tricare,,O,195.07,21.19,21.35,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,tricare,,O,28365.62,4521.08,4592.64,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",tricare,,O,1091.80,160.12,162.47,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84270,cpt,SEX HORMONE BINDING GLOBULIN (PROTEIN) LEVEL,tricare,,O,54.33,7.67,21.82,21.82,32.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,818,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,tricare,,I,35980.97,6833.54,6833.54,6833.54,21588.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,tricare,,O,79.04,16.60,17.01,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,199,ms-drg,PNEUMOTHORAX WITH MCC,tricare,,I,24625.77,6870.06,6870.06,13280.09,14775.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,tricare,,O,231.34,36.98,50.81,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",tricare,,O,184.32,70.33,106.14,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,557,ms-drg,"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",tricare,,I,27652.12,7322.56,7322.56,8463.48,16591.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",tricare,,O,12.72,0.71,4.04,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",tricare,,O,635.27,137.73,317.09,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",tricare,,O,2237.24,324.67,2371.47,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",tricare,,O,494.32,41.98,43.02,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",tricare,,O,4.22,1.00,78.49,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,tricare,,O,752.83,92.79,94.48,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,tricare,,O,383.02,34.82,107.50,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27691,cpt,TRANSPLANT OF DEEP TENDON WITH MUSCLE REROUTING AT LOWER LEG OR ANKLE,tricare,,O,29148.64,5759.36,5847.07,5847.07,17489.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9144,cpt,"INJECTION, DARATUMUMAB, 10 MG AND HYALURONIDASE-FIHJ",tricare,,O,148.31,44.88,47.50,48.33,88.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49651,cpt,REPOSITIONING OF RECURRENT GROIN HERNIA USING AN ENDOSCOPE,tricare,,O,26236.25,7878.05,8032.81,21444.53,15741.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",tricare,,O,2073.43,311.07,311.74,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74240,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST,tricare,,O,513.01,159.41,159.41,543.79,307.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19285,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",tricare,,O,31940.44,2805.32,5130.30,7734.30,19164.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,tricare,,O,1620.71,439.39,445.96,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2350,cpt,"INJECTION, OCRELIZUMAB, 1 MG",tricare,,O,156.72,36.34,60.49,117.73,94.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",tricare,,O,8992.46,1299.03,1325.54,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",tricare,,O,1099.23,114.80,114.80,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55866,cpt,REMOVAL OF PROSTATE AND LYMPH NODES USING AN ENDOSCOPE,tricare,,O,48920.89,8001.96,8058.37,8058.37,8805.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,417,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,tricare,,I,50962.36,13884.27,13884.27,16852.66,30577.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",tricare,,O,267.61,58.94,74.99,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,tricare,,O,36.32,5.40,5.53,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",tricare,,O,4184.57,938.10,957.25,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),tricare,,O,60.03,6.83,12.03,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11621,cpt,"REMOVAL OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",tricare,,O,18352.47,1273.00,1273.00,1273.00,11011.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,tricare,,O,101.33,21.90,29.72,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",tricare,,O,157.91,56.85,157.91,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,tricare,,O,19198.81,2406.74,2623.55,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,tricare,,O,108.53,13.66,14.63,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52352,cpt,REMOVAL OR MANIPULATION OF STONE IN URINARY DUCT (URETER) OR KIDNEY USING AN ENDOSCOPE,tricare,,O,22874.73,2781.70,2781.70,5448.70,13724.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2060,cpt,"INJECTION, LORAZEPAM, 2 MG",tricare,,O,78.01,14.44,77.43,77.43,46.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82157,cpt,ANDROSTENEDIONE (HORMONE) LEVEL,tricare,,O,168.69,23.80,29.40,29.40,101.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23412,cpt,"REPAIR OF TORN TENDONS OF SHOULDER (ROTATOR CUFF), OPEN PROCEDURE, CHRONIC OR OLD",tricare,,O,42342.66,5745.08,5847.07,16913.72,25405.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,tricare,,O,5902.67,923.22,1173.25,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23430,cpt,ANCHORING OF BICEPS TENDON,tricare,,O,33884.87,5667.02,5667.02,5846.87,20330.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9040,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",tricare,,O,756.23,259.12,259.12,756.23,453.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,tricare,,O,83.76,6.73,86.27,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",tricare,,O,85.39,17.80,22.71,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",tricare,,O,51.68,6.81,473.96,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,tricare,,I,75778.57,12009.61,13140.14,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,tricare,,O,69.59,9.12,9.34,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,tricare,,O,221.79,37.03,38.78,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58553,cpt,VAGINAL REMOVAL OF UTERUS (GREATER THAN 250 GRAMS) USING AN ENDOSCOPE,tricare,,O,30769.23,8058.37,8058.37,8058.37,18461.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,tricare,,O,42.58,4.32,7.23,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86769,cpt,MEASURE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIBODY,tricare,,O,94.60,13.14,42.30,70.95,49.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55700,cpt,BIOPSY OF PROSTATE GLAND,tricare,,O,15825.28,1612.35,1619.96,4133.17,1936.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,tricare,,I,22023.98,6812.39,6812.39,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",tricare,,O,369.82,61.44,76.80,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78816,cpt,NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY,tricare,,O,8009.86,1290.20,1316.53,2705.32,4805.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,tricare,,O,6833.06,1646.56,2145.20,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,313,ms-drg,CHEST PAIN,tricare,,I,19828.75,4932.79,4932.79,5325.46,11897.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62370,cpt,ELECTRONIC ANALYSIS REPROGRAMMING AND REFILL OF SPINAL CANAL DRUG INFUSION PUMP BY PHYSICIAN,tricare,,O,2663.70,244.51,244.55,245.80,1598.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,862,ms-drg,POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,tricare,,I,41021.29,8957.01,8957.01,15812.54,24612.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25071,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN AT FOREARM AND/OR WRIST,tricare,,O,19376.77,2283.49,2283.49,2283.49,11626.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64493,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SINGLE LEVEL",tricare,,O,4480.53,1107.35,1129.79,2566.99,2688.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,394,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,tricare,,I,20150.20,5703.31,5703.31,10874.89,12090.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21552,cpt,REMOVAL OF (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF NECK OR FRONT OF CHEST,tricare,,O,19339.12,2214.35,2214.35,2671.52,11603.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0260,cpt,"INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY",tricare,,O,2193.04,562.74,574.51,1003.01,1315.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82671,cpt,"ESTROGEN ANALYSIS, FRACTIONATED",tricare,,O,436.51,31.65,32.43,65.74,261.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,tricare,,O,69.59,8.01,19.78,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86664,cpt,"ANALYSIS FOR ANTIBODY TO EPSTEIN-BARR VIRUS (MONONUCLEOSIS VIRUS), NUCLEAR ANTIGEN",tricare,,O,266.62,15.35,15.35,24.87,159.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",tricare,,I,16029.09,4785.97,4785.97,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",tricare,,O,362.65,61.08,73.18,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0440,revCode,OCCUPATIONAL THERAPY GENERAL,tricare,,O,264.26,74.09,74.09,97.63,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,tricare,,O,60.16,9.91,12.14,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),tricare,,O,283.14,16.69,17.10,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52000,cpt,DIAGNOSTIC EXAMINATION OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,tricare,,O,8341.21,546.15,552.78,552.78,5004.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36410,cpt,"INSERTION OF NEEDLE INTO VEIN, PATIENT 3 YEARS OR OLDER",tricare,,O,4861.11,182.60,182.60,4504.70,2916.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",tricare,,O,35.00,2.32,2.38,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,tricare,,O,2289.17,554.60,732.08,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,314,ms-drg,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,tricare,,I,33150.59,4847.80,4847.80,22580.00,19890.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,30520,cpt,RESHAPING OF NASAL CARTILAGE,tricare,,O,40996.77,2514.81,2514.89,2514.89,24598.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",tricare,,O,4496.04,1078.59,1091.07,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25515,cpt,OPEN TREATMENT OF THE SHAFT OF THE FOREARM BONE ON THE THUMB SIDE OF THE FOREARM (RADIUS BONE),tricare,,O,28212.86,5847.07,5847.07,5847.07,16927.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36830,cpt,CREATION OF ARTERY-VEIN CONNECTION USING TUBE GRAFT FOR HEMODIALYSIS,tricare,,O,30956.95,4464.51,4543.34,4543.34,18574.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),tricare,,O,91.30,14.31,19.39,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,tricare,,O,183.82,19.97,28.31,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70360,cpt,X-RAY OF SOFT TISSUE OF NECK,tricare,,O,240.10,61.44,74.99,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20900,cpt,HARVEST OF GRAFT FROM SMALL BONE,tricare,,O,47977.80,5667.02,5667.02,9856.95,28786.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73090,cpt,"X-RAY OF FOREARM, 2 VIEWS",tricare,,O,245.09,38.03,159.14,183.82,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78014,cpt,NUCLEAR MEDICINE STUDY OF THYROID AND THYROID FUNCTION,tricare,,O,1304.33,342.21,343.58,883.36,782.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,tricare,,O,50.01,3.11,5.20,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11046,cpt,"REMOVAL OF MUSCLE AND/OR TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",tricare,,O,3414.96,473.85,473.85,1078.95,2048.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54065,cpt,DESTRUCTION OF MULTIPLE GROWTHS OF PENIS,tricare,,O,18051.76,1549.63,1549.63,1549.63,10831.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),tricare,,O,50.01,5.20,12.93,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",tricare,,O,19538.26,2569.95,2633.29,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,tricare,,O,1590.91,567.62,753.29,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",tricare,,O,350.39,39.08,62.23,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92551,cpt,AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING,tricare,,O,217.58,10.34,10.34,217.58,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,tricare,,O,316.37,49.55,95.90,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,866,ms-drg,VIRAL ILLNESS WITHOUT MCC,tricare,,I,15194.06,2895.07,2895.07,10253.00,9116.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84112,cpt,CERVICOVAGINAL SECRETION OF PLACENTA PROTEIN,tricare,,O,257.65,98.11,98.51,257.65,49.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80299,cpt,QUANTITATION OF THERAPEUTIC DRUG,tricare,,O,46.60,5.86,18.72,18.72,27.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9303,cpt,"INJECTION, PANITUMUMAB, 10 MG",tricare,,O,565.00,142.42,142.42,170.68,339.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",tricare,,O,1858.47,98.50,159.41,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9100,cpt,PATHOGEN(S) TEST FOR PLATELETS,tricare,,O,142.13,30.02,30.02,97.18,85.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,tricare,,O,2149.71,310.75,317.09,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86148,cpt,PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUREMENT,tricare,,O,87.30,12.69,16.14,46.36,52.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87529,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHNIQUE",tricare,,O,54.75,15.34,35.23,35.23,32.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,370,ms-drg,MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,tricare,,I,17668.24,4324.23,4324.23,4324.23,10600.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72157,cpt,MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST,tricare,,O,4054.33,330.07,333.17,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,433,ms-drg,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,tricare,,I,20174.42,7400.64,7400.64,7769.48,12104.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66982,cpt,COMPLEX REMOVAL OF CATARACT WITH INSERTION OF PROSTHETIC LENS,tricare,,O,16910.08,1876.58,1878.83,4894.22,10146.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91010,cpt,MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT,tricare,,O,3386.38,370.13,370.13,2423.62,2031.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,tricare,,O,71.96,9.99,13.30,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,tricare,,O,101.45,3.58,20.95,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,768,ms-drg,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,tricare,,I,15836.34,3774.13,3774.13,17446.29,9501.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73600,cpt,"X-RAY OF ANKLE, 2 VIEWS",tricare,,O,267.61,61.44,74.99,173.76,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,418,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,tricare,,I,55035.81,10049.90,10049.90,14375.97,33021.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80307,cpt,"TESTING FOR PRESENCE OF DRUG, BY CHEMISTRY ANALYZERS",tricare,,O,197.60,49.05,62.39,77.68,118.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0770,revCode,"PREVENTIVE CARE SERVICES, GENERAL",tricare,,O,175.06,23.49,23.49,166.01,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,tricare,,O,3055.12,204.02,208.18,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52260,cpt,DILATION OF THE BLADDER USING AN ENDOSCOPE UNDER GENERAL OR SPINAL ANESTHESIA,tricare,,O,14534.61,1612.75,1639.64,7644.43,8720.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",tricare,,O,1007.94,158.30,172.56,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86341,cpt,ISLET CELL (PANCREAS) ANTIBODY MEASUREMENT,tricare,,O,139.21,23.10,23.67,23.67,83.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86753,cpt,ANALYSIS FOR ANTIBODY TO PROTOZOA (PARASITE),tricare,,O,30.98,12.44,12.44,12.44,18.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,789,ms-drg,"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",tricare,,I,28579.60,13213.92,15837.91,15837.91,17147.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83605,cpt,LACTIC ACID LEVEL,tricare,,O,71.96,5.48,11.62,53.97,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",tricare,,O,147.58,21.05,35.23,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",tricare,,O,422.68,79.93,239.44,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86671,cpt,ANALYSIS FOR ANTIBODY TO FUNGUS,tricare,,O,30.63,5.89,12.30,30.62,18.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",tricare,,O,345.14,36.70,37.45,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,tricare,,O,132.54,29.82,29.82,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84244,cpt,RENIN (KIDNEY ENZYME) LEVEL,tricare,,O,145.10,21.55,22.08,27.49,87.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",tricare,,O,162.48,33.29,162.48,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82103,cpt,"ALPHA-1-ANTITRYPSIN (PROTEIN) BLOOD TEST, TOTAL",tricare,,O,74.31,13.50,13.50,13.50,44.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27093,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF HIP JOINT,tricare,,O,3830.16,486.86,980.47,980.47,2298.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",tricare,,O,520.22,353.36,360.43,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20936,cpt,HARVEST OF BONE FROM SAME SPINE INCISION FOR GRAFT,tricare,,O,73036.79,11349.44,11533.98,13487.02,43822.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,tricare,,O,16541.64,1561.79,1588.80,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57425,cpt,SURGICAL REPAIR OF VAGINAL DEFECT USING AN ENDOSCOPE,tricare,,O,45441.30,8045.59,8045.59,27112.46,27264.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",tricare,,O,16.23,1.83,16.23,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,790,ms-drg,"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",tricare,,I,18155.15,5100.04,5100.04,5100.04,10893.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76857,cpt,"ULTRASOUND OF PELVIS, LIMITED, NOT PREGNANCY RELATED",tricare,,O,187.57,93.59,94.48,198.82,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25073,cpt,REMOVAL (3 CENTIMETERS OR GREATER) MUSCLE GROWTH AT FOREARM AND/OR WRIST,tricare,,O,22066.52,2283.49,2283.49,2283.49,13239.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",tricare,,O,377.65,43.63,94.48,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),tricare,,O,3857.66,938.20,938.20,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,tricare,,I,16493.28,2797.28,5247.57,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29877,cpt,REMOVAL OR SHAVING OF KNEE JOINT CARTILAGE USING AN ENDOSCOPE,tricare,,O,20747.46,2550.50,2631.25,7792.87,12448.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",tricare,,O,3919.67,159.22,603.82,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,tricare,,O,323.88,75.26,76.80,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47000,cpt,"NEEDLE BIOPSY OF LIVER, ACCESSED THROUGH THE SKIN",tricare,,O,11195.22,1299.27,1299.27,6518.37,6717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",tricare,,O,212.59,22.86,31.36,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",tricare,,O,356.40,83.75,96.96,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12044,cpt,"REPAIR OF WOUND (7.6 TO 12.5 CENTIMETERS) OF NECK, HANDS, FEET, AND/OR GENITALS",tricare,,O,18715.19,1778.25,1778.25,1778.25,11229.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",tricare,,O,650.28,61.44,98.50,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,tricare,,O,1205.09,132.64,15283.15,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,253,ms-drg,OTHER VASCULAR PROCEDURES WITH CC,tricare,,I,71874.05,17117.07,20167.18,31459.36,43124.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29876,cpt,REMOVAL OF JOINT LINING FROM TWO OR MORE KNEE JOINT COMPARTMENTS USING AN ENDOSCOPE,tricare,,O,22731.95,2550.70,2631.25,8021.63,13639.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",tricare,,O,281.36,90.50,96.43,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84207,cpt,VITAMIN B-6 LEVEL,tricare,,O,134.49,18.96,28.22,142.55,80.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,tricare,,I,16915.97,4140.71,4140.71,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82530,cpt,"CORTISOL (HORMONE) MEASUREMENT, FREE",tricare,,O,184.03,14.59,16.78,24.76,110.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,354,ms-drg,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,tricare,,I,51184.48,9616.22,9616.22,9616.22,30710.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45381,cpt,"INJECTIONS BENEATH LINING OF LARGE BOWEL, USING A FLEXIBLE ENDOSCOPE",tricare,,O,6984.17,1407.16,1824.87,3276.29,4190.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,tricare,,O,94.38,2.18,10.78,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52234,cpt,DESTRUCTION AND/OR REMOVAL OF (0.5 TO 2.0 CENTIMETERS) SMALL GROWTHS OF THE BLADDER USING AN ENDOSCOPE,tricare,,O,16688.36,2781.70,2781.70,5224.45,10013.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,tricare,,O,188.17,19.53,59.64,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",tricare,,O,140.38,11.21,20.53,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",tricare,,O,240.10,61.44,73.18,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,tricare,,O,28.83,5.60,11.58,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,439,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,tricare,,I,19744.66,5026.91,5026.91,10330.99,11846.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74455,cpt,REVIEW BY RADIOLOGIST OF URINARY BLADDER AND URETHRA IMAGES WITH CONTRAST AND AFTER PASSING URINE,tricare,,O,1067.98,182.43,207.30,608.75,640.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,tricare,,O,84.93,8.43,12.63,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42820,cpt,REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS),tricare,,O,18532.26,4720.05,4720.05,13899.20,3780.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,312,ms-drg,SYNCOPE AND COLLAPSE,tricare,,I,19356.82,5264.37,5264.37,7437.32,11614.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,tricare,,O,203.82,49.80,50.81,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78580,cpt,NUCLEAR MEDICINE STUDY OF BLOOD CIRCULATION IN THE LUNGS,tricare,,O,1620.71,343.58,343.58,343.58,972.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,41010,cpt,INCISION OF TISSUE CONNECTING TONGUE AND FLOOR OF MOUTH,tricare,,O,19005.45,3597.59,3597.59,4791.91,11403.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11426,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF SCALP, NECK, HANDS, FEET, OR GENITALS, MORE THAN 4.0 CM",tricare,,O,19573.33,2243.72,2283.49,5406.77,11744.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,906,ms-drg,HAND PROCEDURES FOR INJURIES,tricare,,I,32452.25,4773.14,4773.14,12419.58,19471.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80178,cpt,LITHIUM LEVEL,tricare,,O,56.26,6.48,6.64,42.20,7.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88720,cpt,MEASUREMENT OF BILIRUBIN,tricare,,O,132.12,5.04,5.04,132.12,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28039,cpt,REMOVAL (1.5 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF FOOT OR TOE,tricare,,O,22938.61,2145.20,2145.20,2145.20,13763.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",tricare,,O,108.88,10.16,17.01,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23472,cpt,"PROSTHETIC REPAIR OF SHOULDER JOINT, TOTAL SHOULDER",tricare,,O,76075.73,11006.86,11156.14,25947.42,45645.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21620,cpt,PARTIAL REMOVAL OF CHEST BONE,tricare,,O,20416.00,286.50,286.50,286.50,12249.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52224,cpt,DESTRUCTION OF (LESS THAN 0.5 CENTIMETERS) GROWTHS OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,tricare,,O,16231.14,2776.54,2781.70,2782.44,9738.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",tricare,,O,93.19,13.33,13.66,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),tricare,,O,65.11,4.25,8.44,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49656,cpt,"REPAIR OF INCISIONAL HERNIA USING AN ENDOSCOPE, RECURRENT OF SECONDARY",tricare,,O,31340.08,8058.37,8058.37,8058.37,18804.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29581,cpt,APPLICATION OF VEIN WOUND COMPRESSION SYSTEM LOWER LEG BELOW KNEE INCLUDING ANKLE AND FOOT,tricare,,O,1305.86,230.97,314.95,926.72,783.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11420,cpt,"REMOVAL OF NONCANCER SKIN GROWTH OF SCALP, NECK, HANDS, FEET, OR GENITALS, 0.5 CM OR LESS",tricare,,O,24424.89,1325.54,1325.54,7879.69,14654.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,tricare,,O,53.76,5.92,6.06,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,192,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,tricare,,I,13026.11,3415.11,3415.11,5083.42,7815.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,tricare,,O,1159.26,202.49,206.42,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99281,cpt,"EMERGENCY DEPARTMENT VISIT, SELF LIMITED OR MINOR PROBLEM",tricare,,E,206.32,65.63,65.63,531.77,123.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",tricare,,O,98.78,7.87,11.68,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1569,cpt,"INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILIZED, (E.G., LIQUID), 500 MG",tricare,,O,90.46,32.41,45.23,45.23,54.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,tricare,,I,16808.50,4145.69,4145.69,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82542,cpt,CHEMICAL ANALYSIS USING CHROMATOGRAPHY TECHNIQUE,tricare,,O,97.91,11.61,24.19,37.36,58.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82390,cpt,CERULOPLASMIN (PROTEIN) LEVEL,tricare,,O,71.96,2.18,10.78,26.69,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9267,cpt,"INJECTION, PACLITAXEL, 1 MG",tricare,,O,4.99,0.12,4.99,189.00,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,784,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH CC,tricare,,I,14784.88,6415.40,6415.40,20022.84,8870.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,tricare,,O,754.07,203.12,206.42,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,tricare,,O,1952.12,144.93,161.61,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",tricare,,O,231.34,36.97,50.36,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,783,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH MCC,tricare,,I,28796.81,7775.49,7775.49,17845.12,17278.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19303,cpt,SIMPLE COMPLETE REMOVAL OF BREAST,tricare,,O,32479.31,5148.44,5253.51,5253.51,19487.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,tricare,,E,292.62,111.66,118.84,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",tricare,,O,96.29,11.40,96.29,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2270,cpt,"INJECTION, MORPHINE SULFATE, UP TO 10 MG",tricare,,O,84.59,0.76,82.91,82.91,50.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27635,cpt,REMOVAL OR SCRAPING OF CYST OR GROWTH OF EITHER BONE OF LOWER LEG,tricare,,O,34724.90,5847.07,5847.07,5847.07,20834.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84145,cpt,PROCALCITONIN (HORMONE) LEVEL,tricare,,O,97.91,26.68,27.33,32.12,32.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,tricare,,O,647.78,92.97,94.48,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,440,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,tricare,,I,12850.05,3815.31,3815.31,12183.21,7710.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,tricare,,O,130.11,30.48,39.42,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42830,cpt,"REMOVAL OF ADENOIDS PATIENT YOUNGER THAN AGE 12, INITIAL PROCEDURE",tricare,,O,16836.71,2475.13,2475.13,5993.73,10102.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25111,cpt,"REMOVAL OF CYST AT WRIST, INITIAL OR PRIMARY",tricare,,O,17783.77,1248.37,1260.17,4924.66,10670.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9055,cpt,"INJECTION, CETUXIMAB, 10 MG",tricare,,O,245.09,18.02,70.14,70.14,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10006,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, EACH ADDITIONAL GROWTH",tricare,,O,3892.02,563.01,563.01,1811.42,2335.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",tricare,,O,45.06,8.39,11.60,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,140,ms-drg,MAJOR HEAD AND NECK PROCEDURES WITH MCC,tricare,,I,5786.30,4339.01,4339.01,4339.01,3471.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,tricare,,O,67.58,5.08,5.20,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86666,cpt,ANALYSIS FOR ANTIBODY TO EHRLICHIA (BACTERIA TRANSMITTED BY TICKS),tricare,,O,28.31,10.22,10.22,19.08,16.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",tricare,,O,38.92,3.91,4.01,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,tricare,,O,3055.12,202.50,206.42,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,tricare,,O,24173.14,2776.54,2807.45,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49325,cpt,REVISION OF ABDOMINAL CAVITY CATHETER USING AN ENDOSCOPE,tricare,,O,20149.88,4607.33,4607.33,4607.33,12089.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",tricare,,O,691.54,93.84,94.48,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),tricare,,O,132.12,15.79,22.43,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29898,cpt,REMOVAL OF DEAD OR INFECTED ANKLE JOINT TISSUE USING AN ENDOSCOPE,tricare,,O,44710.20,5667.02,5667.02,5667.02,26826.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87497,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS, QUANTIFICATION",tricare,,O,232.41,21.19,43.02,53.55,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,tricare,,O,51.39,9.33,14.18,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,267,ms-drg,ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,tricare,,I,4022.50,2981.08,2981.08,2981.08,2413.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3032,cpt,"INJECTION, EPTINEZUMAB-JJMR, 1 MG",tricare,,O,40.76,17.01,17.01,18.08,24.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,tricare,,O,1479.41,92.59,98.50,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,tricare,,O,93.19,15.38,20.90,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12034,cpt,"REPAIR OF WOUND (7.6 TO 12.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",tricare,,O,18980.81,325.18,4577.95,4577.95,11388.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87350,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS BE SURFACE ANTIGEN,tricare,,O,28.83,6.19,11.58,19.42,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",tricare,,O,757.37,185.43,190.80,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",tricare,,O,70.78,13.97,25.57,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",tricare,,O,45.06,8.66,18.00,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31500,cpt,EMERGENT INSERTION OF BREATHING TUBE INTO WINDPIPE CARTILAGE USING AN ENDOSCOPE,tricare,,O,581.50,183.71,183.71,183.71,348.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",tricare,,O,127.54,21.16,21.35,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1930,cpt,"INJECTION, LANREOTIDE, 1 MG",tricare,,O,216.33,32.32,62.62,62.62,129.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25605,cpt,CLOSED TREATMENT OF BROKEN OR GROWTH PLATE SEPARATE OF FOREARM BONE AT WRIST WITH MANIPULATION,tricare,,O,18580.21,1264.12,1264.12,1264.12,11148.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11403,cpt,"REMOVAL OF GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",tricare,,O,12550.24,933.20,933.20,9600.53,7530.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27447,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE AND OUTSIDE AREA",tricare,,O,76738.27,10981.15,11582.15,59556.87,46042.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,tricare,,O,531.48,100.50,531.48,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,tricare,,O,52.60,6.75,6.92,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88341,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, EACH ADDITIONAL PROCEDURE",tricare,,O,128.79,24.89,132.54,132.54,77.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74174,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST,tricare,,O,1840.81,323.17,329.43,1326.08,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13101,cpt,REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF TRUNK,tricare,,O,17422.96,473.85,473.85,5652.50,10453.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74740,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF UTERINE TUBES AND OVARIES,tricare,,O,1161.76,206.42,206.42,206.42,697.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",tricare,,O,1997.14,273.93,444.75,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58661,cpt,REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE,tricare,,O,27191.57,4592.49,4607.33,23996.68,16314.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",tricare,,O,65.06,17.18,64.78,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,882,ms-drg,NEUROSES EXCEPT DEPRESSIVE,tricare,,I,14589.21,3863.55,3863.55,11557.84,8753.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5117,cpt,"INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG",tricare,,O,320.89,24.34,24.34,107.23,192.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1630,cpt,"INJECTION, HALOPERIDOL, UP TO 5 MG",united healthcare,,O,78.96,21.20,59.22,59.22,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87902,cpt,ANALYSIS TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS,united healthcare,,O,824.65,76.19,437.97,437.97,302.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6197,cpt,"ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING",united healthcare,,O,25.00,9.00,39.75,39.75,15.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9370,cpt,VINCRISTINE SULFATE 1 MG INJ,united healthcare,,O,58.11,8.53,49.70,49.70,34.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2628,cpt,"CATHETER, OCCLUSION",united healthcare,,O,405.17,139.86,295.28,303.88,243.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,united healthcare,,O,107.35,17.69,82.93,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23350,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOINT,united healthcare,,O,5340.22,795.73,4000.22,4000.22,3204.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,united healthcare,,O,31160.78,7903.69,22750.02,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,united healthcare,,O,187.57,13.08,124.76,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",united healthcare,,I,16029.09,4785.97,9048.71,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,united healthcare,,O,116.31,18.99,87.23,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9308,cpt,"INJECTION, RAMUCIRUMAB, 5 MG",united healthcare,,O,244.70,36.68,175.88,175.88,146.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",united healthcare,,O,494.32,41.98,217.91,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",united healthcare,,O,82.88,8.42,8.42,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,united healthcare,,O,183.82,19.97,146.13,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",united healthcare,,O,82.61,19.42,61.96,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",united healthcare,,O,192.85,42.50,136.46,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",united healthcare,,O,267.61,58.94,206.73,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,united healthcare,,O,416.45,133.14,312.34,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",united healthcare,,O,300.00,109.46,453.13,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,united healthcare,,O,2289.17,554.60,1949.84,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,united healthcare,,O,95.55,14.26,30.08,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,united healthcare,,E,880.03,214.07,737.60,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",united healthcare,,O,52.60,8.84,39.45,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9317,cpt,"INJECTION, SACITUZUMAB GOVITECAN-HZIY, 2.5 MG",united healthcare,,O,114.40,85.80,85.80,85.80,68.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0360,cpt,"INJECTION, HYDRALAZINE HCL, UP TO 20 MG",united healthcare,,O,85.01,26.37,68.42,85.01,51.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,united healthcare,,O,101.45,12.63,76.09,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,united healthcare,,O,69.59,7.80,52.19,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92960,cpt,EXTERNAL SHOCK TO HEART TO REGULATE HEART BEAT,united healthcare,,O,854.12,508.26,640.59,905.36,512.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,united healthcare,,O,50.72,6.35,38.04,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",united healthcare,,O,209.99,16.56,166.94,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",united healthcare,,I,145.15,30.77,135.65,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",united healthcare,,O,16.70,0.37,25.55,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85384,cpt,FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,united healthcare,,O,56.26,7.19,75.59,75.59,11.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29822,cpt,LIMITED REMOVAL OF ABNORMAL SHOULDER JOINT TISSUE USING ENDOSCOPE,united healthcare,,O,27841.82,2507.32,20881.37,20881.37,16705.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72070,cpt,"X-RAY OF MIDDLE SPINE, 2 VIEWS",united healthcare,,O,322.63,39.71,256.49,256.49,193.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,united healthcare,,I,27884.18,6142.25,29913.08,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",united healthcare,,O,50.02,5.00,37.52,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9959,cpt,"HIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION, PER ML",united healthcare,,O,2.49,0.64,1.87,1.87,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,united healthcare,,O,567.74,115.42,425.81,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,united healthcare,,O,4630.63,693.07,3472.97,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",united healthcare,,O,1029.19,93.54,771.89,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,united healthcare,,O,4054.33,327.84,3131.97,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",united healthcare,,O,734.07,114.82,550.56,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80051,cpt,"BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM, CHLORIDE, CARBON DIOXIDE)",united healthcare,,O,65.11,6.87,48.83,48.83,39.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",united healthcare,,O,1406.87,198.35,1118.46,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99281,cpt,"EMERGENCY DEPARTMENT VISIT, SELF LIMITED OR MINOR PROBLEM",united healthcare,,E,206.32,65.63,531.77,531.77,123.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",united healthcare,,O,50.72,5.89,38.04,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",united healthcare,,O,231.34,36.97,173.51,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",united healthcare,,E,1724.51,232.62,1289.86,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,united healthcare,,O,9.11,0.50,6.83,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,united healthcare,,O,754.07,203.12,565.55,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",united healthcare,,O,345.14,75.82,258.86,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,united healthcare,,O,989.19,218.69,741.89,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,united healthcare,,O,203.82,49.80,152.87,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,united healthcare,,O,3055.12,202.94,2291.34,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),united healthcare,,O,50.01,5.20,37.51,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,united healthcare,,O,42.51,2.00,31.88,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,united healthcare,,O,79.04,16.60,59.28,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,united healthcare,,O,231.34,36.98,173.51,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",united healthcare,,O,348.89,61.44,261.67,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",united healthcare,,O,502.71,78.63,377.03,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42820,cpt,REMOVAL OF TONSILS AND ADENOID GLANDS (YOUNGER THAN 12 YEARS),united healthcare,,O,18532.26,4720.05,13899.20,13899.20,3780.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",united healthcare,,I,302.21,52.32,528.83,528.83,181.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,united healthcare,,I,84.46,20.40,190.50,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1887,cpt,"CATHETER, GUIDING (MAY INCLUDE INFUSION/PERFUSION CAPABILITY)",united healthcare,,O,357.97,72.03,159.06,218.49,214.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73565,cpt,"X-RAY OF BOTH KNEES, STANDING, FRONT TO BACK VIEW",united healthcare,,O,357.64,32.78,268.23,268.23,214.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,united healthcare,,O,123.87,5.34,92.90,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99215,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 40 MINUTES",united healthcare,,O,569.98,60.00,307.79,427.48,341.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",united healthcare,,O,200.00,27.06,150.00,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76942,cpt,ULTRASONIC GUIDANCE IMAGING SUPERVISION AND INTERPRETATION FOR INSERTION OF NEEDLE,united healthcare,,O,252.59,96.03,195.13,200.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,united healthcare,,I,5986.20,1090.17,5417.51,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,united healthcare,,O,89.65,18.15,67.24,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",united healthcare,,O,212.59,22.86,169.01,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",united healthcare,,O,754.07,158.88,565.55,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",united healthcare,,O,734.07,19.80,550.56,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,united healthcare,,O,3238.42,206.67,2428.82,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,united healthcare,,O,3055.12,202.81,2428.82,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,united healthcare,,O,4852.19,224.32,3639.14,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,472,ms-drg,CERVICAL SPINAL FUSION WITH CC,united healthcare,,I,76071.55,19386.21,38213.93,38213.93,45642.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",united healthcare,,O,45.06,8.39,33.80,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2060,cpt,"INJECTION, LORAZEPAM, 2 MG",united healthcare,,O,78.01,14.44,58.51,77.43,46.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,united healthcare,,O,36.32,4.67,28.87,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9201,cpt,"INJECTION, GEMCITABINE HYDROCHLORIDE, NOT OTHERWISE SPECIFIED, 200 MG",united healthcare,,O,32.61,3.97,24.46,24.46,19.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,united healthcare,,O,28365.62,4521.08,22560.85,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",united healthcare,,O,2073.43,311.07,1555.07,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86920,cpt,"BLOOD UNIT COMPATIBILITY TEST, IMMEDIATE SPIN TECHNIQUE",united healthcare,,O,378.98,183.76,291.33,291.33,81.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",united healthcare,,O,318.54,72.28,253.24,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,united healthcare,,O,38.92,4.65,29.19,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,united healthcare,,O,647.78,92.97,485.84,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,united healthcare,,I,12315.58,3063.82,7646.33,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",united healthcare,,O,422.68,79.92,317.01,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,35840,cpt,"EXPLORATION OF ABDOMEN FOR BLEEDING, BLOOD CLOT, OR INFECTION AFTER SURGERY",united healthcare,,O,30126.77,22301.14,22301.14,22301.14,18076.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",united healthcare,,O,647.78,98.50,514.98,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",united healthcare,,O,154.76,24.25,119.11,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,united healthcare,,I,14560.83,3337.55,9596.47,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,795,ms-drg,NORMAL NEWBORN,united healthcare,,I,4390.63,2140.83,3176.43,4272.65,2634.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10005,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, FIRST GROWTH",united healthcare,,O,2576.47,558.51,1932.35,1932.35,1545.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,united healthcare,,O,3683.73,275.00,2465.28,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,united healthcare,,I,65131.57,7666.11,70105.98,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82731,cpt,FETAL FIBRONECTIN (PROTEIN) ANALYSIS,united healthcare,,O,565.34,62.32,424.01,424.01,108.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",united healthcare,,O,112.07,9.78,89.09,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71101,cpt,"X-RAY OF RIBS ON ONE SIDE OF BODY INCLUDING THE CHEST, MINIMUM OF 3 VIEWS",united healthcare,,O,377.65,61.44,94.48,228.17,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49322,cpt,ASPIRATION OF ABDOMINAL CAVITY OR CYST USING AN ENDOSCOPE,united healthcare,,O,28029.72,21022.30,21022.30,21022.30,16817.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",united healthcare,,O,125.04,27.28,93.78,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,520,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,united healthcare,,I,40151.49,11585.32,22691.31,31059.69,24090.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,united healthcare,,O,145.10,29.21,112.09,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,united healthcare,,O,31.24,2.94,23.43,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,united healthcare,,O,1446.95,312.71,2038.77,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,united healthcare,,O,52.60,6.75,39.45,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43280,cpt,STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE,united healthcare,,O,36571.06,7902.70,26906.78,26906.78,21942.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",united healthcare,,I,231.34,60.43,231.34,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19081,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING X-RAY WITH NEEDLE, FIRST GROWTH",united healthcare,,O,6548.62,1273.00,5582.75,5582.75,3929.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",united healthcare,,O,91.30,6.24,68.48,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,united healthcare,,O,89.65,6.58,69.26,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,united healthcare,,I,19710.37,4922.26,15349.31,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,617,ms-drg,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",united healthcare,,I,39556.14,7942.02,7942.02,33689.17,23733.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11044,cpt,REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS,united healthcare,,O,6092.03,1247.54,23397.56,23397.56,3655.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,united healthcare,,O,266.35,64.70,199.76,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9040,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, IRRADIATED, EACH UNIT",united healthcare,,O,756.23,259.12,601.20,756.23,453.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36416,cpt,PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,united healthcare,,O,11.79,2.31,8.84,11.79,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",united healthcare,,O,4496.04,1078.59,3374.38,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29581,cpt,APPLICATION OF VEIN WOUND COMPRESSION SYSTEM LOWER LEG BELOW KNEE INCLUDING ANKLE AND FOOT,united healthcare,,O,1305.86,230.97,926.72,926.72,783.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,united healthcare,,O,784.37,233.55,2451.28,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,united healthcare,,O,43.18,10.79,32.39,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,united healthcare,,O,3055.12,204.02,2291.34,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1439,cpt,"INJECTION, FERRIC CARBOXYMALTOSE, 1 MG",united healthcare,,O,4.71,0.79,4.99,4.99,2.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,united healthcare,,O,3055.12,206.42,2360.08,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,united healthcare,,O,67.58,3.47,50.69,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36246,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL SECOND ORDER BRANCH",united healthcare,,O,24259.05,2582.02,19004.00,19004.00,14555.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73720,cpt,MRI SCAN OF LEG BEFORE AND AFTER CONTRAST,united healthcare,,O,3055.12,325.59,900.03,1041.43,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",united healthcare,,O,410.17,61.80,307.63,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",united healthcare,,O,12.72,0.71,9.54,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",united healthcare,,O,650.28,61.44,487.71,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73040,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF SHOULDER JOINT,united healthcare,,O,1406.87,212.42,1118.46,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",united healthcare,,O,16.51,4.75,12.38,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,united healthcare,,O,811.59,92.97,608.69,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82595,cpt,CRYOGLOBULIN (PROTEIN) MEASUREMENT,united healthcare,,O,40.11,6.89,30.08,30.08,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,149.83,34.39,112.37,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,united healthcare,,O,560.24,92.59,420.18,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82384,cpt,CATECHOLAMINES (ORGANIC NITROGEN) LEVEL,united healthcare,,O,195.83,25.25,146.87,146.87,117.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),united healthcare,,O,41.28,5.08,30.96,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",united healthcare,,O,50.02,5.17,37.52,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5122,cpt,"INJECTION, PEGFILGRASTIM-APGF, BIOSIMILAR, (NYVEPRIA), 0.5 MG",united healthcare,,O,855.42,167.19,623.41,623.41,513.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",united healthcare,,O,157.91,56.85,118.43,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83605,cpt,LACTIC ACID LEVEL,united healthcare,,O,71.96,5.48,53.97,53.97,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",united healthcare,,O,3457.28,1078.00,2956.79,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,united healthcare,,O,402.67,93.28,302.00,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,united healthcare,,O,119.15,21.42,89.36,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62321,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK USING IMAGING GUIDANCE,united healthcare,,O,2267.14,558.18,1776.12,1776.12,1360.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73100,cpt,"X-RAY OF WRIST, 2 VIEWS",united healthcare,,O,267.61,61.44,200.71,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,812,ms-drg,RED BLOOD CELL DISORDERS WITHOUT MCC,united healthcare,,I,17513.39,3290.25,22466.97,22466.97,10508.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",united healthcare,,O,116.79,7.81,87.59,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74250,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST AND MULTIPLE SERIAL FILMS,united healthcare,,O,530.23,158.38,397.67,397.67,318.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",united healthcare,,I,238.84,62.82,208.99,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,united healthcare,,O,93.19,5.27,69.89,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2920,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 40 MG",united healthcare,,O,13.74,10.30,10.30,10.30,8.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,united healthcare,,O,40.11,4.65,30.08,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,united healthcare,,O,42.58,6.02,31.94,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,united healthcare,,O,3055.12,205.61,2291.34,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5115,cpt,"INJECTION, RITUXIMAB-ABBS, BIOSIMILAR, (TRUXIMA), 10 MG",united healthcare,,O,231.46,173.59,173.59,173.59,138.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1750,cpt,"INJECTION, IRON DEXTRAN, 50 MG",united healthcare,,O,60.87,16.97,45.65,45.65,36.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,445,ms-drg,DISORDERS OF THE BILIARY TRACT WITH CC,united healthcare,,I,16814.63,13639.81,13639.81,13639.81,10088.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92551,cpt,AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING,united healthcare,,O,217.58,10.34,163.19,217.58,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",united healthcare,,O,281.36,90.50,217.35,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",united healthcare,,I,217.58,127.74,230.63,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",united healthcare,,O,39.88,13.23,29.95,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",united healthcare,,O,2526.13,486.47,1894.60,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,united healthcare,,O,71.96,15.59,53.97,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",united healthcare,,O,650.28,61.44,487.71,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87799,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, QUANTIFICATION",united healthcare,,O,264.26,35.66,174.31,174.31,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32555,cpt,ASPIRATION OF FLUID FROM CHEST CAVITY USING IMAGING GUIDANCE,united healthcare,,O,2695.58,507.04,1831.81,1831.81,1617.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",united healthcare,,O,3583.92,323.18,2066.83,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88108,cpt,"CELL EXAMINATION OF SPECIMEN, CONCENTRATION TECHNIQUE",united healthcare,,O,209.99,47.15,157.49,157.49,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,united healthcare,,O,252.59,54.84,189.44,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",united healthcare,,O,290.00,66.00,356.96,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",united healthcare,,O,7.91,1.68,1.87,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1769,cpt,GUIDE WIRE,united healthcare,,O,338.79,40.02,304.82,304.82,203.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2765,cpt,"INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG",united healthcare,,O,79.57,14.40,59.62,59.62,47.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,united healthcare,,O,419.99,136.22,314.99,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,united healthcare,,O,383.02,34.82,324.76,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,16020,cpt,DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5% TOTAL BODY SURFACE),united healthcare,,O,738.64,157.08,553.98,553.98,443.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45999,cpt,OTHER PROCEDURE ON RECTUM,united healthcare,,O,2853.82,2171.24,2171.24,2171.24,1712.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",united healthcare,,O,103.81,18.28,77.86,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",united healthcare,,O,60.03,13.90,47.72,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,united healthcare,,O,80.09,1.66,60.07,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,united healthcare,,I,1274.16,335.11,1012.95,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86593,cpt,SYPHILIS TEST,united healthcare,,O,50.01,2.27,4.40,6.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",united healthcare,,O,20.05,1.78,15.04,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",united healthcare,,O,345.14,36.70,258.86,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",united healthcare,,O,88.24,14.05,65.77,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,united healthcare,,O,1952.12,344.86,1464.09,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",united healthcare,,O,547.73,117.10,410.80,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),united healthcare,,O,91.30,14.31,68.48,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84484,cpt,"TROPONIN (PROTEIN) ANALYSIS, QUANTITATIVE",united healthcare,,O,176.37,12.22,186.95,186.95,14.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",united healthcare,,O,36.32,4.04,27.24,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9171,cpt,"INJECTION, DOCETAXEL, 1 MG",united healthcare,,O,54.77,0.66,12.76,12.96,32.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",united healthcare,,O,19.52,4.40,14.64,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57288,cpt,CREATION OF SLING AROUND BLADDER CANAL (URETHRA) TO CONTROL LEAKAGE,united healthcare,,O,34340.73,4097.25,21424.62,23328.10,20604.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,united healthcare,,O,351.40,92.60,279.36,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,united healthcare,,O,502.71,78.63,377.03,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,united healthcare,,O,252.59,4.78,189.44,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",united healthcare,,O,520.22,353.36,413.57,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88312,cpt,SPECIAL STAINED SPECIMEN SLIDES TO IDENTIFY ORGANISMS INCLUDING INTERPRETATION AND REPORT,united healthcare,,O,63.70,17.04,63.70,63.70,38.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,united healthcare,,I,4152.82,995.38,3114.62,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",united healthcare,,O,31.88,3.63,82.56,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",united healthcare,,O,158.29,56.98,118.00,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,united healthcare,,O,84.93,8.43,63.70,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,united healthcare,,O,303.87,29.81,215.00,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,44970,cpt,REMOVAL OF APPENDIX USING AN ENDOSCOPE,united healthcare,,O,40257.83,30193.37,30193.37,30193.37,24154.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",united healthcare,,O,441.23,35.97,330.92,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59820,cpt,TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER,united healthcare,,O,18205.61,2373.69,13386.01,13386.01,10923.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,786,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,united healthcare,,I,26502.24,8570.18,31953.68,31953.68,15901.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",united healthcare,,O,135.66,25.29,101.75,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",united healthcare,,O,365.14,61.44,273.86,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,100.03,11.76,75.03,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,united healthcare,,O,84.93,8.09,63.70,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,united healthcare,,O,31.88,2.63,23.91,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,united healthcare,,O,30.08,5.04,22.56,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),united healthcare,,O,3857.66,938.20,3733.00,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,united healthcare,,O,1343.10,94.48,1007.33,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",united healthcare,,O,377.65,61.44,283.24,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",united healthcare,,O,3595.37,208.18,2279.74,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93930,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH ARMS,united healthcare,,O,770.33,202.29,577.75,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9956,cpt,"INJECTION, OCTAFLUOROPROPANE MICROSPHERES, PER ML",united healthcare,,O,2.49,1.87,1.87,2.49,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",united healthcare,,O,266.35,64.70,199.76,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,united healthcare,,O,647.78,92.64,372.81,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",united healthcare,,O,1997.14,273.93,1497.86,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",united healthcare,,O,203.82,32.52,152.87,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45384,cpt,"REMOVAL OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL BY HOT BIOPSY FORCEPS, USING A FLEXIBLE ENDOSCOPE",united healthcare,,O,4528.30,938.20,4749.21,4749.21,2716.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17250,cpt,APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,united healthcare,,O,703.02,157.08,777.14,777.14,421.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19000,cpt,"ASPIRATION OF CYST OF BREAST, FIRST CYST",united healthcare,,O,1993.54,1253.04,1435.09,1435.09,1196.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1756,cpt,"INJECTION, IRON SUCROSE, 1 MG",united healthcare,,O,2.08,0.23,0.84,0.94,1.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87116,cpt,CULTURE FOR ACID-FAST BACILLI,united healthcare,,O,113.25,10.59,84.94,84.94,12.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88313,cpt,SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE INCLUDING INTERPRETATION AND REPORT,united healthcare,,O,119.15,50.94,92.04,94.72,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",united healthcare,,O,175.06,87.53,139.17,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",united healthcare,,O,101.45,14.76,76.09,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",united healthcare,,O,1.42,0.39,1.07,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,united healthcare,,O,908.09,156.44,934.81,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84446,cpt,VITAMIN E LEVEL,united healthcare,,O,83.76,7.84,66.59,66.59,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,united healthcare,,O,265.10,8.75,210.75,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12051,cpt,"REPAIR OF WOUND (2.5 CENTIMETERS OR LESS) OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MOUTH",united healthcare,,O,17191.55,1273.00,12893.66,12893.66,10314.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",united healthcare,,O,90.84,9.28,68.13,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,united healthcare,,I,163.02,40.45,303.54,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",united healthcare,,I,78.76,19.94,24.47,24.47,47.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",united healthcare,,O,70.01,13.01,50.12,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",united healthcare,,O,52.60,5.67,39.45,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,united healthcare,,O,1159.26,202.49,206.42,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0744,cpt,"INJECTION, CIPROFLOXACIN FOR INTRAVENOUS INFUSION, 200 MG",united healthcare,,O,67.52,16.35,50.64,50.64,40.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,united healthcare,,I,1386.23,364.58,1386.23,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83516,cpt,"ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, MULTIPLE STEP METHOD",united healthcare,,O,55.44,9.63,41.58,41.58,13.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,united healthcare,,O,123.87,33.18,63.38,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9503,cpt,"TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES",united healthcare,,O,225.10,13.65,168.82,168.82,135.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",united healthcare,,I,799.31,175.61,484.84,484.84,479.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,united healthcare,,I,62688.63,11498.14,66792.27,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,united healthcare,,O,203.82,49.80,152.87,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",united healthcare,,O,2.49,0.02,1.18,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",united healthcare,,O,88.56,20.43,68.80,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",united healthcare,,O,267.61,48.10,212.74,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29825,cpt,RELEASE OR REMOVAL OF SHOULDER SCAR TISSUE USING AN ENDOSCOPE,united healthcare,,O,29814.55,2596.65,11486.03,14706.90,17888.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",united healthcare,,O,190.94,53.23,151.79,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",united healthcare,,O,327.67,47.93,85.49,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,united healthcare,,E,2880.28,490.23,2811.85,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,united healthcare,,I,124.70,13.59,97.54,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,united healthcare,,O,106.28,8.57,79.71,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",united healthcare,,O,647.78,98.50,514.98,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91112,cpt,TRANSIT AND PRESSURE MEASUREMENT OF STOMACH THROUGH COLON WITH WIRELESS CAPSULE,united healthcare,,O,1776.38,206.04,1332.29,1332.29,1065.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,united healthcare,,O,101.33,11.74,76.00,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",united healthcare,,O,373.90,92.59,280.43,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,united healthcare,,O,69.59,9.12,52.19,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare,,O,100.04,20.74,75.03,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",united healthcare,,O,5902.67,335.59,2863.77,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),united healthcare,,O,60.03,6.83,45.02,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,united healthcare,,O,2112.19,159.41,2112.19,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,united healthcare,,O,348.63,85.16,261.47,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9206,cpt,"INJECTION, IRINOTECAN, 20 MG",united healthcare,,O,16.23,4.11,12.17,36.90,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,united healthcare,,I,1133.33,141.17,1069.19,1464.70,680.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",united healthcare,,O,1007.94,158.30,1001.47,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",united healthcare,,O,312.63,61.44,234.47,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",united healthcare,,O,369.82,61.44,261.67,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,united healthcare,,O,16541.64,1561.79,14075.51,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,united healthcare,,O,69.59,8.01,52.19,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,united healthcare,,O,41.28,5.78,30.96,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,united healthcare,,O,96.77,32.33,76.93,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27570,cpt,MANIPULATION OF KNEE JOINT UNDER ANESTHESIA,united healthcare,,O,13902.50,1248.60,10424.46,10424.46,8341.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,united healthcare,,O,19028.38,1098.56,26758.83,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84112,cpt,CERVICOVAGINAL SECRETION OF PLACENTA PROTEIN,united healthcare,,O,257.65,98.11,193.24,257.65,49.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,united healthcare,,E,292.62,111.66,219.47,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,621,ms-drg,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,united healthcare,,I,48014.63,10223.98,12645.72,32094.15,28808.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",united healthcare,,O,422.68,79.93,317.01,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,united healthcare,,O,93.19,15.38,74.09,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",united healthcare,,I,944.41,228.70,958.98,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",united healthcare,,O,47.53,3.60,42.52,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,united healthcare,,O,56.62,7.92,42.46,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",united healthcare,,O,183.82,24.23,137.87,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",united healthcare,,O,183.82,20.70,137.87,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,united healthcare,,O,414.89,93.99,311.17,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,63030,cpt,PARTIAL REMOVAL OF BONE WITH RELEASE OF SPINAL CORD OR SPINAL NERVES OF 1 INTERSPACE IN LOWER SPINE,united healthcare,,O,29485.64,5732.13,22114.23,22114.23,17691.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,united healthcare,,I,20034.03,4988.82,14265.77,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",united healthcare,,O,48.36,3.92,37.36,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",united healthcare,,O,89.65,10.18,67.24,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47379,cpt,OTHER PROCEDURE ON LIVER USING AN ENDOSCOPE,united healthcare,,O,45330.30,21022.30,21022.30,21022.30,27198.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,united healthcare,,O,112.55,9.00,39.75,1270.41,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,united healthcare,,I,976.85,256.92,976.85,976.85,586.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,united healthcare,,O,1952.12,159.41,1464.09,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",united healthcare,,O,252.47,44.06,189.36,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19281,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH MAMMOGRAPHIC GUIDANCE, FIRST LESION",united healthcare,,O,21298.80,131.53,1223.05,5148.44,12779.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,united healthcare,,O,1630.73,338.97,1259.74,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0640,cpt,"INJECTION, LEUCOVORIN CALCIUM, PER 50 MG",united healthcare,,O,24.48,4.06,14.99,38.80,14.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75716,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMAGING OF ARTERIES OF BOTH ARMS OR LEGS,united healthcare,,O,7596.99,64.33,5697.74,5697.74,4558.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,united healthcare,,I,1704.46,353.32,1480.66,2409.63,1022.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",united healthcare,,O,238.84,35.53,189.88,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,united healthcare,,O,53.76,5.92,40.32,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0378,cpt,"HOSPITAL OBSERVATION SERVICE, PER HOUR",united healthcare,,O,16.99,2.44,12.74,22.26,10.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",united healthcare,,O,1099.23,114.80,824.42,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4616,cpt,TUBING (OXYGEN) PER FOOT; MEDICAL AND SURGICAL SUPPLIES - RESPIRATORY SUPPLIES AND EQUIPMENT,united healthcare,,O,1580.92,500.52,1185.69,1675.77,948.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,united healthcare,,O,330.33,24.94,262.61,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,787,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,united healthcare,,I,18030.21,6935.18,13885.01,13885.01,10818.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),united healthcare,,O,29523.82,4577.80,40500.70,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,united healthcare,,O,3222.12,719.92,2251.40,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,united healthcare,,O,547.73,91.89,394.63,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,united healthcare,,O,183.82,20.77,137.87,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,united healthcare,,O,1205.09,132.64,304.82,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,united healthcare,,O,8198.69,1161.40,6333.49,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82941,cpt,GASTRIN (GI TRACT HORMONE) LEVEL,united healthcare,,O,119.15,89.36,89.36,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,united healthcare,,O,3055.12,204.95,2291.34,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",united healthcare,,O,73.14,3.60,54.86,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",united healthcare,,O,338.89,30.54,30.94,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,united healthcare,,O,256.35,58.45,192.26,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",united healthcare,,O,757.37,185.43,568.03,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",united healthcare,,O,3191.43,324.07,2537.19,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),united healthcare,,O,283.14,16.69,212.36,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,united healthcare,,O,188.17,66.99,153.53,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,356,ms-drg,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,united healthcare,,I,81349.62,29653.23,29653.23,29653.23,48809.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,united healthcare,,O,178.08,50.28,133.56,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,united healthcare,,O,188.17,19.53,102.81,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",united healthcare,,O,7.49,1.49,5.62,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96409,cpt,ADMINISTRATION OF CHEMOTHERAPY INTO VEIN USING PUSH TECHNIQUE,united healthcare,,O,448.94,102.13,336.71,361.50,269.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0720,revCode,LABOR ROOM/DELIVERY GENERAL,united healthcare,,I,150.64,21.34,2107.43,4826.59,90.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73723,cpt,MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST,united healthcare,,O,3471.56,325.59,3471.56,3471.56,2082.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",united healthcare,,O,199.37,74.90,149.53,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9042,cpt,"INJECTION, BRENTUXIMAB VEDOTIN, 1 MG",united healthcare,,O,545.23,196.65,408.92,408.92,327.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0114,revCode,ROOM AND BOARD PRIVATE (ONE BED) PSYCHIATRIC,united healthcare,,I,2332.29,629.26,937.00,3095.92,1399.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,united healthcare,,O,30.08,3.63,23.24,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0419,revCode,"RESPIRATORY SERVICES, OTHER",united healthcare,,I,278.86,158.95,278.86,278.86,167.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,united healthcare,,O,187.57,14.84,145.13,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,united healthcare,,O,345.14,124.25,258.86,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85246,cpt,CLOTTING FACTOR VIII (VW FACTOR) ANTIGEN,united healthcare,,O,154.54,22.94,22.94,24.33,92.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,united healthcare,,I,75778.57,12009.61,55745.62,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,united healthcare,,O,152.18,14.75,114.14,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",united healthcare,,O,25.94,5.08,19.46,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75710,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION OF IMAGING OF ARTERY OF ONE ARM OR LEG,united healthcare,,O,3512.82,2634.62,2634.62,2634.62,2107.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,united healthcare,,I,6.27,0.90,18.01,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96368,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, CONCURRENT WITH ANOTHER INFUSION",united healthcare,,O,85.03,16.92,63.77,85.03,51.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9263,cpt,"INJECTION, OXALIPLATIN, 0.5 MG",united healthcare,,O,8.74,0.07,6.56,24.00,5.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1040,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG",united healthcare,,O,105.67,41.27,68.79,103.80,63.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",united healthcare,,O,41.28,3.01,31.89,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",united healthcare,,O,62.51,14.38,46.88,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",united healthcare,,O,365.14,48.65,273.86,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",united healthcare,,O,117.54,58.77,88.16,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,united healthcare,,O,19198.81,2406.74,13237.60,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,377,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH MCC,united healthcare,,I,46517.09,11486.77,18787.25,18787.25,27910.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,440,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,united healthcare,,I,12850.05,3815.31,12183.21,12183.21,7710.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46221,cpt,REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING,united healthcare,,O,3889.72,1284.30,8613.19,8613.19,2333.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,united healthcare,,O,1893.35,157.27,741.89,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),united healthcare,,O,166.34,27.39,124.76,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,united healthcare,,O,83.76,6.73,62.82,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,united healthcare,,O,2261.82,101.22,1670.02,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,united healthcare,,O,28.83,5.59,21.63,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,132.12,25.53,102.06,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",united healthcare,,O,365.24,8.63,290.36,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,united healthcare,,O,290.12,59.69,217.59,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77072,cpt,IMAGING FOR BONE AGE ASSESSMENT,united healthcare,,O,240.10,52.12,169.88,213.76,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",united healthcare,,O,108.88,10.16,81.66,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),united healthcare,,O,50.01,5.20,37.51,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",united healthcare,,O,226.34,61.44,169.76,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare,,O,93.77,21.35,70.33,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare,,O,318.12,56.64,173.51,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,123,ms-drg,NEUROLOGICAL EYE DISORDERS,united healthcare,,I,27446.43,18172.97,18172.97,18172.97,16467.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",united healthcare,,O,331.50,12.98,248.63,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,united healthcare,,O,3595.37,280.86,2696.53,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",united healthcare,,O,245.09,61.44,173.42,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,united healthcare,,O,1479.41,92.59,1109.56,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,united healthcare,,O,167.56,25.68,125.67,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,united healthcare,,O,4054.33,319.17,3040.75,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",united healthcare,,O,38.92,2.65,29.19,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",united healthcare,,O,10827.72,2513.53,7661.15,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,united healthcare,,O,138.03,20.16,109.73,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,united healthcare,,O,5902.67,923.22,4427.00,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",united healthcare,,O,240.10,61.44,180.08,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,151.64,21.05,113.73,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",united healthcare,,O,356.40,83.75,267.30,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86698,cpt,ANALYSIS FOR ANTIBODY TO HISTOPLASMA (FUNGUS),united healthcare,,O,224.15,60.17,60.17,60.17,134.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0760,revCode,SPECIALTY SERVICES GENERAL,united healthcare,,I,474.26,474.26,474.26,474.26,284.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",united healthcare,,O,85.94,24.92,64.46,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",united healthcare,,O,113.79,13.73,30.00,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",united healthcare,,O,13.78,1.69,10.34,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43248,cpt,INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,united healthcare,,O,3996.24,1081.46,3758.90,3758.90,2397.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,united healthcare - medicare advantage,,O,65.11,6.57,6.57,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",united healthcare,,O,151.46,8.03,113.59,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86008,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, RECOMBINANT OR PURIFIED COMPONENT, EACH",united healthcare,,O,44.83,33.62,33.62,33.62,26.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,united healthcare,,O,101.45,3.58,80.65,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,united healthcare,,O,3580.43,810.94,3238.64,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",united healthcare,,I,18651.52,4921.84,10503.74,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",united healthcare,,O,240.10,61.44,180.08,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,united healthcare,,O,792.84,92.74,594.63,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,united healthcare,,O,10678.57,58.46,4166.18,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71100,cpt,"X-RAY OF RIBS OF ONE SIDE OF BODY, 2 VIEWS",united healthcare,,O,426.43,49.08,319.82,319.82,255.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,united healthcare,,O,50.00,8.06,37.50,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89321,cpt,SEMEN ANALYSIS FOR SPERM PRESENCE,united healthcare,,O,70.78,12.05,56.27,72.90,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,united healthcare,,O,60.16,11.87,45.12,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",united healthcare,,O,635.27,137.73,476.45,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72081,cpt,"X-RAY OF SPINE, ENTIRE MIDDLE AND LOWER SPINE, 1 VIEW",united healthcare,,O,226.34,61.44,169.76,173.76,88.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,united healthcare medicare adv,,O,41.28,5.78,6.47,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A6222,cpt,"GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING",united healthcare,,O,1.25,0.67,0.99,0.99,0.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),united healthcare,,O,126.23,10.13,94.67,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43270,cpt,"DESTRUCTION OF POLYP OR GROWTH OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",united healthcare,,O,5865.15,4398.86,4398.86,4398.86,3519.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,united healthcare,,O,65.11,6.57,48.83,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,united healthcare,,O,1880.84,106.44,1410.63,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",united healthcare,,O,91.30,18.02,68.48,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,united healthcare,,O,109.71,43.44,82.28,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",united healthcare,,O,217.58,10.34,163.19,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,united healthcare,,O,101.33,21.90,80.55,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",united healthcare,,O,70.06,8.29,52.55,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",united healthcare,,O,212.36,14.48,159.27,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19020,cpt,DRAINAGE OF ABSCESS OF BREAST,united healthcare,,O,15484.49,11613.37,11613.37,11613.37,9290.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,united healthcare,,O,45.13,4.38,33.85,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",united healthcare,,O,281.00,8.75,210.75,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58662,cpt,DESTRUCTION OR REMOVAL OF OVARY OR GROWTH OF PELVIS USING AN ENDOSCOPE,united healthcare,,O,30175.18,4607.33,22301.14,22301.14,18105.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",united healthcare,,O,4.27,1.25,3.07,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,united healthcare,,O,135.66,26.63,107.84,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0170,revCode,NURSERY GENERAL,united healthcare,,I,1569.44,869.27,1469.70,3331.37,941.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",united healthcare,,O,41.28,5.10,25.10,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",united healthcare,,O,266.35,51.50,199.76,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,united healthcare,,O,94.38,2.18,70.79,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),united healthcare,,O,65.11,4.25,48.83,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0780,cpt,"INJECTION, PROCHLORPERAZINE, UP TO 10 MG",united healthcare,,O,84.30,3.36,62.66,62.66,50.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88300,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, LIMITED EXAMINATION",united healthcare,,O,93.19,26.27,74.09,93.19,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,united healthcare,,I,48.06,11.46,49.03,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,768,ms-drg,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,united healthcare,,I,15836.34,3774.13,17446.29,17446.29,9501.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",united healthcare,,O,65.06,17.18,48.59,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,united healthcare,,O,351.40,81.48,263.55,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80178,cpt,LITHIUM LEVEL,united healthcare,,O,56.26,6.48,42.20,42.20,7.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72202,cpt,"X-RAY OF JOINT BETWEEN LOWER SPINE AND HIP BONE, 3 OR MORE VIEWS",united healthcare,,O,267.61,36.00,212.75,212.75,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,united healthcare,,O,842.86,94.39,632.15,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,united healthcare,,O,221.79,37.03,166.34,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",united healthcare,,O,238.30,63.70,178.73,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49329,cpt,OTHER PROCEDURE ON ABDOMEN USING AN ENDOSCOPE,united healthcare,,O,30927.63,7890.38,28017.68,28017.68,18556.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91037,cpt,MONITORING AND RECORDING OF ESOPHAGEAL FUNCTION THROUGH NASAL TUBE WITH ELECTRODE,united healthcare,,O,3401.95,370.13,2397.37,2397.37,2041.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,96.29,17.55,68.13,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28118,cpt,REMOVAL OF HEEL BONE,united healthcare,,O,31022.88,2578.63,15484.76,15484.76,18613.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,united healthcare,,O,30.49,2.32,26.92,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,united healthcare,,O,647.78,94.48,514.98,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,328,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",united healthcare,,I,48722.60,11664.12,26934.56,45539.96,29233.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,united healthcare,,O,4318.19,810.94,3335.80,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,united healthcare,,O,132.54,29.82,99.41,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27447,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE AND OUTSIDE AREA",united healthcare,,O,76738.27,10981.15,59556.87,59556.87,46042.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",united healthcare,,O,315.99,85.00,236.99,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",united healthcare,,O,47.53,8.48,35.65,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,united healthcare,,O,770.33,202.50,577.75,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",united healthcare,,I,1997.14,545.14,1497.86,19187.06,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",united healthcare,,O,1645.73,583.80,1234.29,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",united healthcare,,O,715.30,48.27,552.57,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84466,cpt,TRANSFERRIN (IRON BINDING PROTEIN) LEVEL,united healthcare,,O,67.24,12.81,50.41,50.41,40.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,united healthcare,,O,42.58,4.32,30.08,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",united healthcare,,O,250.10,18.15,187.58,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,united healthcare,,O,1952.12,144.93,1464.09,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64718,cpt,RELEASE AND/OR RELOCATION OF ULNAR NERVE AT ELBOW,united healthcare,,O,18467.33,1563.58,14075.51,14075.51,11080.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,united healthcare,,O,520.22,353.23,413.57,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95806,cpt,"UNATTENDED SLEEP STUDY WITH RECORDING OF HEART RATE, OXYGEN, RESPIRATORY AIRFLOW AND EFFORT",united healthcare,,O,1695.75,59.68,1271.81,1348.12,1017.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,united healthcare,,O,10678.57,95.85,8249.20,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,united healthcare,,O,190.07,28.97,142.55,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85460,cpt,"FETAL HEMOGLOBIN OR RED BLOOD CELLS MEASUREMENT FOR ASSESSMENT OF FETAL-MATERNAL CIRCULATION, DIFFERENTIAL LYSIS",united healthcare,,O,251.28,7.76,199.76,199.76,150.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",united healthcare,,O,162.48,33.29,121.86,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,united healthcare,,O,4054.33,322.67,3040.75,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",united healthcare,,O,127.54,21.16,95.66,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86769,cpt,MEASURE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIBODY,united healthcare,,O,94.60,13.14,70.95,70.95,49.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,united healthcare,,O,50.01,5.20,37.51,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",united healthcare,,O,2237.24,324.67,1018.09,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,united healthcare,,O,4054.33,324.17,3040.75,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,united healthcare,,O,50.02,4.84,38.65,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,united healthcare,,O,306.38,103.42,229.79,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,united healthcare,,O,41.19,1.80,25.11,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",united healthcare,,O,114.43,3.13,85.82,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,united healthcare,,O,87.53,4.18,65.65,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49651,cpt,REPOSITIONING OF RECURRENT GROIN HERNIA USING AN ENDOSCOPE,united healthcare,,O,26236.25,7878.05,21444.53,21444.53,15741.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,united healthcare,,O,323.88,75.26,242.91,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0461,cpt,"INJECTION, ATROPINE SULFATE, 0.01 MG",united healthcare,,O,1.15,0.19,1.87,11.00,0.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86671,cpt,ANALYSIS FOR ANTIBODY TO FUNGUS,united healthcare,,O,30.63,5.89,12.25,30.62,18.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,460,ms-drg,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,united healthcare,,I,119532.08,24196.90,77295.91,77295.91,71719.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,united healthcare,,O,7543.40,1294.20,5657.55,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),united healthcare,,O,53.08,5.52,39.81,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,788,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,united healthcare,,I,14986.74,7771.24,10339.86,10724.94,8992.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,united healthcare,,O,862.88,61.44,647.16,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,957,ms-drg,OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,united healthcare,,I,64002.21,20698.30,20698.30,20698.30,38401.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,united healthcare,,O,3055.12,204.02,2291.34,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",united healthcare,,O,240.10,27.64,180.08,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,united healthcare,,O,40.11,4.18,30.08,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),united healthcare,,O,132.12,15.79,99.09,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70360,cpt,X-RAY OF SOFT TISSUE OF NECK,united healthcare,,O,240.10,61.44,180.07,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",united healthcare,,O,101.45,25.33,80.65,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58661,cpt,REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE,united healthcare,,O,27191.57,4592.49,23996.68,23996.68,16314.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87535,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,398.76,299.07,299.07,299.07,239.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",united healthcare,,O,35.00,2.32,30.38,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70150,cpt,"X-RAY OF BONES OF FACE, MINIMUM OF 3 VIEWS",united healthcare,,O,495.21,61.44,371.41,371.41,297.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",united healthcare,,O,35.39,4.06,27.34,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,united healthcare,,O,752.83,92.79,564.62,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5116,cpt,"INJECTION, TRASTUZUMAB-QYYP, BIOSIMILAR, (TRAZIMERA), 10 MG",united healthcare,,O,249.43,27.71,187.07,187.07,149.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,united healthcare,,O,287.62,21.62,215.72,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,united healthcare,,O,351.40,51.44,248.64,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,united healthcare,,O,27089.15,2439.68,18837.56,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",united healthcare,,O,183.82,20.21,137.87,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58150,cpt,REMOVAL OF UTERUS AND CERVIX THROUGH ABDOMEN,united healthcare,,O,39194.04,28693.04,28693.04,28693.04,23516.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87210,cpt,SMEAR FOR INFECTIOUS AGENTS,united healthcare,,O,101.45,7.28,76.09,76.09,19.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",united healthcare,,I,1356.71,52.51,1323.44,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,united healthcare medicare adv,,I,6.27,0.90,0.90,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28008,cpt,INCISION OF TISSUES OF MUSCLE COMPARTMENT OF FOOT AND/OR TOE,united healthcare,,O,19100.45,5060.32,15484.76,15484.76,11460.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45338,cpt,"PLACEMENT OF DRAINAGE CATHETER OF BILIARY DUCT, ACCESSED THROUGH THE SKIN WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",united healthcare,,O,4723.92,938.10,1922.90,1922.90,2834.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",united healthcare,,O,94.14,7.61,70.61,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1335,cpt,"INJECTION, ERTAPENEM SODIUM, 500 MG",united healthcare,,O,93.92,25.89,70.44,187.83,56.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,united healthcare,,O,70.06,8.01,52.55,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,united healthcare,,O,55.44,9.79,41.58,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,united healthcare,,O,298.87,98.24,224.15,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",united healthcare,,O,680.29,236.16,510.22,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,united healthcare,,O,143.17,18.59,107.38,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,united healthcare,,O,90.02,12.05,67.52,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,united healthcare,,O,3055.12,206.42,2291.34,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88177,cpt,"PAP TEST, EVALUATION OF FINE NEEDLE ASPIRATE, IMMEDIATE, EACH ADDITIONAL EVALUATION EPISODE",united healthcare,,O,49.54,27.92,37.15,81.12,29.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80050,cpt,GENERAL HEALTH PANEL,united healthcare,,O,300.45,40.45,225.34,300.45,57.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,united healthcare,,O,252.59,55.19,118.96,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",united healthcare,,O,377.65,43.63,283.24,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42826,cpt,REMOVAL OF TONSILS PATIENT AGE 12 OR OVER,united healthcare,,O,21996.72,2514.81,16497.54,16497.54,13198.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,united healthcare,,I,1031.60,200.87,1031.60,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,united healthcare,,O,41.26,8.55,25.91,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,united healthcare,,O,3055.12,206.42,2291.34,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",united healthcare,,O,331.51,119.35,248.63,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,united healthcare,,O,73.83,11.51,55.37,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",united healthcare,,O,19538.26,2569.95,14088.89,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",united healthcare,,O,1858.47,98.50,1322.88,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",united healthcare,,O,50.72,7.45,38.04,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",united healthcare,,O,45.06,8.66,33.80,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,united healthcare,,O,76.68,7.98,60.96,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,united healthcare,,O,513.11,156.86,384.83,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5103,cpt,"INJECTION, INFLIXIMAB-DYYB, BIOSIMILAR, (INFLECTRA), 10 MG",united healthcare,,O,109.30,19.12,109.12,109.12,65.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",united healthcare,,I,142.55,29.95,151.10,151.10,85.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28190,cpt,"REMOVAL OF FOREIGN BODY OF FOOT TISSUE, ACCESSED BENEATH THE SKIN",united healthcare,,O,14067.38,9990.55,9990.55,9990.55,8440.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43250,cpt,"REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE WITH ELECTRICAL CAUTERY",united healthcare,,O,7956.80,5967.60,5967.60,5967.60,4774.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",united healthcare,,O,176.32,30.07,132.24,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",united healthcare,,O,16.23,1.83,12.17,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",united healthcare,,O,117.54,25.46,88.16,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,united healthcare,,O,36.32,5.40,5.51,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",united healthcare,,O,252.47,43.75,189.35,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88720,cpt,MEASUREMENT OF BILIRUBIN,united healthcare,,O,132.12,5.04,105.03,132.12,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,united healthcare,,O,2687.44,201.24,2015.58,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",united healthcare,,O,96.29,11.40,72.22,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",united healthcare,,O,60.16,6.38,45.12,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",united healthcare,,O,70.78,13.97,53.09,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2270,cpt,"INJECTION, MORPHINE SULFATE, UP TO 10 MG",united healthcare,,O,84.59,0.76,63.44,82.91,50.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73222,cpt,MRI SCAN OF ARM JOINT WITH CONTRAST,united healthcare,,O,3055.12,461.27,2428.82,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,united healthcare,,I,752.83,203.26,719.74,719.74,451.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,united healthcare,,O,236.36,11.30,177.27,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83498,cpt,"HYDROXYPROGESTERONE, 17-D (SYNTHETIC HORMONE) LEVEL",united healthcare,,O,126.23,22.15,94.68,94.68,75.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70160,cpt,"X-RAY OF BONES OF NOSE, MINIMUM OF 3 VIEWS",united healthcare,,O,327.63,61.44,245.72,245.72,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,united healthcare,,O,831.61,156.22,623.71,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",united healthcare,,O,50.01,4.43,37.51,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,235,ms-drg,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC,united healthcare,,I,204635.70,89483.07,89483.07,89483.07,122781.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",united healthcare,,O,8.17,0.89,6.13,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",united healthcare,,O,238.30,71.54,178.73,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",united healthcare,,O,2042.16,944.83,1531.62,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1030,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG",united healthcare,,O,87.39,9.18,65.54,65.54,52.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,united healthcare,,O,67.58,8.51,50.69,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,united healthcare,,I,16915.97,4140.71,18732.02,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9045,cpt,"INJECTION, CARBOPLATIN, 50 MG",united healthcare,,O,17.50,2.78,45.93,45.93,10.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",united healthcare,,O,140.04,24.64,105.03,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",united healthcare,,O,90.84,3.51,68.13,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,united healthcare,,O,237.59,106.92,178.19,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",united healthcare,,O,65.11,10.15,48.83,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",united healthcare,,O,101.45,11.20,76.09,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",united healthcare,,O,107.59,3.13,80.69,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",united healthcare,,O,348.89,53.55,277.37,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0834,cpt,"INJECTION, COSYNTROPIN, 0.25 MG",united healthcare,,O,138.82,20.13,113.47,113.47,83.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",united healthcare,,O,126.23,16.29,94.67,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,united healthcare,,O,175.06,87.53,131.30,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,united healthcare,,O,213.87,28.75,160.40,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72193,cpt,CT SCAN PELVIS WITH CONTRAST,united healthcare,,O,1481.91,468.88,1111.43,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",united healthcare,,O,41.06,11.36,30.79,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72157,cpt,MRI SCAN OF MIDDLE SPINAL CANAL BEFORE AND AFTER CONTRAST,united healthcare,,O,4054.33,330.07,3040.75,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,united healthcare,,O,2599.91,94.47,1949.93,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,united healthcare,,O,3055.12,203.12,2428.82,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,united healthcare,,I,36086.42,12423.48,12423.48,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",united healthcare,,O,65.11,8.45,48.83,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86001,cpt,"MEASUREMENT OF ANTIBODY (IGG) TO ALLERGIC SUBSTANCE, EACH ALLERGEN",united healthcare,,O,19.55,14.66,14.66,14.66,11.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73090,cpt,"X-RAY OF FOREARM, 2 VIEWS",united healthcare,,O,245.09,38.03,183.82,183.82,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",united healthcare,,O,120.33,16.46,90.25,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,united healthcare,,O,83.76,14.03,83.76,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,389,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH CC,united healthcare,,I,17143.70,5530.39,15895.68,18965.92,10286.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,united healthcare,,O,287.62,77.37,215.72,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",united healthcare,,O,36.32,6.91,27.22,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",united healthcare,,O,246.35,17.59,184.76,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",united healthcare,,O,1997.14,430.17,1497.86,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,united healthcare,,O,45.06,3.98,33.79,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0521,revCode,FREESTANDING CLINIC CLINIC VISIT BY MEMBER TORHC/FQHC,united healthcare,,O,290.00,111.87,129.00,255.96,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,united healthcare,,O,3055.12,320.47,2360.08,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",united healthcare,,O,56.26,6.34,42.20,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,united healthcare,,O,401.42,94.39,301.07,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",united healthcare,,O,437.43,101.00,328.07,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",united healthcare,,O,130.95,13.50,98.21,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,united healthcare,,O,35679.28,5647.61,25391.48,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,794,ms-drg,NEONATE WITH OTHER SIGNIFICANT PROBLEMS,united healthcare,,I,5174.39,2904.57,12942.69,30750.68,3104.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3105,cpt,"INJECTION, TERBUTALINE SULFATE, UP TO 1 MG",united healthcare,,O,78.97,6.05,58.40,58.40,47.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43281,cpt,REPAIR OF HERNIA OF MUSCLE AT ESOPHAGUS AND STOMACH USING AN ENDOSCOPE,united healthcare,,O,46143.64,34257.41,34257.41,34257.41,27686.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",united healthcare,,O,1434.39,436.85,1140.34,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,united healthcare,,O,28.83,5.60,21.62,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",united healthcare,,O,221.79,37.73,166.34,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,united healthcare,,O,60.16,9.91,45.12,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,united healthcare,,O,176.37,11.81,132.28,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82375,cpt,CARBOXYHEMOGLOBIN (PROTEIN) LEVEL,united healthcare,,O,116.29,15.40,87.22,119.78,14.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",united healthcare,,O,38.92,3.91,29.19,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",united healthcare,,O,91.43,5.96,12.29,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9301,cpt,"INJECTION, OBINUTUZUMAB, 10 MG",united healthcare,,O,257.60,46.78,193.20,193.20,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36818,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, UPPER ARM, CEPHALIC VEIN",united healthcare,,O,22902.81,17177.11,17177.11,17177.11,13741.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",united healthcare,,O,68064.84,9197.64,27373.69,27750.61,40838.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74240,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH SINGLE CONTRAST,united healthcare,,O,513.01,159.41,407.84,543.79,307.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0881,cpt,"INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)",united healthcare,,O,10.64,2.75,7.96,7.96,6.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",united healthcare,,O,3395.81,1103.79,1568.77,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",united healthcare,,O,4.12,1.10,3.09,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",united healthcare,,O,350.39,39.08,262.79,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,united healthcare,,O,76.68,5.83,57.51,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,united healthcare,,I,22023.98,6812.39,19794.73,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9179,cpt,"INJECTION, ERIBULIN MESYLATE, 0.1 MG",united healthcare,,O,480.24,347.96,347.96,347.96,288.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,united healthcare,,O,80.09,5.66,60.07,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",united healthcare,,O,4.22,1.00,2.80,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,638,ms-drg,DIABETES WITH CC,veterans affairs,,I,19597.90,4492.16,6558.23,10285.50,11758.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87305,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ASPERGILLUS (FUNGUS),united healthcare,,O,30.85,11.79,22.46,22.46,18.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",united healthcare,,O,92.99,21.05,65.80,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",united healthcare,,O,13.80,2.61,10.35,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,united healthcare,,O,348.63,85.16,261.47,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",united healthcare,,O,285.11,61.44,213.83,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,united healthcare,,O,16.28,2.44,12.74,4798.21,9.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,united healthcare,,O,60.03,7.19,45.02,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,united healthcare,,I,18716.13,4221.86,6975.15,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",united healthcare,,O,40.11,3.87,30.08,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2350,cpt,"INJECTION, OCRELIZUMAB, 1 MG",united healthcare,,O,156.72,36.34,117.73,117.73,94.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28192,cpt,"REMOVAL OF FOREIGN BODY OF FOOT TISSUE, DEEP",united healthcare,,O,27610.18,20707.64,20707.64,20707.64,16566.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93312,cpt,INSERTION OF PROBE IN ESOPHAGUS FOR HEART ULTRASOUND EXAMINATION INCLUDING INTERPRETATION AND REPORT,united healthcare,,O,1858.32,408.83,1435.55,1435.55,1114.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77001,cpt,"FLUOROSCOPIC GUIDANCE FOR INSERTION, REPLACEMENT OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",united healthcare,,O,847.87,227.86,617.91,847.87,508.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9267,cpt,"INJECTION, PACLITAXEL, 1 MG",united healthcare,,O,4.99,0.12,189.00,189.00,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,veterans affairs,,O,40.11,4.65,4.74,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",united healthcare,,O,826.60,242.61,657.14,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",united healthcare,,O,267.61,46.08,200.71,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94729,cpt,TEST TO EXAMINE HOW WELL THE LUNGS EXCHANGE GASES,united healthcare,,O,231.34,43.74,173.51,238.28,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",united healthcare,,O,223.91,73.72,167.93,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25606,cpt,"INSERTION OF HARDWARE TO LOWER FOREARM BONE BROKEN OR GROWTH PLATE SEPARATION, ACCESSED THROUGH THE SKIN",united healthcare,,O,20764.14,2631.25,15573.11,15573.11,12458.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",united healthcare,,O,108.49,21.05,81.37,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,united healthcare,,O,130.11,30.48,97.58,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",united healthcare,,O,270.00,64.89,212.22,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1874,cpt,"STENT, COATED/COVERED, WITH DELIVERY SYSTEM",united healthcare,,O,3791.70,2041.15,2843.78,2843.78,2275.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",united healthcare,,E,5953.08,743.91,2784.01,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",united healthcare,,O,468.95,93.59,372.81,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",united healthcare,,O,298.47,66.35,223.85,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91010,cpt,MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT,united healthcare,,O,3386.38,370.13,2423.62,2423.62,2031.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27704,cpt,REMOVAL OF ANKLE IMPLANT,united healthcare,,O,22301.38,16726.04,16726.04,16726.04,13380.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36598,cpt,CONTRAST INJECTIONS FOR X-RAY IMAGING PROCEDURE TO EVALUATE CENTRAL VENOUS ACCESS DEVICE,united healthcare,,O,1193.73,178.95,915.85,915.85,716.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58573,cpt,"ABDOMINAL REMOVAL OF UTERUS (GREATER THAN 250 GRAMS), TUBES, AND/OR OVARIES USING AN ENDOSCOPE",united healthcare,,O,30571.05,8058.10,22624.41,22624.41,18342.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9541,cpt,"TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES",united healthcare,,O,245.09,123.76,183.82,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1763,cpt,"CONNECTIVE TISSUE, NON-HUMAN (INCLUDES SYNTHETIC)",united healthcare,,O,5191.09,570.72,4126.91,4126.91,3114.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,united healthcare,,O,26791.18,4521.08,21816.48,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,united healthcare,,O,5444.73,938.10,3555.21,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,united healthcare,,I,18614.53,3748.00,3748.00,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,united healthcare,,O,100.03,11.53,75.02,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9395,cpt,"INJECTION, FULVESTRANT, 25 MG",united healthcare,,O,421.43,10.87,316.07,316.07,252.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94726,cpt,DETERMINATION OF LUNG VOLUMES USING PLETHYSMOGRAPHY,united healthcare,,O,531.48,100.50,398.61,531.48,318.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,united healthcare,,O,76.04,10.15,55.37,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",united healthcare,,I,3595.37,858.13,2535.33,2535.33,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",united healthcare,,I,2599.91,780.60,1949.93,1949.93,1559.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58558,cpt,BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE,united healthcare,,O,24068.17,2373.69,19315.13,19315.13,14440.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1788,cpt,"PORT, INDWELLING (IMPLANTABLE)",united healthcare,,O,1737.02,466.81,1265.90,1737.02,1042.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,united healthcare,,O,102.63,10.90,76.97,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3489,cpt,"INJECTION, ZOLEDRONIC ACID, 1 MG",united healthcare,,O,147.55,10.36,110.66,110.66,88.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",united healthcare,,O,233.84,30.94,175.38,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,united healthcare,,O,694.00,180.07,498.04,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,united healthcare,,I,16493.28,2797.28,6884.48,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",united healthcare,,O,93.19,13.33,69.89,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,united healthcare,,O,113.25,11.78,84.94,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",united healthcare,,O,85.05,7.99,53.97,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,44300,cpt,"INSERTION OF SMALL BOWEL TUBE, OPEN PROCEDURE",united healthcare,,O,30590.41,22942.81,22942.81,22942.81,18354.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,united healthcare,,O,521.47,92.78,391.10,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",united healthcare,,O,71.96,7.91,53.97,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",united healthcare,,O,135.66,14.84,101.75,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,united healthcare,,I,3055.12,691.95,3172.84,3172.84,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,united healthcare,,O,71.96,9.99,57.20,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",united healthcare,,O,44.82,3.29,34.63,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",united healthcare,,O,632.77,59.44,488.82,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",united healthcare,,O,148.64,16.43,118.16,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,united healthcare,,O,50.01,3.11,37.51,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",united healthcare,,O,117.61,12.87,90.86,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",united healthcare,,O,419.99,46.79,324.44,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",united healthcare,,O,348.89,46.07,261.67,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",united healthcare,,O,411.42,47.57,308.57,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",united healthcare,,O,63.63,6.74,47.72,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9190,cpt,"INJECTION, FLUOROURACIL, 500 MG",united healthcare,,O,9.25,1.74,6.56,20.90,5.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",united healthcare,,O,4184.57,938.10,2906.08,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",united healthcare,,O,513.19,16.80,384.89,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",united healthcare,,O,107.59,3.13,107.59,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",united healthcare,,O,41.28,4.92,25.21,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",united healthcare,,O,122.56,1.48,91.92,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",united healthcare,,O,376.41,61.44,282.31,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,united healthcare,,O,1753.28,94.47,1314.96,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,united healthcare,,O,1481.91,158.58,1079.98,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",united healthcare,,O,67.24,14.75,50.43,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9965,cpt,"LOW OSMOLAR CONTRAST MATERIAL, 100-199 MG/ML IODINE CONCENTRATION, PER ML",united healthcare,,O,7.98,1.70,6.34,6.34,4.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",united healthcare,,O,826.60,239.39,510.22,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",united healthcare,,O,31.24,4.67,13.71,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,united healthcare,,O,42.58,3.22,31.94,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99203,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 30-44 MINUTES",united healthcare,,O,280.00,68.79,378.91,378.91,168.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86666,cpt,ANALYSIS FOR ANTIBODY TO EHRLICHIA (BACTERIA TRANSMITTED BY TICKS),united healthcare,,O,28.31,10.22,19.08,19.08,16.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93226,cpt,"HEART RHYTHM ANALYSIS, INTERPRETATION AND REPORT OF 48-HOUR EKG",united healthcare,,O,266.35,64.70,199.76,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,united healthcare,,O,78.05,7.37,55.23,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7030,cpt,"INFUSION, NORMAL SALINE SOLUTION , 1000 CC",united healthcare,,O,9.26,2.95,6.56,58.60,5.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",united healthcare,,O,1680.75,111.66,600.09,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52332,cpt,INSERTION OF STENT IN URINARY DUCT (URETER) USING AN ENDOSCOPE,united healthcare,,O,20654.85,2781.70,11081.54,17672.06,12392.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",united healthcare,,O,2069.24,93.35,1464.09,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",united healthcare,,O,83.33,15.97,62.51,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",united healthcare,,O,362.65,61.08,271.99,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,united healthcare,,O,195.07,21.19,146.30,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",united healthcare,,I,212.36,46.07,127.71,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36410,cpt,"INSERTION OF NEEDLE INTO VEIN, PATIENT 3 YEARS OR OLDER",united healthcare,,O,4861.11,182.60,1279.13,4504.70,2916.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,united healthcare,,O,122.03,31.49,94.53,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,united healthcare,,O,899.10,136.27,674.32,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,195,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,united healthcare,,I,12306.54,4159.34,4286.11,8390.31,7383.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,united healthcare,,O,67.58,5.08,50.69,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,united healthcare,,O,2149.71,310.75,1660.65,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",united healthcare - medicare advantage,,O,338.89,30.54,33.51,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",united healthcare - medicare advantage,,O,40.11,3.87,3.88,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",united healthcare - medicare advantage,,O,1858.47,98.50,98.50,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,united healthcare - medicare advantage,,I,18651.11,4387.85,6120.94,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17003,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 2-14 GROWTHS",united healthcare - medicare advantage,,O,1040.92,159.38,160.53,1315.38,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83930,cpt,BLOOD OSMOLALITY (CONCENTRATION) MEASUREMENT,united healthcare - medicare advantage,,O,119.15,6.48,6.48,6.64,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75635,cpt,CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES WITH CONTRAST,united healthcare - medicare advantage,,O,1952.12,159.41,159.41,528.47,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,united healthcare - medicare advantage,,O,647.78,92.64,94.48,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,united healthcare - medicare advantage,,O,1590.91,567.62,567.62,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82365,cpt,INFRARED ANALYSIS OF STONE,united healthcare - medicare advantage,,O,73.14,12.65,12.65,38.76,15.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,475,ms-drg,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,united healthcare - medicare advantage,,I,50430.81,14456.44,14456.44,18120.59,30258.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",united healthcare - medicare advantage,,O,4.12,1.10,4.12,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",united healthcare - medicare advantage,,O,65.06,17.18,64.78,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",united healthcare - medicare advantage,,O,226.34,61.44,75.27,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,244,ms-drg,PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC,united healthcare - medicare advantage,,I,54971.01,12462.35,12462.35,12462.35,32982.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,united healthcare - medicare advantage,,O,3683.73,275.00,3853.61,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",united healthcare - medicare advantage,,O,3395.81,1103.79,1103.79,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,united healthcare - medicare advantage,,O,93.19,11.22,11.81,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,united healthcare - medicare advantage,,O,27089.15,2439.68,2576.57,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,united healthcare - medicare advantage,,O,784.37,233.55,233.55,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0881,cpt,"INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRD USE)",united healthcare - medicare advantage,,O,10.64,2.75,2.75,7.96,6.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83921,cpt,ORGANIC ACID LEVEL,united healthcare - medicare advantage,,O,102.63,10.90,20.79,76.97,61.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,292,ms-drg,HEART FAILURE AND SHOCK WITH CC,united healthcare - medicare advantage,,I,17047.40,4692.10,4692.10,7821.94,10228.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,673,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,united healthcare - medicare advantage,,I,69347.05,21366.97,21954.05,39818.00,41608.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57260,cpt,"PLASTIC REPAIR OF VAGINA AND TISSUE SEPARATING VAGINA, RECTUM, AND BLADDER",united healthcare - medicare advantage,,O,42179.41,7936.42,7936.42,11664.05,25307.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",united healthcare - medicare advantage,,O,190.94,53.23,255.21,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",united healthcare - medicare advantage,,O,411.42,47.57,92.90,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare - medicare advantage,,O,318.12,56.64,178.95,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73580,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF KNEE JOINT,united healthcare - medicare advantage,,O,836.43,323.17,323.17,325.07,501.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),united healthcare - medicare advantage,,O,60.03,6.83,11.75,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,454,ms-drg,COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC,united healthcare - medicare advantage,,I,105825.66,37543.02,37543.02,37543.02,63495.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,united healthcare - medicare advantage,,I,1386.23,364.58,1088.23,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",united healthcare - medicare advantage,,O,88.24,14.05,174.28,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,united healthcare - medicare advantage,,O,123.87,5.34,8.73,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82947,cpt,BLOOD GLUCOSE (SUGAR) LEVEL,united healthcare - medicare advantage,,O,36.32,3.85,3.86,20.70,4.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",united healthcare - medicare advantage,,O,183.82,20.70,21.82,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,312,ms-drg,SYNCOPE AND COLLAPSE,united healthcare - medicare advantage,,I,19356.82,5264.37,5924.78,7437.32,11614.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,644,ms-drg,ENDOCRINE DISORDERS WITH CC,united healthcare - medicare advantage,,I,20353.94,6922.12,6969.71,23799.96,12212.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",united healthcare - medicare advantage,,O,212.36,14.48,44.07,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",united healthcare - medicare advantage,,O,112.07,9.78,15.98,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",united healthcare - medicare advantage,,O,4184.57,938.10,1295.68,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,4054.33,327.84,331.39,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,31160.78,7903.69,7936.42,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,united healthcare - medicare advantage,,O,306.38,103.42,115.55,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17271,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF SCALP, NECK, HANDS, FEET, OR GENITALS",united healthcare - medicare advantage,,O,1881.00,241.28,352.38,1015.48,1128.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,united healthcare - medicare advantage,,O,203.82,49.80,49.80,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,united healthcare - medicare advantage,,O,290.12,59.69,115.54,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,united healthcare - medicare advantage,,O,2261.82,101.22,567.62,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,united healthcare - medicare advantage,,O,90.02,12.05,13.36,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",united healthcare - medicare advantage,,O,290.00,66.00,241.10,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17272,cpt,"DESTRUCTION OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF SCALP, NECK, HANDS, FEET, OR GENITALS",united healthcare - medicare advantage,,O,1605.90,352.38,352.38,352.38,963.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,united healthcare - medicare advantage,,O,316.37,49.55,50.21,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0360,cpt,"INJECTION, HYDRALAZINE HCL, UP TO 20 MG",united healthcare - medicare advantage,,O,85.01,26.37,85.01,85.01,51.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84445,cpt,THYROID STIMULATING IMMUNE GLOBULINS (THYROID RELATED PROTEIN) LEVEL,united healthcare - medicare advantage,,O,135.66,26.63,49.85,107.84,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),united healthcare - medicare advantage,,O,132.12,15.79,21.90,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84132,cpt,BLOOD POTASSIUM LEVEL,united healthcare - medicare advantage,,O,36.32,4.67,4.67,28.87,5.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97605,cpt,"NEGATIVE PRESSURE WOUND THERAPY, SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS, PER SESSION",united healthcare - medicare advantage,,O,1881.44,329.77,503.27,540.81,1128.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,442,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",united healthcare - medicare advantage,,I,23206.50,6521.42,6521.42,8487.22,13923.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,united healthcare - medicare advantage,,O,567.74,115.42,288.14,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,united healthcare - medicare advantage,,O,55.44,9.79,11.31,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86618,cpt,ANALYSIS FOR ANTIBODY BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),united healthcare - medicare advantage,,O,283.14,16.69,16.69,212.36,169.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,united healthcare - medicare advantage,,O,138.03,20.16,20.81,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,united healthcare - medicare advantage,,O,41.28,5.78,6.35,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,united healthcare - medicare advantage,,O,502.71,78.63,244.11,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93931,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE ARM OR LIMITED,united healthcare - medicare advantage,,O,646.53,92.68,94.48,216.32,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27447,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE AND OUTSIDE AREA",united healthcare - medicare advantage,,O,76738.27,10981.15,10981.15,59556.87,46042.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",united healthcare - medicare advantage,,O,4.22,1.00,78.49,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",united healthcare - medicare advantage,,O,183.82,20.21,21.94,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",united healthcare - medicare advantage,,O,212.59,22.86,22.87,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72192,cpt,CT SCAN OF PELVIS WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1344.34,94.48,98.50,98.50,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81241,cpt,GENE ANALYSIS (COAGULATION FACTOR V) LEIDEN VARIANT,united healthcare - medicare advantage,,O,331.51,68.48,71.91,331.51,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,united healthcare - medicare advantage,,O,752.83,92.79,94.48,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77293,cpt,OBTAINING RESPIRATORY DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT,united healthcare - medicare advantage,,O,1511.29,1511.29,1511.29,1511.29,906.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",united healthcare - medicare advantage,,I,944.41,228.70,1142.46,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",united healthcare - medicare advantage,,O,266.35,51.50,72.07,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76857,cpt,"ULTRASOUND OF PELVIS, LIMITED, NOT PREGNANCY RELATED",united healthcare - medicare advantage,,O,187.57,93.59,98.50,198.82,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",united healthcare - medicare advantage,,O,122.56,1.48,9.98,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73000,cpt,X-RAY OF COLLAR BONE,united healthcare - medicare advantage,,O,267.61,51.43,72.12,152.54,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,united healthcare - medicare advantage,,O,116.31,18.99,19.00,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83695,cpt,LIPOPROTEIN (A) LEVEL,united healthcare - medicare advantage,,O,83.76,14.03,14.04,83.76,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",united healthcare - medicare advantage,,E,1724.51,232.62,663.66,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1479.41,92.59,98.50,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",united healthcare - medicare advantage,,O,107.59,3.13,19.65,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84450,cpt,"LIVER ENZYME (SGOT), LEVEL",united healthcare - medicare advantage,,O,40.11,5.08,5.08,8.75,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,439,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,united healthcare - medicare advantage,,I,19744.66,5026.91,5948.55,10330.99,11846.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,united healthcare - medicare advantage,,O,84.93,8.09,20.67,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,united healthcare - medicare advantage,,I,20034.03,4988.82,5289.02,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45330,cpt,DIAGNOSTIC EXAMINATION OF THE LOWER PORTION OF THE LARGE BOWEL USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,3245.25,719.92,719.92,2991.30,1947.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36901,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",united healthcare - medicare advantage,,O,15374.12,2544.37,2558.92,4389.29,9224.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70220,cpt,"X-RAY OF PARANASAL SINUS, COMPLETE, MINIMUM OF 3 VIEWS",united healthcare - medicare advantage,,O,362.65,72.01,75.67,271.99,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",united healthcare - medicare advantage,,O,50.01,4.43,4.43,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82627,cpt,DEHYDROEPIANDROSTERONE (DHEA-S) HORMONE LEVEL,united healthcare - medicare advantage,,O,119.15,21.42,21.79,89.36,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",united healthcare - medicare advantage,,O,246.35,17.59,20.00,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,208,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,united healthcare - medicare advantage,,I,75679.94,16342.73,16527.16,23209.18,45407.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84446,cpt,VITAMIN E LEVEL,united healthcare - medicare advantage,,O,83.76,7.84,13.90,66.59,50.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",united healthcare - medicare advantage,,O,348.89,53.55,75.62,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",united healthcare - medicare advantage,,O,10827.72,2513.53,2558.92,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",united healthcare - medicare advantage,,O,377.65,43.63,96.93,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,united healthcare - medicare advantage,,O,183.82,19.97,21.99,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",united healthcare - medicare advantage,,O,377.65,61.44,93.00,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29827,cpt,REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,38417.80,5736.03,5776.91,17014.63,23050.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0413,revCode,"RESPIRATORY SERVICES, HYPERBARIC OXYGEN THERAPY",united healthcare - medicare advantage,,O,820.35,105.74,105.74,110.56,492.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37252,cpt,"ULTRASOUND EVALUATION OF BLOOD VESSEL DURING DIAGNOSIS OR TREATMENT, INITIAL VESSEL",united healthcare - medicare advantage,,O,55673.45,14994.33,14994.33,14994.33,33404.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89051,cpt,BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,united healthcare - medicare advantage,,O,42.58,5.49,5.49,30.20,6.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1300,cpt,"INJECTION, ECULIZUMAB, 10 MG",united healthcare - medicare advantage,,O,975.43,164.71,164.71,23209.20,585.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91010,cpt,MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT,united healthcare - medicare advantage,,O,3386.38,370.13,662.90,2423.62,2031.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0521,revCode,FREESTANDING CLINIC CLINIC VISIT BY MEMBER TORHC/FQHC,united healthcare - medicare advantage,,O,290.00,111.87,240.50,255.96,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,united healthcare - medicare advantage,,O,60.16,9.91,11.85,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,united healthcare - medicare advantage,,O,45.13,4.38,43.86,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5116,cpt,"INJECTION, TRASTUZUMAB-QYYP, BIOSIMILAR, (TRAZIMERA), 10 MG",united healthcare - medicare advantage,,O,249.43,27.71,27.71,187.07,149.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",united healthcare - medicare advantage,,O,270.00,64.89,236.58,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,united healthcare - medicare advantage,,O,989.19,218.69,230.48,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",united healthcare - medicare advantage,,O,36.32,6.91,13.47,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36226,cpt,INSERTION OF CATHETER INTO CHEST ARTERY FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,united healthcare - medicare advantage,,O,38021.84,2564.86,2564.86,4229.97,22813.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",united healthcare - medicare advantage,,I,225.50,61.14,214.83,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),united healthcare - medicare advantage,,O,41.28,5.08,5.08,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,united healthcare - medicare advantage,,O,3595.37,280.86,377.70,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,908,ms-drg,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,united healthcare - medicare advantage,,I,61086.11,11576.87,13334.79,20349.19,36651.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,251,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC,united healthcare - medicare advantage,,I,66765.78,10498.59,10498.59,16705.15,40059.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,united healthcare - medicare advantage,,O,6833.06,1646.56,2243.38,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),united healthcare - medicare advantage,,O,3857.66,938.20,1418.66,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,united healthcare - medicare advantage,,O,50.01,3.11,5.08,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,united healthcare - medicare advantage,,O,1958.01,473.85,505.33,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",united healthcare - medicare advantage,,O,135.66,25.29,25.30,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3111,cpt,"INJECTION, ROMOSOZUMAB-AQQG, 1 MG",united healthcare - medicare advantage,,O,25.46,6.54,9.58,9.58,15.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28120,cpt,PARTIAL REMOVAL OF FOOT OR HEEL BONE FOR BONE INFECTION IN THE MID HINDFOOT AREA,united healthcare - medicare advantage,,O,34724.90,2630.53,11395.58,11395.58,20834.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,689,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,united healthcare - medicare advantage,,I,21131.83,6249.42,6249.42,7144.57,12679.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,united healthcare - medicare advantage,,O,694.00,180.07,591.03,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,united healthcare - medicare advantage,,O,419.99,136.22,136.22,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",united healthcare - medicare advantage,,O,2.49,0.02,1.57,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,united healthcare - medicare advantage,,O,19028.38,1098.56,7762.10,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",united healthcare - medicare advantage,,O,140.04,24.64,26.33,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,287,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",united healthcare - medicare advantage,,I,42121.79,7205.02,7205.02,13887.33,25273.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93455,cpt,INSERTION OF CATHETER FOR IMAGING OF HEART BLOOD VESSELS AND/OR GRAFTS INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,united healthcare - medicare advantage,,O,61121.26,9202.34,9202.34,9202.34,36672.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70490,cpt,CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1343.10,94.48,98.50,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",united healthcare - medicare advantage,,O,2069.24,93.35,95.51,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,united healthcare - medicare advantage,,O,330.33,24.94,24.94,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85597,cpt,PLATELET FUNCTION TEST,united healthcare - medicare advantage,,O,89.65,6.58,17.63,69.26,21.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80203,cpt,ZONISAMIDE LEVEL,united healthcare - medicare advantage,,O,33.13,12.99,12.99,12.99,19.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,180,ms-drg,RESPIRATORY NEOPLASMS WITH MCC,united healthcare - medicare advantage,,I,39026.63,7529.96,7529.96,7529.96,23415.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",united healthcare - medicare advantage,,O,41.28,5.10,5.12,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,united healthcare - medicare advantage,,O,3055.12,202.81,205.10,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",united healthcare - medicare advantage,,O,82.88,8.42,83.42,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",united healthcare - medicare advantage,,O,1040.92,159.87,159.88,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",united healthcare - medicare advantage,,O,70.01,13.01,22.65,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,united healthcare - medicare advantage,,O,73.83,11.51,14.78,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",united healthcare - medicare advantage,,O,1724.51,97.60,665.06,959.65,801.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5117,cpt,"INJECTION, TRASTUZUMAB-ANNS, BIOSIMILAR, (KANJINTI), 10 MG",united healthcare - medicare advantage,,O,320.89,24.34,34.93,107.23,192.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",united healthcare - medicare advantage,,O,315.99,85.00,194.77,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,united healthcare - medicare advantage,,O,792.84,92.74,94.48,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,united healthcare - medicare advantage,,O,3055.12,203.12,322.92,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,united healthcare - medicare advantage,,O,831.61,156.22,156.53,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36246,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL SECOND ORDER BRANCH",united healthcare - medicare advantage,,O,24259.05,2582.02,2584.63,19004.00,14555.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,united healthcare - medicare advantage,,I,17457.81,5769.18,5769.18,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,united healthcare - medicare advantage,,O,42.58,3.22,3.22,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11602,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",united healthcare - medicare advantage,,O,1956.76,463.46,463.46,469.08,1174.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45331,cpt,BIOPSY OF THE LOWER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY),united healthcare - medicare advantage,,O,4384.17,710.14,710.14,3810.64,2630.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27814,cpt,OPEN TREATMENT OF PROMINENCES OF BOTH BONES OF THE LEG (TIBIA AND FIBULA) IN THE REGION OF THE ANKLE WITHOUT HARDWARE FIXATION,united healthcare - medicare advantage,,O,35327.03,5736.33,5736.33,10489.40,21196.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,united healthcare - medicare advantage,,O,73.83,12.70,14.30,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,253,ms-drg,OTHER VASCULAR PROCEDURES WITH CC,united healthcare - medicare advantage,,I,71874.05,17117.07,17117.07,31459.36,43124.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",united healthcare - medicare advantage,,O,691.54,93.84,94.48,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1442,cpt,"INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM",united healthcare - medicare advantage,,O,4.99,0.72,0.72,269.36,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,united healthcare - medicare advantage,,O,3055.12,204.95,206.30,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,united healthcare - medicare advantage,,O,252.59,75.92,76.80,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,united healthcare - medicare advantage,,O,53.76,5.92,5.92,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,united healthcare - medicare advantage,,O,560.24,92.59,92.60,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11641,cpt,"REMOVAL OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",united healthcare - medicare advantage,,O,3244.66,783.95,783.95,1903.39,1946.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9228,cpt,"INJECTION, IPILIMUMAB, 1 MG",united healthcare - medicare advantage,,O,624.02,124.58,162.79,827.27,374.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,4852.19,224.32,323.17,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11044,cpt,REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS,united healthcare - medicare advantage,,O,6092.03,1247.54,1299.03,23397.56,3655.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,united healthcare - medicare advantage,,O,323.88,75.26,75.27,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,united healthcare - medicare advantage,,O,547.73,91.89,283.87,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,united healthcare - medicare advantage,,I,16808.50,4145.69,4178.28,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",united healthcare - medicare advantage,,O,47.53,8.48,8.48,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",united healthcare - medicare advantage,,O,238.84,35.53,75.27,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",united healthcare - medicare advantage,,O,220.61,25.26,46.05,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85306,cpt,PROTEIN S (CLOTTING INHIBITOR) MEASUREMENT,united healthcare - medicare advantage,,O,187.57,15.02,15.02,187.57,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",united healthcare - medicare advantage,,O,41.28,3.01,4.92,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19084,cpt,"BIOPSY OF BREAST AND PLACEMENT OF LOCATING DEVICE USING ULTRASOUND, EACH ADDITIONAL GROWTH",united healthcare - medicare advantage,,O,13165.69,1257.73,1257.73,2878.34,7899.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5112,cpt,"INJECTION, TRASTUZUMAB-DTTB, BIOSIMILAR, (ONTRUZANT), 10 MG",united healthcare - medicare advantage,,O,297.75,13.43,48.86,2873.58,178.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64447,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO FEMORAL NERVE OF THIGH,united healthcare - medicare advantage,,O,50206.22,11395.58,11395.58,11395.58,30123.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17004,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 15 OR MORE GROWTHS",united healthcare - medicare advantage,,O,978.38,386.09,386.09,386.09,587.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9043,cpt,"INJECTION, CABAZITAXEL, 1 MG",united healthcare - medicare advantage,,O,792.07,201.91,201.91,201.91,475.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,united healthcare - medicare advantage,,I,419.99,92.55,432.59,432.59,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",united healthcare - medicare advantage,,O,734.07,114.82,778.11,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26210,cpt,REMOVAL OR SCRAPING OF FINGER BONE CYST OR GROWTH,united healthcare - medicare advantage,,O,17881.16,1245.05,1245.05,1245.05,10728.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,united healthcare - medicare advantage,,O,1893.35,157.27,300.71,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,united healthcare - medicare advantage,,O,811.59,92.97,96.53,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",united healthcare - medicare advantage,,O,3191.43,324.07,326.39,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29826,cpt,SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,33765.02,2631.25,5776.91,16721.96,6904.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85660,cpt,RED BLOOD CELL SICKLING MEASUREMENT,united healthcare - medicare advantage,,O,36.32,5.40,5.40,20.70,6.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89060,cpt,CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,united healthcare - medicare advantage,,O,40.11,7.18,7.19,40.11,8.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",united healthcare - medicare advantage,,I,190.07,49.10,190.07,190.07,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,580,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",united healthcare - medicare advantage,,I,52656.26,7319.59,11869.75,18388.00,31593.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",united healthcare - medicare advantage,,O,8992.46,1299.03,1299.03,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,233,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC,united healthcare - medicare advantage,,I,285898.27,47239.96,65615.64,86794.01,171538.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,united healthcare - medicare advantage,,O,132.54,29.82,55.09,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",united healthcare - medicare advantage,,O,140.38,11.21,21.33,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",united healthcare - medicare advantage,,O,63.63,6.74,6.74,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,441,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",united healthcare - medicare advantage,,I,27183.75,11619.11,12402.21,20379.28,16310.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,united healthcare - medicare advantage,,O,287.62,21.62,77.66,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,united healthcare - medicare advantage,,O,122.03,31.49,151.09,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36556,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, NOT TUNNELED",united healthcare - medicare advantage,,O,18017.97,2538.20,2538.20,9233.37,10810.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27446,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE OR OUTSIDE AREA",united healthcare - medicare advantage,,O,48530.29,10939.22,10939.22,10939.22,29118.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,179,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,united healthcare - medicare advantage,,I,17711.14,5740.24,6314.99,6314.99,10626.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",united healthcare - medicare advantage,,O,241.34,30.35,30.94,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,3055.12,320.47,326.34,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,united healthcare - medicare advantage,,O,31.24,2.94,8.40,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",united healthcare - medicare advantage,,O,60.16,6.38,6.38,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",united healthcare - medicare advantage,,O,113.79,13.73,29.40,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,28365.62,4521.08,4552.05,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),united healthcare - medicare advantage,,O,166.34,27.39,27.39,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,united healthcare - medicare advantage,,I,1031.60,200.87,807.20,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38505,cpt,NEEDLE BIOPSY OR REMOVAL OF SURFACE LYMPH NODES,united healthcare - medicare advantage,,O,13047.69,1305.53,1305.53,3254.84,7828.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",united healthcare - medicare advantage,,O,245.09,61.44,72.07,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",united healthcare - medicare advantage,,O,151.46,8.03,13.13,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,united healthcare - medicare advantage,,O,908.09,156.44,156.44,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,united healthcare - medicare advantage,,I,26926.14,6286.85,6762.45,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17261,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF TRUNK, ARMS, OR LEGS",united healthcare - medicare advantage,,O,1535.94,159.87,276.16,761.92,921.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81240,cpt,"GENE ANALYSIS (PROTHROMBIN, COAGULATION FACTOR II) A VARIANT",united healthcare - medicare advantage,,O,28.31,27.75,27.75,27.75,16.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,united healthcare - medicare advantage,,I,976.85,256.92,976.85,976.85,586.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",united healthcare - medicare advantage,,I,302.21,52.32,285.11,528.83,181.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90694,cpt,"INFLUENZA VIRUS VACCINE, QUADRIVALENT (AIIV4), INACTIVATED, ADJUVANTED, PRESERVATIVE FREE, FOR INJECTION INTO MUSCLE, 0.5 ML DOSAGE",united healthcare - medicare advantage,,O,205.61,31.23,31.24,31.24,123.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,united healthcare - medicare advantage,,O,71.96,15.59,15.60,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",united healthcare - medicare advantage,,O,41.28,4.92,4.92,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",united healthcare - medicare advantage,,O,176.32,30.07,30.07,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85240,cpt,CLOTTING FACTOR VIII (AHG) MEASUREMENT,united healthcare - medicare advantage,,O,195.83,17.55,17.55,28.62,117.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",united healthcare - medicare advantage,,O,114.43,3.13,19.65,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36558,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, TUNNELED",united healthcare - medicare advantage,,O,20661.93,2586.12,2594.67,6323.15,12397.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36819,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, UPPER ARM, BASILIC VEIN",united healthcare - medicare advantage,,O,28569.86,4455.22,4488.40,8737.59,17141.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33228,cpt,REMOVAL AND REPLACEMENT OF DUAL LEAD PERMANENT PACEMAKER PULSE GENERATOR,united healthcare - medicare advantage,,O,35778.64,8954.12,8954.12,9324.25,21467.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,united healthcare - medicare advantage,,O,2687.44,201.24,203.78,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,united healthcare - medicare advantage,,O,520.22,353.23,353.23,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28810,cpt,AMPUTATION OF TOE AND MIDFOOT BONE,united healthcare - medicare advantage,,O,19213.79,2584.52,2584.83,2584.83,11528.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",united healthcare - medicare advantage,,O,365.14,48.65,75.27,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,united healthcare - medicare advantage,,I,84785.32,12190.37,12219.75,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",united healthcare - medicare advantage,,O,45.06,8.66,17.57,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,united healthcare - medicare advantage,,O,84.93,8.43,12.33,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,united healthcare - medicare advantage,,O,3055.12,206.42,208.18,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",united healthcare - medicare advantage,,O,298.47,56.42,94.55,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82271,cpt,SPECIMEN ANALYSIS FOR BLOOD,united healthcare - medicare advantage,,O,33.85,5.22,5.22,5.22,20.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52224,cpt,DESTRUCTION OF (LESS THAN 0.5 CENTIMETERS) GROWTHS OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,16231.14,2776.54,2776.54,2782.44,9738.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43255,cpt,"CONTROL OF BLEEDING OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",united healthcare - medicare advantage,,O,6706.29,1451.88,1451.88,1514.87,4023.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,united healthcare - medicare advantage,,I,62688.63,11498.14,13206.50,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,united healthcare - medicare advantage,,O,105.03,8.42,35.49,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21933,cpt,"REMOVAL OF GROWTH OF MUSCLE OF BACK OR LOWER SIDES, 5.0 CM OR MORE",united healthcare - medicare advantage,,O,19820.30,2226.69,2226.69,2283.41,11892.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92924,cpt,"REMOVAL OF PLAQUE OF MAJOR CORONARY ARTERY OR BRANCH, ACCESSED THROUGH THE SKIN, SINGLE ARTERY OR BRANCH",united healthcare - medicare advantage,,O,69980.61,9237.12,9237.12,9237.12,41988.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",united healthcare - medicare advantage,,O,1406.87,198.35,331.01,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,united healthcare - medicare advantage,,O,1952.12,144.93,159.41,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",united healthcare - medicare advantage,,O,85.05,7.99,8.84,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,552,ms-drg,MEDICAL BACK PROBLEMS WITHOUT MCC,united healthcare - medicare advantage,,I,21073.12,6620.86,6620.86,9898.71,12643.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5106,cpt,"INJECTION, EPOETIN ALFA-EPBX, BIOSIMILAR, (RETACRIT) (FOR NON-ESRD USE), 1000 UNITS",united healthcare - medicare advantage,,O,34.20,7.63,7.93,16.35,20.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,640,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",united healthcare - medicare advantage,,I,24682.45,5356.97,5356.97,14419.00,14809.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,united healthcare - medicare advantage,,O,143.17,18.59,18.59,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",united healthcare - medicare advantage,,O,91.30,18.02,18.03,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73552,cpt,"X-RAY OF THIGH BONE, MINIMUM 2 VIEWS",united healthcare - medicare advantage,,O,327.63,38.17,75.57,173.76,196.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52310,cpt,"REMOVAL OF FOREIGN BODY, STONE, OR STENT FROM BLADDER CANAL (URETHRA) OR BLADDER USING AN ENDOSCOPE",united healthcare - medicare advantage,,O,18156.04,1619.97,1619.97,2833.10,10893.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23350,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOINT,united healthcare - medicare advantage,,O,5340.22,795.73,968.79,4000.22,3204.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,united healthcare - medicare advantage,,O,236.36,11.30,11.30,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,united healthcare - medicare advantage,,O,69.59,9.12,9.12,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,175,ms-drg,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,united healthcare - medicare advantage,,I,23982.29,5734.35,5734.35,14746.99,14389.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77075,cpt,X-RAY SURVEY OF FOREARM OR WRIST BONE DENSITY,united healthcare - medicare advantage,,O,735.32,61.44,92.90,97.23,441.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,united healthcare - medicare advantage,,I,14826.55,4677.51,5970.81,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52000,cpt,DIAGNOSTIC EXAMINATION OF THE BLADDER AND BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,8341.21,546.15,546.15,552.78,5004.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,96.29,17.55,34.39,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",united healthcare - medicare advantage,,O,513.19,16.80,16.80,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73523,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, MINIMUM OF 5 VIEWS",united healthcare - medicare advantage,,O,715.30,48.27,94.97,552.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",united healthcare - medicare advantage,,O,632.77,59.44,159.23,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",united healthcare - medicare advantage,,O,1997.14,430.17,437.73,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86696,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 2",united healthcare - medicare advantage,,O,126.23,16.29,18.97,94.67,22.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,united healthcare - medicare advantage,,O,101.33,21.90,29.01,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74150,cpt,CT SCAN OF ABDOMEN WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1344.34,95.70,98.50,766.27,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,329,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,united healthcare - medicare advantage,,I,114604.99,18176.89,18176.89,42391.95,68762.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27680,cpt,RELEASE OF LEG AND/OR ANKLE TENDON,united healthcare - medicare advantage,,O,20970.77,2578.63,2578.63,2631.16,12582.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",united healthcare - medicare advantage,,O,221.79,37.73,37.73,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",united healthcare - medicare advantage,,O,101.45,11.20,11.21,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38525,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES OF UNDER THE ARM, OPEN PROCEDURE",united healthcare - medicare advantage,,O,34276.96,4931.97,5150.44,12984.24,20566.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,united healthcare - medicare advantage,,O,351.40,92.60,92.60,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95819,cpt,"MEASUREMENT AND RECORDING OF BRAIN WAVE (EEG) ACTIVITY, AWAKE AND ASLEEP",united healthcare - medicare advantage,,O,826.60,242.61,242.61,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",united healthcare - medicare advantage,,O,47.53,3.60,3.60,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,united healthcare - medicare advantage,,O,348.63,85.16,85.17,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,united healthcare - medicare advantage,,E,2880.28,490.23,528.99,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52601,cpt,REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,21140.75,3922.58,4106.67,12709.61,12684.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23472,cpt,"PROSTHETIC REPAIR OF SHOULDER JOINT, TOTAL SHOULDER",united healthcare - medicare advantage,,O,76075.73,11006.86,11006.86,25947.42,45645.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36223,cpt,INSERTION OF CATHETER INTO INTRACRANIAL ARTERY ON ONE SIDE OF NECK FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,united healthcare - medicare advantage,,O,33170.52,2564.86,2564.86,4542.11,19902.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,united healthcare - medicare advantage,,O,42.51,2.00,2.21,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,united healthcare - medicare advantage,,O,109.71,43.44,43.44,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66982,cpt,COMPLEX REMOVAL OF CATARACT WITH INSERTION OF PROSTHETIC LENS,united healthcare - medicare advantage,,O,16910.08,1876.58,1885.96,4894.22,10146.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52240,cpt,DESTRUCTION AND/OR REMOVAL OF LARGE GROWTHS OF THE BLADDER USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,20599.90,4073.41,4073.41,4073.41,12359.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1569,cpt,"INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILIZED, (E.G., LIQUID), 500 MG",united healthcare - medicare advantage,,O,90.46,32.41,32.41,45.23,54.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",united healthcare - medicare advantage,,O,266.35,64.70,100.59,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71100,cpt,"X-RAY OF RIBS OF ONE SIDE OF BODY, 2 VIEWS",united healthcare - medicare advantage,,O,426.43,49.08,75.67,319.82,255.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,193,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,united healthcare - medicare advantage,,I,28507.68,8334.78,8334.78,17274.09,17104.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,united healthcare - medicare advantage,,I,22023.98,6812.39,8555.98,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",united healthcare - medicare advantage,,O,4116.84,594.86,1283.69,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57283,cpt,REPAIR OF PROLAPSING VAGINAL VAULT THROUGH VAGINA,united healthcare - medicare advantage,,O,42179.41,7936.42,7936.42,7936.42,25307.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),united healthcare - medicare advantage,,O,126.23,10.13,100.59,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",united healthcare - medicare advantage,,O,93.19,13.33,13.33,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73620,cpt,"X-RAY OF FOOT, 2 VIEWS",united healthcare - medicare advantage,,O,267.61,58.94,75.57,206.73,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,united healthcare - medicare advantage,,O,3953.80,1077.08,1077.08,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36410,cpt,"INSERTION OF NEEDLE INTO VEIN, PATIENT 3 YEARS OR OLDER",united healthcare - medicare advantage,,O,4861.11,182.60,182.87,4504.70,2916.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,united healthcare - medicare advantage,,O,78.05,7.37,7.37,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,536,ms-drg,FRACTURES OF HIP AND PELVIS WITHOUT MCC,united healthcare - medicare advantage,,I,16125.10,5605.93,5605.93,6454.84,9675.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,united healthcare - medicare advantage,,O,237.59,106.92,178.95,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",united healthcare - medicare advantage,,O,36.32,4.04,4.21,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0875,cpt,"INJECTION, DALBAVANCIN, 5 MG",united healthcare - medicare advantage,,O,23.28,14.41,14.41,1722.94,13.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,united healthcare - medicare advantage,,O,1880.84,106.44,159.41,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85303,cpt,PROTEIN C ANTIGEN (CLOTTING INHIBITOR) MEASUREMENT,united healthcare - medicare advantage,,O,264.26,13.57,13.57,264.26,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",united healthcare - medicare advantage,,O,240.10,61.44,72.45,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,united healthcare - medicare advantage,,O,3238.42,206.67,319.17,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,147.58,21.05,34.39,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,united healthcare - medicare advantage,,O,513.11,156.86,157.71,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),united healthcare - medicare advantage,,O,91.30,14.31,18.93,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",united healthcare - medicare advantage,,O,98.78,7.87,7.92,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,united healthcare - medicare advantage,,E,880.03,214.07,214.07,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",united healthcare - medicare advantage,,O,52.60,5.67,9.26,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45384,cpt,"REMOVAL OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL BY HOT BIOPSY FORCEPS, USING A FLEXIBLE ENDOSCOPE",united healthcare - medicare advantage,,O,4528.30,938.20,945.46,4749.21,2716.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,united healthcare - medicare advantage,,I,4152.82,995.38,1738.06,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,united healthcare - medicare advantage,,O,3099.12,461.58,610.07,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",united healthcare - medicare advantage,,O,4.27,1.25,4.85,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49324,cpt,INSERTION OF ABDOMINAL CAVITY CATHETER USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,22261.75,4488.40,4488.40,8563.22,13357.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",united healthcare - medicare advantage,,O,148.64,16.43,16.44,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,149.83,34.39,34.39,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",united healthcare - medicare advantage,,O,231.34,36.97,50.36,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,united healthcare - medicare advantage,,O,3055.12,204.02,468.00,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,united healthcare - medicare advantage,,O,862.88,61.44,96.93,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37228,cpt,"BALLOON DILATION OF ARTERY OF ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",united healthcare - medicare advantage,,O,63926.71,9198.02,9198.02,18046.03,38356.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",united healthcare - medicare advantage,,O,345.14,75.82,178.95,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,united healthcare - medicare advantage,,I,108746.38,30644.47,30774.48,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",united healthcare - medicare advantage,,O,356.40,83.75,83.75,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,united healthcare - medicare advantage,,O,351.40,51.44,79.49,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,493,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",united healthcare - medicare advantage,,I,69921.76,14158.62,14158.62,24367.50,41953.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,280,ms-drg,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",united healthcare - medicare advantage,,I,31302.10,10044.53,10841.34,76220.28,18781.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",united healthcare - medicare advantage,,O,348.89,46.07,75.27,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,united healthcare - medicare advantage,,O,130.11,30.48,38.48,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",united healthcare - medicare advantage,,O,441.23,35.97,49.36,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",united healthcare - medicare advantage,,E,5953.08,743.91,846.10,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,united healthcare - medicare advantage,,O,1446.95,312.71,325.83,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,united healthcare - medicare advantage,,O,101.33,11.74,23.60,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,390,ms-drg,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,united healthcare - medicare advantage,,I,12721.53,4148.74,4148.74,6879.39,7632.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,united healthcare - medicare advantage,,O,100.03,11.53,11.54,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,united healthcare - medicare advantage,,O,71.96,7.48,12.17,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25607,cpt,"TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST, ABOVE WRIST, WITH PLACEMENT OF STABILIZING DEVICE",united healthcare - medicare advantage,,O,35608.49,5736.03,5776.91,11244.87,21365.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,100.03,11.76,36.53,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29881,cpt,REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,21489.40,2516.47,2523.67,7609.83,3025.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",united healthcare - medicare advantage,,O,101.45,14.76,20.40,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74175,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN WITH CONTRAST,united healthcare - medicare advantage,,O,1952.12,159.41,270.86,547.34,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",united healthcare - medicare advantage,,O,267.61,46.08,75.67,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86593,cpt,SYPHILIS TEST,united healthcare - medicare advantage,,O,50.01,2.27,4.32,6.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81025,cpt,URINE PREGNANCY TEST,united healthcare - medicare advantage,,O,28.39,1.36,8.44,9.77,17.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,united healthcare - medicare advantage,,O,76.68,5.83,9.52,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",united healthcare - medicare advantage,,O,38.92,3.91,3.92,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83630,cpt,STOOL LACTOFERRIN (IMMUNE SYSTEM PROTEIN) ANALYSIS,united healthcare - medicare advantage,,O,69.59,8.01,19.31,52.19,23.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",united healthcare - medicare advantage,,O,50.72,7.45,11.76,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,united healthcare - medicare advantage,,O,396.41,290.00,312.10,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,united healthcare - medicare advantage,,O,1159.26,202.49,206.30,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",united healthcare - medicare advantage,,O,1015.48,95.84,159.23,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,195,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,united healthcare - medicare advantage,,I,12306.54,4159.34,4643.29,8390.31,7383.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",united healthcare - medicare advantage,,O,3595.37,208.18,208.18,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1753.28,96.00,96.49,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",united healthcare - medicare advantage,,O,1007.94,158.30,163.39,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36569,cpt,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER FOR INFUSION (PICC), PATIENT 5 YEARS OR OLDER",united healthcare - medicare advantage,,O,2853.53,1292.67,1292.67,2529.35,1712.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,united healthcare - medicare advantage,,I,30232.58,9248.60,9289.62,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99496,cpt,"TRANSITIONAL CARE MANAGEMENT SERVICES, HIGHLY COMPLEXITY, REQUIRING FACE-TO-FACE VISITS WITHIN 7 DAYS OF DISCHARGE",united healthcare - medicare advantage,,O,322.00,247.37,247.37,247.37,193.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70487,cpt,CT SCAN OF FACE WITH CONTRAST,united healthcare - medicare advantage,,O,1526.37,159.37,376.11,376.11,915.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",united healthcare - medicare advantage,,I,16029.09,4785.97,5418.88,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80177,cpt,LEVETIRACETAM LEVEL,united healthcare - medicare advantage,,O,71.96,9.99,12.99,57.20,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1750,cpt,"INJECTION, IRON DEXTRAN, 50 MG",united healthcare - medicare advantage,,O,60.87,16.97,16.97,45.65,36.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,united healthcare - medicare advantage,,O,1481.91,158.58,379.61,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,united healthcare - medicare advantage,,O,108.53,13.66,14.28,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,united healthcare - medicare advantage,,O,351.40,81.48,81.48,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,united healthcare - medicare advantage,,O,76.68,7.98,11.17,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,united healthcare - medicare advantage,,O,266.35,64.70,100.59,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22514,cpt,INJECTION OF BONE CEMENT INTO BODY OF LOWER SPINE BONE ACCESSED THROUGH THE SKIN USING IMAGING GUIDANCE,united healthcare - medicare advantage,,O,37406.27,5736.03,18976.00,18976.00,22443.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46922,cpt,REMOVAL OF TISSUE ABNORMALITIES OF ANUS,united healthcare - medicare advantage,,O,21622.26,2226.69,2226.69,2226.69,12973.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,united healthcare - medicare advantage,,O,440.18,84.89,206.30,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84100,cpt,PHOSPHATE LEVEL,united healthcare - medicare advantage,,O,40.11,4.65,4.65,30.08,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,371,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,united healthcare - medicare advantage,,I,34493.37,11008.95,11008.95,12164.75,20696.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1343.10,94.47,94.48,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",united healthcare - medicare advantage,,O,252.47,43.75,44.07,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,united healthcare - medicare advantage,,O,83.78,3.34,3.64,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86695,cpt,"ANALYSIS FOR ANTIBODY TO HERPES SIMPLEX VIRUS, TYPE 1",united healthcare - medicare advantage,,O,89.65,10.18,12.93,67.24,15.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",united healthcare - medicare advantage,,O,35.00,2.32,2.33,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64624,cpt,DESTRUCTION OF GENICULAR NERVE BRANCHES OF KNEE BY INJECTION USING IMAGING GUIDANCE,united healthcare - medicare advantage,,O,5206.83,1562.39,1563.67,2589.93,3124.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L4396,cpt,"STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR FIT, FOR POSITIONING, MAY BE USED FOR MINIMAL AMBULATION, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDE",united healthcare - medicare advantage,,O,580.18,189.66,189.66,189.66,348.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",united healthcare - medicare advantage,,O,650.28,61.44,93.00,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",united healthcare - medicare advantage,,O,70.78,13.97,24.97,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",united healthcare - medicare advantage,,O,365.14,61.44,75.27,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73600,cpt,"X-RAY OF ANKLE, 2 VIEWS",united healthcare - medicare advantage,,O,267.61,61.44,75.47,173.76,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20930,cpt,FRAGMENTED DONOR BONE GRAFT OR PLACEMENT OF MATERIAL TO PROMOTE BONE GROWTH FOR SPINE SURGERY,united healthcare - medicare advantage,,O,75615.32,11349.44,18976.00,18976.00,45369.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,united healthcare - medicare advantage,,O,16541.64,1561.79,1561.79,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84207,cpt,VITAMIN B-6 LEVEL,united healthcare - medicare advantage,,O,134.49,18.96,27.54,142.55,80.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,67042,cpt,"REMOVAL OF MEMBRANE FROM THE RETINA, PARS PLANA APPROACH WITH REMOVAL OF INTERNAL LIMITING MEMBRANE OF RETINA",united healthcare - medicare advantage,,O,25134.50,7237.96,7237.96,7237.96,15080.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,2707.46,156.22,160.51,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",united healthcare - medicare advantage,,O,70.06,8.29,8.30,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,united healthcare - medicare advantage,,O,69.59,7.80,16.14,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,united healthcare - medicare advantage,,O,70.06,8.01,8.01,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",united healthcare - medicare advantage,,O,135.66,14.84,18.03,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,united healthcare - medicare advantage,,O,67.58,5.08,5.08,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80299,cpt,QUANTITATION OF THERAPEUTIC DRUG,united healthcare - medicare advantage,,O,46.60,5.86,18.27,18.72,27.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80162,cpt,"DIGOXIN LEVEL, TOTAL",united healthcare - medicare advantage,,O,101.33,13.02,13.02,13.33,15.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73040,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF SHOULDER JOINT,united healthcare - medicare advantage,,O,1406.87,212.42,331.20,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,united healthcare - medicare advantage,,O,35679.28,5647.61,5776.91,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28118,cpt,REMOVAL OF HEEL BONE,united healthcare - medicare advantage,,O,31022.88,2578.63,2578.63,15484.76,18613.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,united healthcare - medicare advantage,,O,345.14,124.25,182.87,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),united healthcare - medicare advantage,,O,65.11,4.25,8.25,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0277,cpt,"HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL",united healthcare - medicare advantage,,O,820.35,105.74,105.74,110.56,492.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,united healthcare - medicare advantage,,O,348.63,85.16,85.17,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,309,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,united healthcare - medicare advantage,,I,17858.14,5166.37,5166.37,8901.93,10714.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64494,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SECOND LEVEL",united healthcare - medicare advantage,,O,4519.81,1107.35,1107.35,2566.99,2711.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",united healthcare - medicare advantage,,O,127.54,21.16,21.19,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11105,cpt,"PUNCH BIOPSY, EACH ADDITIONAL SKIN GROWTH",united healthcare - medicare advantage,,O,1676.92,308.97,308.97,308.97,1006.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,884,ms-drg,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,united healthcare - medicare advantage,,I,19200.53,9086.43,9086.43,10997.54,11520.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17260,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS OR LESS) OF TRUNK, ARMS, OR LEGS",united healthcare - medicare advantage,,O,1985.48,273.66,273.66,761.92,1191.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,337,ms-drg,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,united healthcare - medicare advantage,,I,42487.64,10142.47,10257.75,11374.57,25492.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,united healthcare - medicare advantage,,O,2149.71,310.75,310.75,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,united healthcare - medicare advantage,,O,41.19,1.80,22.06,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87496,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS (CMV), AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,202.57,34.39,34.39,34.39,121.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82803,cpt,BLOOD GASES MEASUREMENT,united healthcare - medicare advantage,,O,167.56,25.68,25.68,172.59,30.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,897,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",united healthcare - medicare advantage,,I,20249.18,5831.92,5928.62,9701.00,12149.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,united healthcare - medicare advantage,,O,52.60,6.75,6.76,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,united healthcare - medicare advantage,,O,3055.12,204.02,207.12,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,united healthcare - medicare advantage,,O,106.28,8.57,8.57,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",united healthcare - medicare advantage,,O,36.32,3.59,4.40,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",united healthcare - medicare advantage,,I,551.43,162.47,726.43,1560.66,330.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",united healthcare - medicare advantage,,O,125.04,27.28,58.45,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",united healthcare - medicare advantage,,O,2042.16,944.83,1164.10,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,united healthcare - medicare advantage,,O,203.82,49.80,49.80,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,united healthcare - medicare advantage,,O,9.11,0.50,78.37,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",united healthcare - medicare advantage,,O,51.68,6.81,180.97,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",united healthcare - medicare advantage,,O,19538.26,2569.95,2569.95,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83090,cpt,HOMOCYSTEINE (AMINO ACID) LEVEL,united healthcare - medicare advantage,,O,48.76,14.61,17.57,22.40,29.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",united healthcare - medicare advantage,,O,71.96,7.91,7.91,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",united healthcare - medicare advantage,,O,422.68,79.93,236.16,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L4386,cpt,"WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PA",united healthcare - medicare advantage,,O,646.53,179.87,180.97,222.75,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73701,cpt,CT SCAN OF LEG WITH CONTRAST MATERIAL,united healthcare - medicare advantage,,O,1630.73,156.23,156.23,159.02,978.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,united healthcare - medicare advantage,,O,195.07,21.19,21.19,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",united healthcare - medicare advantage,,O,734.07,19.80,778.11,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",united healthcare - medicare advantage,,O,91.30,6.24,10.35,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",united healthcare - medicare advantage,,O,154.76,24.25,30.74,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9354,cpt,"INJECTION, ADO-TRASTUZUMAB EMTANSINE, 1 MG",united healthcare - medicare advantage,,O,131.30,30.33,30.33,43.44,78.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,united healthcare - medicare advantage,,E,292.62,111.66,122.82,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",united healthcare - medicare advantage,,O,1893.35,485.97,496.27,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",united healthcare - medicare advantage,,O,12.72,0.71,3.94,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",united healthcare - medicare advantage,,I,212.36,46.07,144.72,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",united healthcare - medicare advantage,,O,184.32,70.33,104.45,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49083,cpt,DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE,united healthcare - medicare advantage,,O,3277.05,723.30,723.30,2260.51,1966.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",united healthcare - medicare advantage,,O,5902.67,335.59,1156.23,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84681,cpt,C-PEPTIDE (PROTEIN) LEVEL,united healthcare - medicare advantage,,O,93.19,15.38,20.40,74.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86592,cpt,SYPHILIS DETECTION TEST,united healthcare - medicare advantage,,O,40.11,4.18,4.19,30.08,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",united healthcare - medicare advantage,,O,547.73,117.10,288.14,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,united healthcare - medicare advantage,,O,42.58,4.32,7.06,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,698,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,united healthcare - medicare advantage,,I,27219.24,6918.41,6918.41,18262.00,16331.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,22630,cpt,"FUSION OF LOWER SPINE BONE AND PARTIAL REMOVAL OF SPINE BONE OR DISC THROUGH BACK, 1 DISC",united healthcare - medicare advantage,,O,75615.32,18976.00,18976.00,18976.00,45369.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",united healthcare - medicare advantage,,O,348.89,56.80,75.62,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,united healthcare - medicare advantage,,O,402.67,93.28,93.54,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",united healthcare - medicare advantage,,O,90.84,3.51,20.40,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,united healthcare - medicare advantage,,O,188.17,66.99,104.71,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86148,cpt,PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUREMENT,united healthcare - medicare advantage,,O,87.30,12.69,15.75,46.36,52.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,147.58,21.05,34.39,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",united healthcare - medicare advantage,,O,1029.19,93.54,93.82,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare - medicare advantage,,O,100.04,20.74,58.45,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73720,cpt,MRI SCAN OF LEG BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,3055.12,325.59,329.51,1041.43,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0105,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK,united healthcare - medicare advantage,,O,3209.39,717.96,719.92,719.92,1925.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,united healthcare - medicare advantage,,O,287.62,77.37,78.63,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",united healthcare - medicare advantage,,O,3457.28,1078.00,1078.00,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",united healthcare - medicare advantage,,O,3583.92,323.18,325.83,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,united healthcare - medicare advantage,,O,231.34,36.98,50.59,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38500,cpt,"BIOPSY OR REMOVAL OF LYMPH NODES, OPEN PROCEDURE",united healthcare - medicare advantage,,O,29779.21,5148.44,5148.44,5148.44,17867.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78816,cpt,NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY,united healthcare - medicare advantage,,O,8009.86,1290.20,1294.20,2705.32,4805.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,united healthcare - medicare advantage,,O,107.35,17.69,19.24,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",united healthcare - medicare advantage,,O,365.24,8.63,14.10,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,240,ms-drg,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,united healthcare - medicare advantage,,I,48148.78,17032.79,17364.48,31073.16,28889.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",united healthcare - medicare advantage,,O,362.65,61.08,72.12,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,united healthcare - medicare advantage,,O,87.53,4.18,4.19,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",united healthcare - medicare advantage,,O,281.36,90.50,95.49,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",united healthcare - medicare advantage,,I,1997.14,545.14,1997.14,19187.06,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,united healthcare - medicare advantage,,I,1274.16,335.11,590.00,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",united healthcare - medicare advantage,,O,345.14,36.70,36.71,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,united healthcare - medicare advantage,,O,252.59,55.19,58.45,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85048,cpt,AUTOMATED WHITE BLOOD CELL COUNT,united healthcare - medicare advantage,,O,41.12,2.49,2.49,2.49,24.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,united healthcare - medicare advantage,,O,67.58,3.47,5.67,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,united healthcare - medicare advantage,,O,3580.43,810.94,810.94,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,united healthcare - medicare advantage,,O,187.57,14.84,100.59,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49406,cpt,"FLUID COLLECTION DRAINAGE OF THE ABDOMINAL REGION BY CATHETER USING IMAGING GUIDANCE, ACCESSED THROUGH THE SKIN",united healthcare - medicare advantage,,O,10801.65,1304.34,1304.34,2260.51,6480.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,united healthcare - medicare advantage,,O,256.35,58.45,58.45,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,united healthcare - medicare advantage,,O,5444.73,938.10,938.11,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36600,cpt,ARTERIAL PUNCTURE WITHDRAWAL OF BLOOD FOR DIAGNOSIS,united healthcare - medicare advantage,,O,190.07,28.97,100.59,195.77,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73222,cpt,MRI SCAN OF ARM JOINT WITH CONTRAST,united healthcare - medicare advantage,,O,3055.12,461.27,637.59,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",united healthcare - medicare advantage,,O,650.28,61.44,93.00,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87902,cpt,ANALYSIS TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS,united healthcare - medicare advantage,,O,824.65,76.19,252.31,437.97,302.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,united healthcare - medicare advantage,,I,17945.73,6102.59,7367.09,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93668,cpt,PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION PER SESSION,united healthcare - medicare advantage,,O,148.80,49.55,50.21,64.11,89.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9023,cpt,"INJECTION, AVELUMAB, 10 MG",united healthcare - medicare advantage,,O,358.90,86.41,86.41,86.41,215.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,united healthcare - medicare advantage,,O,1952.12,344.86,378.11,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,551,ms-drg,MEDICAL BACK PROBLEMS WITH MCC,united healthcare - medicare advantage,,I,43126.53,10113.34,11872.78,11872.78,25875.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",united healthcare - medicare advantage,,O,90.84,9.28,9.29,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,870,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,united healthcare - medicare advantage,,I,192936.51,41518.66,45377.47,55725.83,115761.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",united healthcare - medicare advantage,,O,218.83,30.93,33.02,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36592,cpt,COLLECTION OF BLOOD SPECIMEN FROM CENTRAL OR PERIPHERAL VENOUS CATHETER,united healthcare - medicare advantage,,O,187.57,13.08,100.59,190.87,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,242,ms-drg,PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC,united healthcare - medicare advantage,,I,73228.16,26146.55,26146.55,26146.55,43936.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11104,cpt,PUNCH BIOPSY OF SINGLE SKIN LESION,united healthcare - medicare advantage,,O,1520.45,308.97,308.97,312.72,912.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,united healthcare - medicare advantage,,O,19198.81,2406.74,2578.47,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",united healthcare - medicare advantage,,O,622.77,61.44,92.95,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,united healthcare - medicare advantage,,I,74793.54,13792.29,14048.60,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,united healthcare - medicare advantage,,O,7543.40,1294.20,1294.20,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",united healthcare - medicare advantage,,O,50.72,5.89,5.89,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",united healthcare - medicare advantage,,O,16.70,0.37,34.06,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86141,cpt,"MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION, HIGH SENSITIVITY",united healthcare - medicare advantage,,O,83.78,12.69,12.70,17.55,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",united healthcare - medicare advantage,,O,105.03,12.96,35.49,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,united healthcare - medicare advantage,,O,95.55,14.26,14.26,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,united healthcare - medicare advantage,,O,3055.12,205.61,206.30,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",united healthcare - medicare advantage,,O,108.88,10.16,16.61,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,4054.33,319.17,323.17,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77372,cpt,"RADIATION THERAPY DELIVERY, STEREOTACTIC RADIOSURGERY (SRS) FOR CRANIAL GROWTHS, PER SESSION, USING A LINEAR ACCELERATOR",united healthcare - medicare advantage,,O,23204.58,6663.20,10102.14,10102.14,13922.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27369,cpt,INJECTION OF CONTRAST FOR IMAGING OF KNEE JOINT,united healthcare - medicare advantage,,O,3155.01,479.40,479.40,481.29,1893.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",united healthcare - medicare advantage,,O,31.24,4.67,5.20,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,united healthcare - medicare advantage,,O,83.76,6.73,88.78,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",united healthcare - medicare advantage,,O,1099.23,114.80,115.55,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",united healthcare - medicare advantage,,O,13.80,2.61,3.11,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",united healthcare - medicare advantage,,O,494.32,41.98,41.99,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11981,cpt,INSERTION OF DRUG DELIVERY IMPLANT INTO TISSUE,united healthcare - medicare advantage,,O,40615.05,2631.16,5776.91,5776.91,24369.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,united healthcare - medicare advantage,,I,48.06,11.46,22.68,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83825,cpt,MERCURY LEVEL,united healthcare - medicare advantage,,O,132.12,15.93,15.94,27.18,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,857,ms-drg,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,united healthcare - medicare advantage,,I,58450.53,13402.18,13437.77,19974.44,35070.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,united healthcare - medicare advantage,,I,27884.18,6142.25,8108.54,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33208,cpt,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER INCLUDING UPPER AND LOWER CHAMBER ELECTRODES,united healthcare - medicare advantage,,O,42383.14,9221.09,9223.30,17558.91,25429.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52356,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) WITH STENT USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,26186.13,3916.85,3916.85,10931.90,15711.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",united healthcare - medicare advantage,,O,757.37,185.43,185.43,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",united healthcare - medicare advantage,,O,826.60,239.39,239.39,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64495,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, THIRD AND ANY ADDITIONAL LEVEL(S)",united healthcare - medicare advantage,,O,4552.63,1111.87,1111.87,2202.56,2731.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,united healthcare - medicare advantage,,O,899.10,136.27,337.23,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",united healthcare - medicare advantage,,O,1138.00,159.38,160.53,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,708,ms-drg,MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC,united healthcare - medicare advantage,,I,50441.22,9356.57,9356.57,9356.57,30264.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,605,ms-drg,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",united healthcare - medicare advantage,,I,13265.14,6299.63,6299.63,9754.07,7959.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19301,cpt,PARTIAL REMOVAL OF BREAST,united healthcare - medicare advantage,,O,31896.98,2805.32,5150.44,12984.24,19138.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9305,cpt,"INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG",united healthcare - medicare advantage,,O,280.11,3.19,46.79,76.83,168.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,united healthcare - medicare advantage,,I,5986.20,1090.17,2867.18,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74174,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST,united healthcare - medicare advantage,,O,1840.81,323.17,323.17,1326.08,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",united healthcare - medicare advantage,,O,245.09,44.06,75.67,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9025,cpt,"INJECTION, AZACITIDINE, 1 MG",united healthcare - medicare advantage,,O,14.99,0.42,0.42,6.63,8.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",united healthcare - medicare advantage,,O,2526.13,486.47,496.27,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,478,ms-drg,BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,united healthcare - medicare advantage,,I,59227.50,15137.07,15137.07,22824.33,35536.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9395,cpt,"INJECTION, FULVESTRANT, 25 MG",united healthcare - medicare advantage,,O,421.43,10.87,11.89,316.07,252.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52204,cpt,BIOPSY OF THE BLADDER USING AN ENDOSCOPE,united healthcare - medicare advantage,,O,16937.27,1612.75,1619.97,8967.03,10162.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,602,ms-drg,CELLULITIS WITH MCC,united healthcare - medicare advantage,,I,27263.26,7119.45,9415.25,14531.98,16357.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,236,ms-drg,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,united healthcare - medicare advantage,,I,167790.54,25758.09,25758.09,46477.00,100674.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",united healthcare - medicare advantage,,O,1680.75,111.66,988.52,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,united healthcare - medicare advantage,,O,93.19,5.27,98.78,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,united healthcare - medicare advantage,,O,754.07,203.12,206.30,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",united healthcare - medicare advantage,,O,369.82,61.44,92.60,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",united healthcare - medicare advantage,,I,18651.52,4921.84,5464.36,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",united healthcare - medicare advantage,,O,754.07,158.88,206.30,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",united healthcare - medicare advantage,,O,635.27,137.73,310.75,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,united healthcare - medicare advantage,,I,16493.28,2797.28,5732.06,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93283,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, DUAL LEAD DEFIBRILLATOR SYSTEM",united healthcare - medicare advantage,,O,288.87,30.93,30.94,32.32,173.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,178,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,united healthcare - medicare advantage,,I,19678.73,7277.47,7277.47,14434.95,11807.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,united healthcare - medicare advantage,,O,4630.63,693.07,1540.46,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",united healthcare - medicare advantage,,O,19.52,4.40,19.56,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",united healthcare - medicare advantage,,O,13.78,1.69,4.19,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37226,cpt,"INSERTION OF STENTS INTO ARTERIES IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",united healthcare - medicare advantage,,O,79683.80,11770.38,14994.33,14994.33,47810.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,united healthcare - medicare advantage,,O,213.87,28.75,46.68,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,united healthcare - medicare advantage,,O,113.25,11.78,13.99,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",united healthcare - medicare advantage,,O,108.49,21.05,34.39,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36821,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, ANY SITE AS SEPARATE PROCEDURE",united healthcare - medicare advantage,,O,21470.01,2569.92,2601.70,10309.61,12882.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",united healthcare - medicare advantage,,O,73.14,3.60,3.60,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,united healthcare - medicare advantage,,O,31.88,2.63,4.30,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",united healthcare - medicare advantage,,I,238.84,62.82,301.99,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,535,ms-drg,FRACTURES OF HIP AND PELVIS WITH MCC,united healthcare - medicare advantage,,I,21743.33,8468.58,8468.58,10843.67,13046.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,639,ms-drg,DIABETES WITHOUT CC/MCC,united healthcare - medicare advantage,,I,14759.59,3312.91,4277.96,10029.42,8855.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,united healthcare - medicare advantage,,I,32181.45,11429.58,11616.52,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",united healthcare - medicare advantage,,O,2073.43,311.07,312.10,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,united healthcare - medicare advantage,,O,145.10,29.21,40.46,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",united healthcare - medicare advantage,,O,680.29,236.16,236.16,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0121,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK,united healthcare - medicare advantage,,O,3195.82,717.96,719.92,1255.30,1917.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,united healthcare - medicare advantage,,I,124.70,13.59,124.70,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,united healthcare - medicare advantage,,I,16915.97,4140.71,5577.85,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,united healthcare - medicare advantage,,O,188.17,19.53,104.71,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",united healthcare - medicare advantage,,O,3919.67,159.22,463.46,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,234,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,united healthcare - medicare advantage,,I,205358.74,31986.81,31986.81,50803.66,123215.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",united healthcare - medicare advantage,,O,203.82,32.52,53.46,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70480,cpt,CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1343.10,93.35,94.48,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36247,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL THIRD ORDER BRANCH",united healthcare - medicare advantage,,O,26881.27,2581.62,2584.63,29201.92,16128.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",united healthcare - medicare advantage,,O,107.59,3.13,19.65,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,united healthcare - medicare advantage,,O,10678.57,58.46,2542.70,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,united healthcare - medicare advantage,,I,18716.13,4221.86,5894.37,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0114,revCode,ROOM AND BOARD PRIVATE (ONE BED) PSYCHIATRIC,united healthcare - medicare advantage,,I,2332.29,629.26,835.66,3095.92,1399.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,united healthcare - medicare advantage,,O,67.58,8.51,8.51,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13132,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, UNDERARMS, GENITALS, HANDS, AND/OR FEET",united healthcare - medicare advantage,,O,5466.42,783.95,783.95,2243.72,3279.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,256,ms-drg,UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,united healthcare - medicare advantage,,I,46734.84,10563.76,10563.76,10563.76,28040.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",united healthcare - medicare advantage,,O,56.26,6.34,6.35,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,united healthcare - medicare advantage,,I,75778.57,12009.61,12009.61,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93291,cpt,"EVALUATION OF HEART RHYTHM MONITOR SYSTEM IMPLANTED UNDER SKIN WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",united healthcare - medicare advantage,,O,139.10,21.65,21.65,22.06,83.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,united healthcare - medicare advantage,,I,19710.37,4922.26,6789.37,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,united healthcare - medicare advantage,,O,80.09,1.66,10.13,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82553,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, MB FRACTION ONLY",united healthcare - medicare advantage,,O,45.06,8.39,11.32,33.80,13.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19303,cpt,SIMPLE COMPLETE REMOVAL OF BREAST,united healthcare - medicare advantage,,O,32479.31,5148.44,5148.44,5253.51,19487.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",united healthcare - medicare advantage,,O,25.94,5.08,5.08,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,united healthcare - medicare advantage,,O,80.09,5.66,9.26,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",united healthcare - medicare advantage,,I,1356.71,52.51,854.25,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,united healthcare - medicare advantage,,O,646.53,93.49,95.65,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",united healthcare - medicare advantage,,O,101.45,14.76,20.40,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",united healthcare - medicare advantage,,O,67.24,14.75,14.75,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",united healthcare - medicare advantage,,O,183.82,24.23,26.87,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",united healthcare - medicare advantage,,O,66.26,9.83,9.84,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",united healthcare - medicare advantage,,O,312.63,61.44,72.12,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36589,cpt,REMOVAL OF CENTRAL VENOUS CATHETER FOR INFUSION,united healthcare - medicare advantage,,O,1252.35,2586.12,2594.67,4542.11,751.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3262,cpt,"INJECTION, TOCILIZUMAB, 1 MG",united healthcare - medicare advantage,,O,16.33,5.84,5.84,5.84,9.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2353,cpt,"INJECTION, OCTREOTIDE, DEPOT FORM FOR INTRAMUSCULAR INJECTION, 1 MG",united healthcare - medicare advantage,,O,714.06,172.18,202.35,205.65,428.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9022,cpt,"INJECTION, ATEZOLIZUMAB, 10 MG",united healthcare - medicare advantage,,O,156.30,38.92,79.18,82.27,93.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",united healthcare - medicare advantage,,O,4496.04,1078.59,1079.21,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",united healthcare - medicare advantage,,O,60.03,13.90,13.90,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",united healthcare - medicare advantage,,O,519.10,54.18,83.40,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,286,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",united healthcare - medicare advantage,,I,55760.94,13702.32,13702.32,26072.17,33456.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",united healthcare - medicare advantage,,O,350.39,39.08,60.75,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46260,cpt,REMOVAL OF MULTIPLE INTERNAL AND EXTERNAL HEMORRHOID GROUPS,united healthcare - medicare advantage,,O,18904.18,2231.78,2244.06,4726.84,11342.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",united healthcare - medicare advantage,,O,1091.80,160.12,160.53,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,united healthcare - medicare advantage,,O,842.86,94.39,96.49,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93281,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT MULTIPLE LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",united healthcare - medicare advantage,,O,257.60,30.44,30.94,136.53,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,united healthcare - medicare advantage,,O,42.58,6.02,6.02,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,united healthcare - medicare advantage,,O,770.33,202.50,206.30,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",united healthcare - medicare advantage,,O,120.33,16.46,16.47,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",united healthcare - medicare advantage,,O,285.11,61.44,73.90,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",united healthcare - medicare advantage,,O,38.92,2.65,2.65,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,united healthcare - medicare advantage,,O,521.47,92.78,94.48,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43248,cpt,INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,united healthcare - medicare advantage,,O,3996.24,1081.46,1081.46,3758.90,2397.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",united healthcare - medicare advantage,,O,158.29,56.98,158.29,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85732,cpt,"COAGULATION ASSESSMENT BLOOD TEST, SUBSTITUTION, PLASMA FRACTIONS",united healthcare - medicare advantage,,O,35.39,4.06,6.35,27.34,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9041,cpt,"INJECTION, BORTEZOMIB (VELCADE), 0.1 MG",united healthcare - medicare advantage,,O,20.57,3.00,3.00,39.05,12.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,united healthcare - medicare advantage,,I,84.46,20.40,20.40,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,united healthcare - medicare advantage,,O,50.72,6.35,6.36,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,united healthcare - medicare advantage,,I,1704.46,353.32,2409.63,2409.63,1022.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,100,ms-drg,SEIZURES WITH MCC,united healthcare - medicare advantage,,I,27764.15,6132.00,12296.08,14577.74,16658.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62321,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK USING IMAGING GUIDANCE,united healthcare - medicare advantage,,O,2267.14,558.18,558.18,1776.12,1360.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,united healthcare - medicare advantage,,O,152.18,14.75,14.75,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",united healthcare - medicare advantage,,O,281.00,8.75,810.94,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1439,cpt,"INJECTION, FERRIC CARBOXYMALTOSE, 1 MG",united healthcare - medicare advantage,,O,4.71,0.79,0.79,4.99,2.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,469,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT,united healthcare - medicare advantage,,I,100772.39,20511.57,20511.57,20511.57,60463.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,268,ms-drg,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,united healthcare - medicare advantage,,I,18273.76,15118.51,44762.62,44762.62,10964.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,united healthcare - medicare advantage,,O,10678.57,95.85,2542.70,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",united healthcare - medicare advantage,,O,54.32,13.67,14.15,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,united healthcare - medicare advantage,,O,6554.34,441.62,1157.61,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",united healthcare - medicare advantage,,O,4.99,0.54,0.55,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,united healthcare - medicare advantage,,O,412.67,92.59,92.60,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,united healthcare - medicare advantage,,O,1952.12,159.41,161.38,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19285,cpt,"PLACEMENT OF BREAST LOCALIZATION DEVICES ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",united healthcare - medicare advantage,,O,31940.44,2805.32,5150.44,7734.30,19164.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28725,cpt,"FUSION OF FOOT BELOW THE ANKLE, SIMPLE",united healthcare - medicare advantage,,O,50206.22,11395.58,11395.58,11395.58,30123.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,united healthcare - medicare advantage,,O,5902.67,923.22,1153.79,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,united healthcare - medicare advantage,,O,221.79,37.03,37.85,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80185,cpt,"PHENYTOIN LEVEL, TOTAL",united healthcare - medicare advantage,,O,108.53,12.98,12.99,17.58,15.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11642,cpt,"REMOVAL OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",united healthcare - medicare advantage,,O,3061.00,710.75,710.75,2453.97,1836.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,united healthcare - medicare advantage,,O,148.64,17.37,18.42,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82310,cpt,"CALCIUM LEVEL, TOTAL",united healthcare - medicare advantage,,O,38.80,5.06,5.06,11.12,23.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11644,cpt,"REMOVAL OF MALIGNANT GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE FACE, EARS, EYELIDS, NOSE, OR LIPS",united healthcare - medicare advantage,,O,6093.94,1257.73,1257.73,1257.73,3656.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",united healthcare - medicare advantage,,O,373.90,92.59,92.60,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,united healthcare - medicare advantage,,I,36086.42,12423.48,12709.66,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84075,cpt,"PHOSPHATASE (ENZYME) LEVEL, ALKALINE",united healthcare - medicare advantage,,O,40.11,5.08,5.08,5.63,24.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",united healthcare - medicare advantage,,O,318.54,72.28,86.28,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38221,cpt,BIOPSY OF BONE MARROW,united healthcare - medicare advantage,,O,11762.92,1253.74,1253.74,1253.74,7057.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93459,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND/OR GRAFTS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,united healthcare - medicare advantage,,O,28921.96,2582.89,5906.55,5906.55,17353.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",united healthcare - medicare advantage,,O,52.60,8.84,8.84,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36830,cpt,CREATION OF ARTERY-VEIN CONNECTION USING TUBE GRAFT FOR HEMODIALYSIS,united healthcare - medicare advantage,,O,30956.95,4464.51,4477.41,4543.34,18574.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,united healthcare - medicare advantage,,I,78211.42,12813.14,13649.58,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,united healthcare - medicare advantage,,O,89.65,18.15,18.15,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83935,cpt,URINE OSMOLALITY (CONCENTRATION) MEASUREMENT,united healthcare - medicare advantage,,O,104.49,6.68,6.69,6.69,62.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,united healthcare - medicare advantage,,O,2599.91,94.47,94.48,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0885,cpt,"INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS",united healthcare - medicare advantage,,O,96.21,6.95,6.95,6.95,57.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,united healthcare - medicare advantage,,O,3055.12,202.50,202.50,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",united healthcare - medicare advantage,,O,65.11,10.15,14.41,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73060,cpt,"X-RAY OF UPPER ARM, MINIMUM OF 2 VIEWS",united healthcare - medicare advantage,,O,245.09,22.66,75.57,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",united healthcare - medicare advantage,,O,200.00,27.06,33.29,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,269,ms-drg,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,united healthcare - medicare advantage,,I,126793.83,26601.95,27046.79,29409.56,76076.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86709,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),united healthcare - medicare advantage,,O,106.28,11.04,11.04,19.42,63.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,united healthcare - medicare advantage,,O,414.89,93.99,96.53,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87106,cpt,"FUNGAL CULTURE, YEAST",united healthcare - medicare advantage,,O,112.65,7.28,10.12,16.71,67.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",united healthcare - medicare advantage,,I,145.15,30.77,104.97,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",united healthcare - medicare advantage,,I,231.34,60.43,231.34,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86341,cpt,ISLET CELL (PANCREAS) ANTIBODY MEASUREMENT,united healthcare - medicare advantage,,O,139.21,23.10,23.10,23.67,83.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,united healthcare - medicare advantage,,O,138.03,9.70,24.94,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,308,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,united healthcare - medicare advantage,,I,28408.75,7603.87,7734.68,14046.88,17045.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42400,cpt,NEEDLE BIOPSY OF SALIVARY GLAND,united healthcare - medicare advantage,,O,3268.58,556.26,556.26,573.66,1961.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",united healthcare - medicare advantage,,O,233.84,30.94,30.94,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",united healthcare - medicare advantage,,O,199.37,74.90,94.75,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0330,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION GENERAL,united healthcare - medicare advantage,,O,1511.29,404.86,1511.29,1511.29,906.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17280,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.5 CENTIMETERS OR LESS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",united healthcare - medicare advantage,,O,1675.86,159.23,159.23,410.05,1005.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,united healthcare - medicare advantage,,O,43.18,10.79,16.93,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12052,cpt,"REPAIR OF WOUND (2.6 TO 5.0 CENTIMETERS) OF FACE, EARS, EYELIDS, NOSE, LIPS, AND/OR MOUTH",united healthcare - medicare advantage,,O,2739.04,984.24,984.24,1248.81,1643.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,united healthcare - medicare advantage,,O,56.62,7.92,7.92,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,united healthcare - medicare advantage,,O,184.32,70.33,104.45,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,united healthcare - medicare advantage,,O,3222.12,719.92,902.21,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,united healthcare - medicare advantage,,I,6.27,0.90,5.57,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64493,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SINGLE LEVEL",united healthcare - medicare advantage,,O,4480.53,1107.35,1107.35,2566.99,2688.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17282,cpt,"DESTRUCTION OF MALIGNANT GROWTH (1.1 TO 2.0 CENTIMETERS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",united healthcare - medicare advantage,,O,2553.54,312.72,545.53,545.53,1532.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",united healthcare - medicare advantage,,O,151.64,21.05,34.39,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,united healthcare - medicare advantage,,O,60.03,7.19,11.75,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,united healthcare - medicare advantage,,O,252.59,54.84,58.45,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5101,cpt,"INJECTION, FILGRASTIM-SNDZ, BIOSIMILAR, (ZARXIO), 1 MICROGRAM",united healthcare - medicare advantage,,O,1.96,0.20,0.27,0.53,1.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97164,cpt,"RE-EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",united healthcare - medicare advantage,,O,133.30,44.40,64.84,75.98,79.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",united healthcare - medicare advantage,,O,419.99,46.79,290.70,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,united healthcare - medicare advantage,,O,178.08,50.28,50.29,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87116,cpt,CULTURE FOR ACID-FAST BACILLI,united healthcare - medicare advantage,,O,113.25,10.59,10.59,84.94,12.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",united healthcare - medicare advantage,,O,1997.14,273.93,435.86,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,united healthcare - medicare advantage,,O,30.49,2.32,2.33,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",united healthcare - medicare advantage,,O,68064.84,9197.64,11757.85,27750.61,40838.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,united healthcare - medicare advantage,,O,101.45,12.63,14.46,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,4054.33,322.67,322.67,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84484,cpt,"TROPONIN (PROTEIN) ANALYSIS, QUANTITATIVE",united healthcare - medicare advantage,,O,176.37,12.22,12.23,186.95,14.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,united healthcare - medicare advantage,,O,176.37,11.81,11.81,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",united healthcare - medicare advantage,,O,15729.98,1862.99,1877.19,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",united healthcare - medicare advantage,,O,376.41,61.44,93.00,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0260,cpt,"INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY",united healthcare - medicare advantage,,O,2193.04,562.74,562.74,1003.01,1315.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91037,cpt,MONITORING AND RECORDING OF ESOPHAGEAL FUNCTION THROUGH NASAL TUBE WITH ELECTRODE,united healthcare - medicare advantage,,O,3401.95,370.13,662.90,2397.37,2041.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",united healthcare - medicare advantage,,O,116.79,7.81,10.53,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,united healthcare - medicare advantage,,O,1630.73,338.97,338.97,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",united healthcare - medicare advantage,,O,437.43,101.00,102.02,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",united healthcare - medicare advantage,,O,62.51,14.38,36.71,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",united healthcare - medicare advantage,,O,94.14,7.61,7.62,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,united healthcare - medicare advantage,,O,298.87,98.24,99.01,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,united healthcare - medicare advantage,,O,383.02,34.82,312.72,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,300,ms-drg,PERIPHERAL VASCULAR DISORDERS WITH CC,united healthcare - medicare advantage,,I,16027.98,6756.27,7109.24,12036.47,9616.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85613,cpt,"CLOTTING FACTOR X ASSESSMENT TEST, DILUTED",united healthcare - medicare advantage,,O,44.82,3.29,9.39,34.63,11.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,united healthcare - medicare advantage,,O,8198.69,1161.40,1161.40,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",united healthcare - medicare advantage,,I,757.37,203.30,757.37,5591.21,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80051,cpt,"BLOOD TEST PANEL FOR ELECTROLYTES (SODIUM POTASSIUM, CHLORIDE, CARBON DIOXIDE)",united healthcare - medicare advantage,,O,65.11,6.87,6.87,48.83,39.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36245,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, EACH FIRST ORDER BRANCH",united healthcare - medicare advantage,,O,25437.42,2540.45,2540.45,4685.12,15262.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,896,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",united healthcare - medicare advantage,,I,34188.85,7909.34,11313.11,19332.34,20513.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",united healthcare - medicare advantage,,O,422.68,79.92,239.49,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64479,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO UPPER OR MIDDLE SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",united healthcare - medicare advantage,,O,7223.75,739.73,1116.39,2764.46,4334.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84300,cpt,URINE SODIUM LEVEL,united healthcare - medicare advantage,,O,37.50,3.04,4.96,5.08,22.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,united healthcare - medicare advantage,,O,41.26,8.55,57.51,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",united healthcare - medicare advantage,,O,7.91,1.68,7.92,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93660,cpt,EVALUATION OF HEART FUNCTION USING TILT TABLE,united healthcare - medicare advantage,,O,1208.02,288.64,434.31,821.83,724.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73590,cpt,"X-RAY OF LOWER LEG, 2 VIEWS",united healthcare - medicare advantage,,O,267.61,48.10,75.67,212.74,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82330,cpt,"CALCIUM LEVEL, IONIZED",united healthcare - medicare advantage,,O,89.65,13.41,13.41,21.16,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,246,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,united healthcare - medicare advantage,,I,112798.01,18912.25,18912.25,59595.14,67678.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,united healthcare - medicare advantage,,I,26508.25,6362.98,9824.28,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",united healthcare - medicare advantage,,O,85.39,17.80,22.05,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10140,cpt,DRAINAGE OF BLOOD OR FLUID ACCUMULATION,united healthcare - medicare advantage,,O,18672.07,1309.64,1309.64,5930.73,11203.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64484,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",united healthcare - medicare advantage,,O,7561.13,743.72,1103.79,2728.97,4536.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9316,cpt,"INJECTION, PERTUZUMAB, TRASTUZUMAB, AND HYALURONIDASE-ZZXF, PER 10 MG",united healthcare - medicare advantage,,O,254.14,66.85,66.85,66.85,152.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78070,cpt,NUCLEAR MEDICINE STUDY OF PARATHYROID,united healthcare - medicare advantage,,O,1393.12,337.82,337.82,777.36,835.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,164,ms-drg,MAJOR CHEST PROCEDURES WITH CC,united healthcare - medicare advantage,,I,103938.91,16060.55,16060.55,25897.15,62363.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17281,cpt,"DESTRUCTION OF MALIGNANT GROWTH (0.6 TO 1.0 CENTIMETERS) OF FACE, EARS, EYELIDS, NOSE, LIPS, OR MOUTH",united healthcare - medicare advantage,,O,2044.74,311.97,545.53,545.53,1226.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1753.28,94.47,97.52,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73702,cpt,CT SCAN OF LEG BEFORE AND AFTER CONTRAST INJECTION,united healthcare - medicare advantage,,O,2362.30,156.43,156.43,482.16,1417.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",united healthcare - medicare advantage,,O,238.30,63.70,94.00,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92920,cpt,"BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORONARY ARTERY OR BRANCH (ACCESSED THROUGH THE SKIN), EACH ADDITIONAL ARTERY OR BRANCH",united healthcare - medicare advantage,,O,56646.63,4554.88,4554.88,22653.36,33987.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,united healthcare - medicare advantage,,O,183.82,20.77,22.21,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,united healthcare - medicare advantage,,O,2289.17,554.60,719.92,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,united healthcare - medicare advantage,,O,50.00,8.06,12.70,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",united healthcare - medicare advantage,,I,1952.12,434.32,1952.12,1952.12,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5120,cpt,"INJECTION, PEGFILGRASTIM-BMEZ, BIOSIMILAR, (ZIEXTENZO), 0.5 MG",united healthcare - medicare advantage,,O,1004.49,80.06,132.84,411.12,602.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",united healthcare - medicare advantage,,O,331.50,12.98,12.98,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,501,ms-drg,SOFT TISSUE PROCEDURES WITH CC,united healthcare - medicare advantage,,I,78496.87,11464.77,11494.70,19965.84,47098.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84145,cpt,PROCALCITONIN (HORMONE) LEVEL,united healthcare - medicare advantage,,O,97.91,26.68,26.68,32.12,32.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86161,cpt,MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM PROTEINS),united healthcare - medicare advantage,,O,30.00,9.98,11.76,15.00,18.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73140,cpt,"X-RAY OF FINGERS, MINIMUM OF 2 VIEWS",united healthcare - medicare advantage,,O,240.10,61.44,75.47,180.08,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93279,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT SINGLE LEAD PACEMAKER SYSTEM IN ONE CHAMBER OF HEART WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",united healthcare - medicare advantage,,O,191.31,30.35,33.02,33.02,114.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9308,cpt,"INJECTION, RAMUCIRUMAB, 5 MG",united healthcare - medicare advantage,,O,244.70,36.68,67.62,175.88,146.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,united healthcare - medicare advantage,,O,1753.28,94.47,96.49,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",united healthcare - medicare advantage,,O,238.30,71.54,94.43,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",united healthcare - medicare advantage,,O,502.71,78.63,244.11,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37607,cpt,TYING OR BANDING OF SURGICALLY CREATED ARTERY-VEIN CONNECTION,united healthcare - medicare advantage,,O,17782.73,2551.81,2551.81,2580.62,10669.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80307,cpt,"TESTING FOR PRESENCE OF DRUG, BY CHEMISTRY ANALYZERS",united healthcare - medicare advantage,,O,197.60,49.05,60.90,77.68,118.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,united healthcare - medicare advantage,,O,4054.33,324.17,732.63,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",united healthcare - medicare advantage,,O,65.11,8.45,8.45,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,united healthcare - medicare advantage,,O,3055.12,202.94,206.30,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66991,cpt,EXTRACAPSULAR REMOVAL OF CATARACT WITH INSERTION OF ARTIFICIAL LENS AND INSERTION OF DRAINAGE DEVICE IN FRONT CHAMBER OF EYE,united healthcare - medicare advantage,,O,9278.04,2229.79,3690.13,3757.14,5566.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",united healthcare - medicare advantage,,O,91.43,5.96,95.00,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,united healthcare - medicare advantage,,O,303.87,29.81,58.93,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),united healthcare - medicare advantage,,O,29523.82,4577.80,11206.20,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,united healthcare - medicare advantage,,O,94.38,2.18,10.53,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",united healthcare - medicare advantage,,O,348.89,61.44,75.67,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73120,cpt,"X-RAY OF HAND, 2 VIEWS",united healthcare - medicare advantage,,O,240.10,38.01,96.93,96.93,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",united healthcare - medicare advantage,,O,130.95,13.50,17.70,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,united healthcare - medicare advantage,,O,4318.19,810.94,810.94,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",united healthcare - medicare advantage,,O,83.33,15.97,26.08,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare - medicare advantage,,O,93.77,21.35,36.71,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",united healthcare - medicare advantage,,O,1.42,0.39,1.44,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",united healthcare - medicare advantage,,O,252.47,44.06,155.84,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93923,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, COMPLETE",united healthcare - medicare advantage,,O,445.18,123.80,123.80,125.34,267.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",united healthcare - medicare advantage,,O,117.54,25.46,58.45,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,united healthcare medicare adv,,O,3055.12,203.12,2291.34,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,united healthcare medicare adv,,I,1274.16,335.11,335.11,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,united healthcare medicare adv,,I,84.46,20.40,89.89,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",united healthcare medicare adv,,O,47.53,8.48,8.65,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",united healthcare medicare adv,,O,266.35,51.50,76.80,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,united healthcare medicare adv,,I,976.85,256.92,256.92,976.85,586.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",united healthcare medicare adv,,I,183.82,35.02,46.38,172.26,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",united healthcare medicare adv,,O,71.96,7.91,8.07,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,united healthcare medicare adv,,I,18716.13,4221.86,14130.71,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,united healthcare medicare adv,,O,73.83,11.51,55.37,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,united healthcare medicare adv,,O,547.73,91.89,332.64,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,united healthcare medicare adv,,O,188.17,19.53,125.04,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",united healthcare medicare adv,,O,5902.67,335.59,4552.18,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",united healthcare medicare adv,,O,220.61,25.26,46.98,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",united healthcare medicare adv,,O,151.46,8.03,13.39,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,united healthcare medicare adv,,O,67.58,3.47,5.78,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,united healthcare medicare adv,,O,31.24,2.94,8.57,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",united healthcare medicare adv,,O,120.33,16.46,16.80,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",united healthcare medicare adv,,O,36.32,4.04,4.29,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,united healthcare medicare adv,,O,42.51,2.00,2.25,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",united healthcare medicare adv,,O,82.61,19.42,82.61,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",united healthcare medicare adv,,O,519.10,54.18,85.10,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,united healthcare medicare adv,,O,351.40,51.44,204.93,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,united healthcare medicare adv,,O,647.78,92.64,615.32,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,united healthcare medicare adv,,O,76.68,7.98,57.51,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,united healthcare medicare adv,,O,106.28,8.57,8.74,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",united healthcare medicare adv,,I,944.41,228.70,228.70,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,united healthcare medicare adv,,O,752.83,92.79,598.49,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",united healthcare medicare adv,,I,238.84,62.82,62.82,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",united healthcare medicare adv,,I,799.31,175.61,292.06,484.84,479.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,united healthcare medicare adv,,O,1893.35,157.27,2008.27,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,united healthcare medicare adv,,O,4054.33,324.17,3040.75,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,united healthcare medicare adv,,O,3683.73,275.00,5218.57,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",united healthcare medicare adv,,O,65.06,17.18,65.39,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",united healthcare medicare adv,,O,91.30,6.24,10.56,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",united healthcare medicare adv,,O,93.77,21.35,93.77,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,united healthcare medicare adv,,O,3055.12,206.42,3055.12,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",united healthcare medicare adv,,O,85.05,7.99,10.56,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",united healthcare medicare adv,,O,13.80,2.61,6.76,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,united healthcare medicare adv,,O,351.40,81.48,263.55,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,united healthcare medicare adv,,O,101.33,11.74,24.08,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,united healthcare medicare adv,,O,53.76,5.92,6.04,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",united healthcare medicare adv,,O,19.52,4.40,19.55,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,united healthcare medicare adv,,O,3055.12,204.95,3055.12,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",united healthcare medicare adv,,O,117.54,25.46,117.54,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,united healthcare medicare adv,,O,1205.09,132.64,1737.02,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,united healthcare medicare adv,,O,42.58,3.22,42.58,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,united healthcare medicare adv,,I,22023.98,6812.39,8934.32,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",united healthcare medicare adv,,O,547.73,117.10,547.73,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",united healthcare medicare adv,,O,10827.72,2513.53,6367.55,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",united healthcare medicare adv,,O,2526.13,486.47,2008.27,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0430,revCode,"OCCUPATIONAL THERAPY, GENERAL",united healthcare medicare adv,,I,194.27,39.00,46.37,54.36,116.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,united healthcare medicare adv,,O,101.33,21.90,52.80,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,united healthcare medicare adv,,O,122.03,31.49,122.03,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,united healthcare medicare adv,,O,145.10,29.21,75.06,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",united healthcare medicare adv,,O,41.06,11.36,41.06,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,united healthcare medicare adv,,O,4054.33,319.17,3040.75,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,united healthcare medicare adv,,I,4152.82,995.38,1092.21,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83835,cpt,METANEPHRINES LEVEL,united healthcare medicare adv,,O,79.04,16.60,16.94,59.28,47.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",united healthcare medicare adv,,O,125.04,27.28,125.04,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",united healthcare medicare adv,,O,1997.14,273.93,437.16,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,united healthcare medicare adv,,O,306.38,103.42,243.57,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,united healthcare medicare adv,,O,93.19,5.27,69.89,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,united healthcare medicare adv,,O,195.07,21.19,146.30,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",united healthcare medicare adv,,O,16.23,1.83,12.17,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,united healthcare medicare adv,,O,50.01,3.11,5.18,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,united healthcare medicare adv,,O,38.92,4.65,29.20,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",united healthcare medicare adv,,O,70.06,8.29,8.46,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,united healthcare medicare adv,,I,163.02,40.45,40.45,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,united healthcare medicare adv,,O,41.26,8.55,25.88,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,united healthcare medicare adv,,O,3055.12,320.47,2291.34,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",united healthcare medicare adv,,O,94.14,7.61,7.77,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,united healthcare medicare adv,,I,316.37,68.94,83.21,633.75,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,united healthcare medicare adv,,I,1386.23,364.58,364.58,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",united healthcare medicare adv,,O,4.22,1.00,3.73,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),united healthcare medicare adv,,O,91.30,14.31,19.31,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",united healthcare medicare adv,,O,8.17,0.89,7.85,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",united healthcare medicare adv,,O,38.92,3.91,3.99,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",united healthcare medicare adv,,O,135.66,14.84,18.39,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,united healthcare medicare adv,,O,221.79,37.03,38.62,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",united healthcare medicare adv,,O,331.50,12.98,248.62,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,united healthcare medicare adv,,O,113.25,11.78,14.27,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,united healthcare medicare adv,,O,3055.12,204.02,3055.12,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",united healthcare medicare adv,,O,315.99,85.00,198.74,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82652,cpt,"DIHYDROXYVITAMIN D, 1, 25 LEVEL",united healthcare medicare adv,,O,221.79,37.73,38.50,166.34,45.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,united healthcare medicare adv,,O,440.18,84.89,208.18,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78195,cpt,NUCLEAR MEDICINE STUDY OF LYMPHATIC SYSTEM,united healthcare medicare adv,,O,2847.53,457.66,2847.53,2847.53,1708.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9520,cpt,"TECHNETIUM TC-99M TILMANOCEPT, DIAGNOSTIC, UP TO 0.5 MILLICURIES",united healthcare medicare adv,,O,1862.08,641.93,1862.08,1862.08,1117.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2930,cpt,"INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UP TO 125 MG",united healthcare medicare adv,,O,91.43,5.96,95.00,95.00,54.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77001,cpt,"FLUOROSCOPIC GUIDANCE FOR INSERTION, REPLACEMENT OR REMOVAL OF CENTRAL VENOUS ACCESS DEVICE",united healthcare medicare adv,,O,847.87,227.86,847.87,847.87,508.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,united healthcare medicare adv,,O,842.86,94.39,632.15,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",united healthcare medicare adv,,O,4.12,1.10,4.12,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2370,cpt,"INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML",united healthcare medicare adv,,O,88.24,14.05,91.52,174.28,52.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",united healthcare medicare adv,,O,1997.14,430.17,440.96,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",united healthcare medicare adv,,O,90.84,3.51,72.22,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",united healthcare medicare adv,,O,369.82,61.44,462.34,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,united healthcare medicare adv,,O,41.19,1.80,41.06,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",united healthcare medicare adv,,O,50.01,4.43,4.52,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",united healthcare medicare adv,,O,734.07,114.82,778.11,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,united healthcare medicare adv,,O,213.87,28.75,47.63,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",united healthcare medicare adv,,I,231.34,60.43,60.85,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",united healthcare medicare adv,,O,56.26,6.34,6.47,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,united healthcare medicare adv,,I,48.06,11.46,12.33,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,united healthcare medicare adv,,O,56.62,7.92,8.08,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",united healthcare medicare adv,,O,252.47,43.75,298.47,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",united healthcare medicare adv,,O,298.47,66.35,298.47,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",united healthcare medicare adv,,O,13.78,1.69,4.27,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1788,cpt,"PORT, INDWELLING (IMPLANTABLE)",united healthcare medicare adv,,O,1737.02,466.81,1737.02,1737.02,1042.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",united healthcare medicare adv,,O,502.71,78.63,532.87,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,united healthcare medicare adv,,O,9.11,0.50,19.17,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",united healthcare medicare adv,,O,734.07,19.80,1320.10,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83525,cpt,"INSULIN MEASUREMENT, TOTAL",united healthcare medicare adv,,O,101.45,11.20,11.43,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",united healthcare medicare adv,,O,52.60,8.84,9.02,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,united healthcare medicare adv,,O,203.82,49.80,50.81,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",united healthcare medicare adv,,O,290.00,66.00,367.85,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",united healthcare medicare adv,,O,88.56,20.43,88.56,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",united healthcare medicare adv,,O,419.99,46.79,419.99,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,united healthcare medicare adv,,O,502.71,78.63,532.87,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",united healthcare medicare adv,,O,38.92,2.65,2.70,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,united healthcare medicare adv,,O,694.00,180.07,964.08,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9968,cpt,"INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION ADJUNCT (E.G., METHYLENE BLUE, ISOSULFAN BLUE), 1 MG",united healthcare medicare adv,,O,50.44,21.10,50.44,50.44,30.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,united healthcare medicare adv,,O,419.99,136.22,419.99,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",united healthcare medicare adv,,I,145.15,30.77,30.77,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,united healthcare medicare adv,,O,203.82,49.80,50.81,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,united healthcare medicare adv,,O,90.02,12.05,13.63,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,united healthcare medicare adv,,O,71.96,7.48,53.97,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,united healthcare medicare adv,,O,383.02,34.82,329.78,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,united healthcare medicare adv,,O,76.68,5.83,9.71,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,veterans administration medicare advantage,,I,124.70,13.59,13.59,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",veterans administration medicare advantage,,I,145.15,30.77,39.43,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,veterans administration medicare advantage,,O,502.71,78.63,239.34,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,veterans administration medicare advantage,,O,383.02,34.82,208.61,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",veterans administration medicare advantage,,I,212.36,46.07,55.02,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,veterans administration medicare advantage,,I,5902.00,1055.41,3278.26,28002.03,3541.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0440,revCode,OCCUPATIONAL THERAPY GENERAL,veterans administration medicare advantage,,I,380.16,90.74,129.79,129.79,228.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,veterans administration medicare advantage,,I,36086.42,12423.48,13599.17,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,veterans administration medicare advantage,,I,19710.37,4922.26,7181.87,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",veterans administration medicare advantage,,I,757.37,203.30,401.57,5591.21,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,veterans administration medicare advantage,,I,36086.42,12423.48,13643.05,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",veterans administration medicare advantage,,I,238.84,62.82,80.56,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",veterans administration medicare advantage,,I,2599.91,780.60,887.63,1949.93,1559.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,veterans administration medicare advantage,,I,84.46,20.40,74.43,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,veterans administration medicare advantage,,I,6.27,0.90,5.33,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,veterans administration medicare advantage,,I,75778.57,12009.61,13823.39,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,veterans administration medicare advantage,,I,1031.60,200.87,239.52,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,veterans administration medicare advantage,,O,188.17,66.99,105.13,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",veterans administration medicare advantage,,I,231.34,60.43,78.98,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,veterans administration medicare advantage,,I,1704.46,353.32,710.54,2409.63,1022.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",veterans administration medicare advantage,,I,183.82,35.02,40.06,172.26,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",veterans administration medicare advantage,,I,302.21,52.32,52.32,528.83,181.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",veterans administration medicare advantage,,I,3595.37,858.13,1227.48,2535.33,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",veterans administration medicare advantage,,I,944.41,228.70,237.19,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",veterans administration medicare advantage,,O,502.71,78.63,239.34,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,veterans administration medicare advantage,,I,48.06,11.46,17.06,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,veterans administration medicare advantage,,O,647.78,92.97,92.97,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",veterans administration medicare advantage,,I,1356.71,52.51,228.45,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,veterans administration medicare advantage,,I,5986.20,1090.17,2043.73,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,381,ms-drg,COMPLICATED PEPTIC ULCER WITH CC,veterans administration medicare advantage,,I,26479.34,7578.10,7578.10,12742.06,15887.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,veterans administration medicare advantage,,I,1133.33,141.17,141.17,1464.70,680.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,veterans administration medicare advantage,,I,16915.97,4140.71,5891.34,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,veterans administration medicare advantage,,I,1386.23,364.58,387.69,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",veterans administration medicare advantage,,I,405.73,85.84,85.84,95.96,243.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,veterans administration medicare advantage,,I,316.37,68.94,68.94,633.75,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,veterans administration medicare advantage,,I,163.02,40.45,52.50,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,veterans administration medicare advantage,,I,108746.38,30644.47,32607.64,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",veterans administration medicare advantage,,I,225.50,61.14,72.72,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,veterans administration medicare advantage,,O,647.78,92.64,92.97,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,veterans administration medicare advantage,,I,1274.16,335.11,435.01,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26055,cpt,INCISION OF TENDON COVERING OF FINGER,veterans affairs,,O,17730.63,1248.60,1260.13,4980.73,10638.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11103,cpt,"BIOPSY OF RELATED SKIN GROWTH, EACH ADDITIONAL GROWTH",veterans affairs,,O,1138.00,159.38,162.46,685.82,682.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,veterans affairs,,I,17945.73,6102.59,8407.92,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,558,ms-drg,"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",veterans affairs,,I,9766.23,3665.63,6494.17,9877.45,5859.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,163,ms-drg,MAJOR CHEST PROCEDURES WITH MCC,veterans affairs,,I,127066.02,46734.06,46734.06,46734.06,76239.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78306,cpt,NUCLEAR MEDICINE STUDY OF BONE AND/OR JOINT WHOLE BODY,veterans affairs,,O,899.10,136.27,342.26,777.36,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,veterans affairs,,O,187.57,14.84,102.63,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11044,cpt,REMOVAL OF SKIN AND BONE FIRST 20 SQ CM OR LESS,veterans affairs,,O,6092.03,1247.54,1325.18,23397.56,3655.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72158,cpt,MRI SCAN OF LOWER SPINAL CANAL BEFORE AND AFTER CONTRAST,veterans affairs,,O,4054.33,327.84,333.16,3131.97,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",veterans affairs,,I,265.10,62.70,62.70,62.70,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,veterans affairs,,O,7543.40,1294.20,1316.48,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,374,ms-drg,DIGESTIVE MALIGNANCY WITH MCC,veterans affairs,,I,21410.93,11344.37,11796.91,12885.84,12846.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36830,cpt,CREATION OF ARTERY-VEIN CONNECTION USING TUBE GRAFT FOR HEMODIALYSIS,veterans affairs,,O,30956.95,4464.51,4543.19,4543.34,18574.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,veterans affairs,,O,213.87,28.75,47.63,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,veterans affairs,,O,42.51,2.00,2.25,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,179,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,veterans affairs,,I,17711.14,5740.24,5740.24,6314.99,10626.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",veterans affairs,,O,71.96,7.91,8.07,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0277,cpt,"HYPERBARIC OXYGEN UNDER PRESSURE, FULL BODY CHAMBER, PER 30 MINUTE INTERVAL",veterans affairs,,O,820.35,105.74,110.55,110.56,492.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33249,cpt,INSERTION OR REPLACEMENT OF SINGLE OR DUAL CHAMBER PACING DEFIBRILLATOR LEADS,veterans affairs,,O,103183.41,27788.91,28346.49,50189.53,61910.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,165,ms-drg,MAJOR CHEST PROCEDURES WITHOUT CC/MCC,veterans affairs,,I,72218.89,13702.50,13702.50,13702.50,43331.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82731,cpt,FETAL FIBRONECTIN (PROTEIN) ANALYSIS,veterans affairs,,O,565.34,62.32,64.41,424.01,108.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20690,cpt,PLACEMENT OF SINGLE DIRECTION EXTERNAL BONE STABILIZING DEVICE TO ARM OR LEG,veterans affairs,,O,36360.21,5846.87,5846.87,5846.87,21816.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,270,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,veterans affairs,,I,66302.58,30493.48,34458.62,58398.86,39781.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86225,cpt,"MEASUREMENT OF DNA ANTIBODY, NATIVE OR DOUBLE STRANDED",veterans affairs,,O,36.32,6.91,13.74,27.22,21.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23515,cpt,OPEN TREATMENT OF COLLAR BONE BROKEN,veterans affairs,,O,44215.64,5667.02,5845.48,5845.48,26529.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27654,cpt,SECONDARY REPAIR OF RUPTURED ACHILLES TENDON,veterans affairs,,O,32249.15,5736.03,5846.87,16282.30,19349.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,veterans affairs,,O,41.26,8.55,30.60,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,330,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,veterans affairs,,I,65131.57,7666.11,17210.61,70105.98,39078.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,veterans affairs,,I,18651.11,4387.85,6577.73,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86255,cpt,SCREENING TEST FOR ANTIBODY TO NONINFECTIOUS AGENT,veterans affairs,,O,93.19,11.22,12.05,53.12,14.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1561,cpt,"INJECTION, IMMUNE GLOBULIN, (GAMUNEX-C/GAMMAKED), NON-LYOPHILIZED (E.G., LIQUID), 500 MG",veterans affairs,,O,181.32,15.19,15.19,57.73,108.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,veterans affairs,,I,17457.81,5769.18,6324.50,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,433,ms-drg,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,veterans affairs,,I,20174.42,7400.64,7769.48,7769.48,12104.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",veterans affairs,,O,199.37,74.90,95.90,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,veterans affairs,,O,1893.35,157.27,317.05,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28750,cpt,FUSION OF GREAT TOE AT THE JOINT WITH THE FOOT,veterans affairs,,O,33226.41,5666.83,5666.83,11244.87,19935.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77301,cpt,MANAGEMENT OF MODULATION RADIOTHERAPY PLANNING,veterans affairs,,O,8198.69,1161.40,1184.78,6333.49,1349.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46250,cpt,REMOVAL OF MULTIPLE EXTERNAL HEMORRHOIDS,veterans affairs,,O,17632.50,2210.23,2210.23,5521.37,10579.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84146,cpt,PROLACTIN (MILK PRODUCING HORMONE) LEVEL,veterans affairs,,O,116.31,18.99,19.38,87.23,22.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84520,cpt,"UREA NITROGEN LEVEL TO ASSESS KIDNEY FUNCTION, QUANTITATIVE",veterans affairs,,O,40.11,3.87,3.95,30.08,4.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72131,cpt,CT SCAN OF LOWER SPINE WITHOUT CONTRAST,veterans affairs,,O,1753.28,94.47,94.47,400.81,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11771,cpt,EXTENSIVE REMOVAL OF CYST OF TAILBONE,veterans affairs,,O,19648.60,2145.13,2145.13,5607.96,11789.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28153,cpt,PARTIAL REMOVAL OF TOE BONE JOINTS,veterans affairs,,O,14689.76,2630.53,2630.53,2630.53,8813.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97606,cpt,"NEGATIVE PRESSURE WOUND THERAPY, SURFACE AREA GREATER THAN 50 SQUARE CENTIMETERS, PER SESSION",veterans affairs,,O,5770.63,513.40,513.40,513.40,3462.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36246,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, INITIAL SECOND ORDER BRANCH",veterans affairs,,O,24259.05,2582.02,2632.89,19004.00,14555.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11422,cpt,"REMOVAL OF GROWTH (1.1 TO 2.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",veterans affairs,,O,18352.47,1273.00,1325.50,2649.40,11011.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",veterans affairs,,O,513.19,16.80,17.14,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,101,ms-drg,SEIZURES WITHOUT MCC,veterans affairs,,I,18716.13,4221.86,7026.52,14130.71,11229.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",veterans affairs,,O,691.54,93.84,98.50,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64495,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, THIRD AND ANY ADDITIONAL LEVEL(S)",veterans affairs,,O,4552.63,1111.87,1129.63,2202.56,2731.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,veterans affairs,,O,3055.12,204.95,206.42,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",veterans affairs,,O,345.14,75.82,182.59,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,236,ms-drg,CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC,veterans affairs,,I,167790.54,25758.09,27632.49,46477.00,100674.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43280,cpt,STRENGTHENING OF MUSCLE BETWEEN ESOPHAGUS AND STOMACH BY WRAPPING PART OF STOMACH AROUND ESOPHAGUS USING AN ENDOSCOPE,veterans affairs,,O,36571.06,7902.70,8030.63,26906.78,21942.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84155,cpt,"TOTAL PROTEIN LEVEL, BLOOD",veterans affairs,,O,73.14,3.60,3.67,54.86,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25607,cpt,"TREATMENT OF BROKEN FOREARM BONE ON THUMB SIDE OF WRIST, ABOVE WRIST, WITH PLACEMENT OF STABILIZING DEVICE",veterans affairs,,O,35608.49,5736.03,5756.85,11244.87,21365.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",veterans affairs,,O,10827.72,2513.53,2562.13,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,veterans affairs,,O,50.00,8.06,12.95,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86161,cpt,MEASUREMENT OF COMPLEMENT FUNCTION (IMMUNE SYSTEM PROTEINS),veterans affairs,,O,30.00,9.98,12.00,15.00,18.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",veterans affairs,,O,135.66,25.29,25.81,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0256,cpt,"INJECTION, ALPHA 1 PROTEINASE INHIBITOR (HUMAN), NOT OTHERWISE SPECIFIED, 10 MG",veterans affairs,,O,7.94,5.85,5.85,5.85,4.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",veterans affairs,,I,2599.91,780.60,780.60,1949.93,1559.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",veterans affairs,,O,38.92,3.91,3.99,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,veterans affairs,,E,292.62,111.66,123.45,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86709,cpt,MEASUREMENT OF HEPATITIS A ANTIBODY (IGM),veterans affairs,,O,106.28,11.04,11.26,19.42,63.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58571,cpt,ABDOMINAL REMOVAL OF UTERUS (250 GRAMS OR LESS) WITH REMOVAL OF TUBES AND/OR OVARIES USING AN ENDOSCOPE,veterans affairs,,O,31160.78,7903.69,8032.54,22750.02,18696.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",veterans affairs,,O,25.94,5.08,5.18,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36430,cpt,TRANSFUSION OF BLOOD OR BLOOD PRODUCTS,veterans affairs,,O,520.22,353.23,360.34,520.22,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36589,cpt,REMOVAL OF CENTRAL VENOUS CATHETER FOR INFUSION,veterans affairs,,O,1252.35,2586.12,4542.11,4542.11,751.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,252,ms-drg,OTHER VASCULAR PROCEDURES WITH MCC,veterans affairs,,I,66686.69,20797.71,22243.38,38100.00,40012.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82024,cpt,ADRENOCORTICOTROPIC HORMONE (ACTH) LEVEL,veterans affairs,,O,221.79,37.03,38.62,166.34,133.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,veterans affairs,,O,183.82,20.77,23.01,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,veterans affairs,,O,76.68,5.83,9.71,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,207,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,veterans affairs,,I,183013.56,35773.89,40061.86,40158.29,109808.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27380,cpt,"SUTURE OF TENDON BELOW KNEE, PRIMARY",veterans affairs,,O,30213.09,5845.48,5845.48,5847.07,18127.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",veterans affairs,,I,78.76,19.94,19.94,24.47,47.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,veterans affairs,,O,2289.17,554.60,732.06,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",veterans affairs,,O,250.10,18.15,18.52,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),veterans affairs,,O,126.23,10.13,102.61,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9311,cpt,"INJECTION, RITUXIMAB 10 MG AND HYALURONIDASE",veterans affairs,,O,175.06,36.40,442.86,5983.60,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26160,cpt,REMOVAL OF GROWTH OF TENDON FINGER OR HAND,veterans affairs,,O,19482.74,1247.77,1268.02,5351.19,11689.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,veterans affairs,,O,178.08,50.28,51.31,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58563,cpt,EXAMINATION OF UTERUS WITH DESTRUCTION OF UTERINE LINING USING AN ENDOSCOPE,veterans affairs,,O,30147.26,4351.66,4351.66,12495.98,18088.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",veterans affairs,,O,238.30,63.70,96.35,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93225,cpt,ELECTROCARDIOGRAM (ECG) 2-DAY CONTINUOUS,veterans affairs,,O,266.35,64.70,102.01,266.35,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",veterans affairs,,O,108.88,10.16,16.94,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,veterans affairs,,O,73.83,11.51,15.08,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,veterans affairs,,O,3055.12,206.42,206.42,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28285,cpt,CORRECTION OF TOE JOINT DEFORMITY,veterans affairs,,O,17411.66,2596.33,2596.33,13419.43,10447.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71270,cpt,CT SCAN OF CHEST BEFORE AND AFTER CONTRAST,veterans affairs,,O,2707.46,156.22,159.37,974.69,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,482,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,veterans affairs,,I,55990.08,11135.77,11135.77,19728.27,33594.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,veterans affairs,,O,50.01,3.11,5.18,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,veterans affairs,,I,419.99,92.55,92.55,432.59,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36569,cpt,"INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER FOR INFUSION (PICC), PATIENT 5 YEARS OR OLDER",veterans affairs,,O,2853.53,1292.67,1314.84,2529.35,1712.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36556,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, NOT TUNNELED",veterans affairs,,O,18017.97,2538.20,2611.24,9233.37,10810.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86880,cpt,"RED BLOOD CELL ANTIBODY DETECTION TEST, DIRECT",veterans affairs,,O,441.23,35.97,50.81,330.92,60.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",veterans affairs,,O,107.59,3.13,20.05,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",veterans affairs,,O,1858.47,98.50,98.50,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73200,cpt,CT SCAN OF ARM WITHOUT CONTRAST,veterans affairs,,O,1343.10,94.48,98.50,1343.10,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28270,cpt,INCISION OF JOINT CAPSULE OF FOOT AND TOE,veterans affairs,,O,43492.65,2630.53,2630.53,22181.74,26095.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93279,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT SINGLE LEAD PACEMAKER SYSTEM IN ONE CHAMBER OF HEART WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",veterans affairs,,O,191.31,30.35,30.94,33.02,114.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0434,revCode,"OCCUPATIONAL THERAPY, EVALUATION OR REEVALUATION",veterans affairs,,O,316.37,96.96,96.96,124.90,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92979,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL OR GRAFT WITH REVIEW BY RADIOLOGIST, EACH ADDITIONAL VESSEL",veterans affairs,,O,85208.04,9383.19,9383.19,9383.19,51124.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57260,cpt,"PLASTIC REPAIR OF VAGINA AND TISSUE SEPARATING VAGINA, RECTUM, AND BLADDER",veterans affairs,,O,42179.41,7936.42,8032.54,11664.05,25307.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,380,ms-drg,COMPLICATED PEPTIC ULCER WITH MCC,veterans affairs,,I,54507.15,12744.17,12744.17,15865.59,32704.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2997,cpt,"INJECTION, ALTEPLASE RECOMBINANT, 1 MG",veterans affairs,,O,318.54,72.28,88.03,253.24,191.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10140,cpt,DRAINAGE OF BLOOD OR FLUID ACCUMULATION,veterans affairs,,O,18672.07,1309.64,5930.73,5930.73,11203.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77295,cpt,"MANAGEMENT OF RADIATION THERAPY, 3D",veterans affairs,,O,2042.16,944.83,1185.06,1531.62,1360.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0801,revCode,INPATIENT RENAL DIALYSIS INPATIENT HEMODIALYSIS,veterans affairs,,I,1970.87,415.51,415.51,415.51,1182.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",veterans affairs,,I,1356.71,52.51,306.74,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73222,cpt,MRI SCAN OF ARM JOINT WITH CONTRAST,veterans affairs,,O,3055.12,461.27,647.26,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,460,ms-drg,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,veterans affairs,,I,119532.08,24196.90,25887.20,77295.91,71719.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,veterans affairs,,O,754.07,203.12,206.42,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",veterans affairs,,O,1029.19,93.54,94.47,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,271,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,veterans affairs,,I,91403.84,19680.56,24984.60,24984.60,54842.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42804,cpt,SIMPLE BIOPSY OF GROWTH OF THROAT BEHIND NOSE,veterans affairs,,O,23373.99,2514.21,2514.21,2514.21,14024.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,240,ms-drg,AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,veterans affairs,,I,48148.78,17032.79,19041.11,31073.16,28889.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0410,revCode,"RESPIRATORY SERVICES, GENERAL",veterans affairs,,I,225.50,61.14,79.73,381.34,135.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96374,cpt,"INJECTION OF DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",veterans affairs,,O,318.12,56.64,182.59,245.22,190.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,veterans affairs,,O,60.03,7.19,11.98,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",veterans affairs,,O,240.10,27.64,94.47,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,315,ms-drg,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,veterans affairs,,I,15856.64,6712.08,7143.80,7143.80,9513.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,veterans affairs,,O,101.33,21.90,29.60,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",veterans affairs,,O,734.07,114.82,734.07,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45381,cpt,"INJECTIONS BENEATH LINING OF LARGE BOWEL, USING A FLEXIBLE ENDOSCOPE",veterans affairs,,O,6984.17,1407.16,1473.35,3276.29,4190.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,veterans affairs,,O,106.28,8.57,8.74,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0875,cpt,"INJECTION, DALBAVANCIN, 5 MG",veterans affairs,,O,23.28,14.41,1722.94,1722.94,13.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),veterans affairs,,O,3857.66,938.20,1435.48,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",veterans affairs,,O,135.66,14.84,18.39,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",veterans affairs,,O,130.95,13.50,18.06,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,699,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,veterans affairs,,I,19519.09,6879.34,7472.91,9803.04,11711.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,veterans affairs,,O,1446.95,312.71,329.77,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",veterans affairs,,O,356.40,83.75,96.43,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,veterans affairs,,O,41.28,5.78,6.47,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31536,cpt,BIOPSY OF VOICE BOX USING AN ENDOSCOPE WITH OPERATING MICROSCOPE OR TELESCOPE,veterans affairs,,O,19316.41,2899.66,2946.71,2946.71,11589.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,328,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",veterans affairs,,I,48722.60,11664.12,11664.12,45539.96,29233.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1442,cpt,"INJECTION, FILGRASTIM (G-CSF), EXCLUDES BIOSIMILARS, 1 MICROGRAM",veterans affairs,,O,4.99,0.72,0.98,269.36,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,254,ms-drg,OTHER VASCULAR PROCEDURES WITHOUT CC/MCC,veterans affairs,,I,43574.21,11908.23,12722.09,22388.66,26144.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85246,cpt,CLOTTING FACTOR VIII (VW FACTOR) ANTIGEN,veterans affairs,,O,154.54,22.94,22.94,24.33,92.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25608,cpt,TREATMENT OF 2 BROKEN LOWER FOREARM BONE PIECES ON THUMB SIDE INSIDE WRIST JOINT WITH PLACEMENT OF STABILIZING DEVICE,veterans affairs,,O,35679.28,5647.61,5756.85,25391.48,21407.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23472,cpt,"PROSTHETIC REPAIR OF SHOULDER JOINT, TOTAL SHOULDER",veterans affairs,,O,76075.73,11006.86,11533.59,25947.42,45645.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70480,cpt,CT SCAN OF CRANIAL CAVITY WITHOUT CONTRAST,veterans affairs,,O,1343.10,93.35,94.47,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,veterans affairs,,I,27884.18,6142.25,8797.25,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37191,cpt,"INSERTION OF VENA CAVA FILTER BY ENDOVASCULAR APPROACH, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",veterans affairs,,O,25610.22,4543.19,4543.19,4543.19,15366.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82140,cpt,AMMONIA LEVEL,veterans affairs,,O,108.53,13.66,14.57,18.21,17.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64494,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SECOND LEVEL",veterans affairs,,O,4519.81,1107.35,1129.63,2566.99,2711.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,veterans affairs,,O,316.37,49.55,74.59,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,veterans affairs,,O,3008.85,207.30,208.17,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86021,cpt,ANTIBODY IDENTIFICATION TEST FOR WHITE BLOOD CELL ANTIBODIES,veterans affairs,,O,152.18,14.75,15.05,114.14,91.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,veterans affairs,,O,1880.84,106.44,161.61,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9173,cpt,"INJECTION, DURVALUMAB, 10 MG",veterans affairs,,O,267.80,77.11,77.11,87.07,160.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,641,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",veterans affairs,,I,16029.09,4785.97,5885.83,9048.71,9617.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43235,cpt,"DIAGNOSTIC EXAMINATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE",veterans affairs,,O,3457.28,1078.00,1091.04,2956.79,1286.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86704,cpt,HEPATITIS B CORE ANTIBODY MEASUREMENT,veterans affairs,,O,176.37,11.81,12.05,132.28,105.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9600,cpt,"PERCUTANEOUS TRANSCATHETER PLACEMENT OF DRUG ELUTING INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",veterans affairs,,O,68064.84,9197.64,9383.19,27750.61,40838.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83993,cpt,STOOL CALPROTECTIN (PROTEIN) LEVEL,veterans affairs,,O,107.35,17.69,19.63,82.93,23.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,veterans affairs,,I,3055.12,820.73,820.73,1741.42,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73040,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF SHOULDER JOINT,veterans affairs,,O,1406.87,212.42,333.16,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,veterans affairs,,I,316.37,68.94,73.24,633.75,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,veterans affairs,,O,101.33,11.74,24.08,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64483,cpt,"INJECTION OF ANESTHETIC AND/OR STEROID DRUG INTO SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, SINGLE LEVEL",veterans affairs,,O,3395.81,1103.79,1117.14,2242.95,1319.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q9969,cpt,"TC-99M FROM NON-HIGHLY ENRICHED URANIUM SOURCE, FULL COST RECOVERY ADD-ON, PER STUDY DOSE",veterans affairs,,O,66.26,9.83,10.00,22.80,39.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3380,cpt,"INJECTION, VEDOLIZUMAB, 1 MG",veterans affairs,,O,68.13,21.84,22.68,3747.37,40.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,309,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,veterans affairs,,I,17858.14,5166.37,5650.93,8901.93,10714.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",veterans affairs,,O,246.35,17.59,20.76,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29880,cpt,REMOVAL OF BOTH KNEE CARTILAGES USING AN ENDOSCOPE,veterans affairs,,O,21409.78,2586.84,2630.53,7284.82,12845.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74174,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN AND PELVIS WITH CONTRAST,veterans affairs,,O,1840.81,323.17,325.67,1326.08,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,175,ms-drg,PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,veterans affairs,,I,23982.29,5734.35,10307.55,14746.99,14389.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21556,cpt,REMOVAL OF (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,veterans affairs,,O,18486.84,2243.72,3444.75,4391.53,11092.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,veterans affairs,,O,65.11,6.57,6.70,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,veterans affairs,,O,96.77,32.33,96.77,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70110,cpt,"X-RAY OF LOWER JAW, MINIMUM OF 4 VIEWS",veterans affairs,,O,436.43,61.44,98.50,268.03,261.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13101,cpt,REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF TRUNK,veterans affairs,,O,17422.96,473.85,1804.46,5652.50,10453.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28113,cpt,COMPLETE REMOVAL OF FOOT BONE AT FIFTH TOE JOINT,veterans affairs,,O,16491.85,2562.13,2562.13,2562.13,9895.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36832,cpt,"REVISION OF DIALYSIS GRAFT, OPEN PROCEDURE",veterans affairs,,O,21325.08,4464.51,4543.19,4543.19,12795.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77412,cpt,DELIVERY OF COMPLEX RADIATION TREATMENT,veterans affairs,,O,989.19,218.69,218.69,989.19,258.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93572,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL DURING DIAGNOSIS OR TREATMENT, EACH ADDITIONAL VESSEL",veterans affairs,,O,39972.83,4536.44,4610.05,4610.05,23983.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,veterans affairs,,O,1479.41,92.59,94.47,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,906,ms-drg,HAND PROCEDURES FOR INJURIES,veterans affairs,,I,32452.25,4773.14,12419.58,12419.58,19471.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,90686,cpt,"VACCINE FOR INFLUENZA FOR ADMINISTRATION INTO MUSCLE, 0.5 ML DOSAGE, QUADRIVALENT, PRESERVATION FREE",veterans affairs,,O,140.38,11.21,21.76,63.17,84.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97033,cpt,"APPLICATION OF MEDICATION THROUGH SKIN USING ELECTRICAL CURRENT, EACH 15 MINUTES",veterans affairs,,O,137.91,13.88,13.88,13.88,82.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43248,cpt,INSERTION OF GUIDE WIRE WITH DILATION OF ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,veterans affairs,,O,3996.24,1081.46,1094.28,3758.90,2397.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17003,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 2-14 GROWTHS",veterans affairs,,O,1040.92,159.38,162.46,1315.38,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,419,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,veterans affairs,,I,40465.41,9645.93,9645.93,26459.17,24279.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",veterans affairs,,O,281.00,8.75,825.93,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,veterans affairs,,O,3055.12,206.42,208.17,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",veterans affairs,,O,50.01,4.43,4.52,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,804,ms-drg,OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,veterans affairs,,I,82148.60,9431.20,9431.20,9431.20,49289.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49083,cpt,DRAINAGE OF FLUID FROM ABDOMINAL CAVITY USING IMAGING GUIDANCE,veterans affairs,,O,3277.05,723.30,861.54,2260.51,1966.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,veterans affairs,,O,1753.28,96.00,96.49,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,421,ms-drg,HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,veterans affairs,,I,68216.96,13230.42,13230.42,13230.42,40930.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36475,cpt,DESTRUCTION OF FIRST INCOMPETENT VEIN OF ARM OR LEG USING RADIOFREQUENCY AND IMAGING GUIDANCE,veterans affairs,,O,27732.57,3410.10,4543.19,10128.50,16639.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,veterans affairs,,I,4152.82,995.38,995.38,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,veterans affairs,,I,20034.03,4988.82,5614.92,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,veterans affairs,,O,2687.44,201.24,201.24,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",veterans affairs,,I,5902.67,1024.93,1024.93,4692.62,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",veterans affairs,,O,67.24,14.75,15.05,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0409,revCode,OTHER IMAGING SERVICES OTHER,veterans affairs,,I,167.56,25.40,25.40,25.40,100.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",veterans affairs,,O,48.36,3.92,3.92,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",veterans affairs,,O,281.36,90.50,95.90,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,47563,cpt,REMOVAL OF GALLBLADDER WITH X-RAY STUDY OF BILE DUCTS USING AN ENDOSCOPE,veterans affairs,,O,26791.18,4521.08,4577.80,21816.48,16074.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97597,cpt,"REMOVAL OF TISSUE FROM WOUNDS PER SESSION, FIRST 20 SQ CMS OR LESS",veterans affairs,,O,632.77,59.44,159.58,488.82,379.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,337,ms-drg,PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,veterans affairs,,I,42487.64,10142.47,11212.49,11374.57,25492.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28112,cpt,"REMOVAL OF BONES AT SECOND, THIRD, OR FOURTH TOE JOINTS",veterans affairs,,O,17438.28,2562.21,2630.85,5466.53,10462.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87497,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CYTOMEGALOVIRUS, QUANTIFICATION",veterans affairs,,O,232.41,21.19,42.84,53.55,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92978,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL OR GRAFT WITH REVIEW BY RADIOLOGIST, INITIAL VESSEL",veterans affairs,,O,81139.05,9201.74,9383.19,27750.61,48683.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",veterans affairs,,I,302.21,52.32,88.70,528.83,181.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45384,cpt,"REMOVAL OF TISSUE ABNORMALITIES, TUMORS, OR POLYPS OF LARGE BOWEL BY HOT BIOPSY FORCEPS, USING A FLEXIBLE ENDOSCOPE",veterans affairs,,O,4528.30,938.20,1421.54,4749.21,2716.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,30140,cpt,"REMOVAL OF NASAL AIR PASSAGE, UNDER THE LINING TISSUE",veterans affairs,,O,40405.33,2514.21,2514.21,2514.89,24243.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,94060,cpt,"MEASUREMENT AND GRAPHIC RECORDING OF THE AMOUNT AND SPEED OF BREATHED AIR, BEFORE AND FOLLOWING MEDICATION ADMINISTRATION",veterans affairs,,O,422.68,79.92,247.52,422.68,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",veterans affairs,,O,754.07,158.88,206.42,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58670,cpt,DESTRUCTION OF FALLOPIAN TUBES USING AN ENDOSCOPE,veterans affairs,,O,21604.39,4491.89,4591.94,9350.46,12962.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93926,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE LEG OR LIMITED,veterans affairs,,O,646.53,93.49,94.47,359.62,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76604,cpt,ULTRASOUND SCAN OF CHEST,veterans affairs,,O,652.17,94.47,94.47,216.32,391.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83010,cpt,HAPTOGLOBIN (SERUM PROTEIN) LEVEL,veterans affairs,,O,84.93,8.43,12.58,63.70,14.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,493,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC",veterans affairs,,I,69921.76,14158.62,16017.13,24367.50,41953.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25000,cpt,INCISION OR THE TENDON COVERING ON THE TOP SIDE OF THE WRIST,veterans affairs,,O,17800.46,1260.13,1260.13,5839.17,10680.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",veterans affairs,,O,70.06,8.29,8.46,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76080,cpt,IMAGING FOR ABSCESS OR ABNORMAL DRAINAGE TRACT PROCEDURE,veterans affairs,,O,1318.08,176.36,437.15,661.02,790.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77385,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, SIMPLE",veterans affairs,,O,1893.35,485.97,505.90,1144.94,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89060,cpt,CRYSTAL IDENTIFICATION FROM TISSUE OR BODY FLUID,veterans affairs,,O,40.11,7.18,7.33,40.11,8.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,896,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",veterans affairs,,I,34188.85,7909.34,12453.00,19332.34,20513.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37227,cpt,"REMOVAL OF PLAQUE AND INSERTION OF STENTS INTO ARTERIES IN ONE LEG, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",veterans affairs,,O,117834.01,14529.99,14529.99,14529.99,70700.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",veterans affairs,,O,826.60,239.39,247.55,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58570,cpt,"REMOVAL OF UTERUS THROUGH ABDOMEN USING AN ENDOSCOPE, 250.0 G OR LESS",veterans affairs,,O,32349.41,8032.54,8032.54,10429.05,19409.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,veterans affairs,,O,2599.91,94.47,94.47,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",veterans affairs,,O,2237.24,324.67,333.16,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,199,ms-drg,PNEUMOTHORAX WITH MCC,veterans affairs,,I,24625.77,6870.06,12902.92,13280.09,14775.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",veterans affairs,,O,3595.37,208.18,333.16,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",veterans affairs,,O,1997.14,430.17,444.63,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,176,ms-drg,PULMONARY EMBOLISM WITHOUT MCC,veterans affairs,,I,19404.23,4326.04,6195.32,23340.67,11642.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S2900,cpt,SURGICAL TECHNIQUES REQUIRING USE OF ROBOTIC SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),veterans affairs,,O,29523.82,4577.80,4577.80,40500.70,17714.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82105,cpt,"ALPHA-FETOPROTEIN (AFP) LEVEL, SERUM",veterans affairs,,O,148.64,16.43,16.77,118.16,19.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86364,cpt,MEASUREMENT OF TISSUE TRANSGLUTAMINASE,veterans affairs,,O,28.83,5.60,11.53,21.62,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,26111,cpt,REMOVAL (1.5 CENTIMETERS OR GREATER) TISSUE BENEATH THE SKIN GROWTH OF HAND OR FINGER,veterans affairs,,O,17353.10,1325.18,1325.18,1325.18,10411.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",veterans affairs,,O,373.90,92.59,98.50,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74425,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF URINARY TRACT,veterans affairs,,O,1132.05,325.67,325.67,325.67,679.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29823,cpt,REMOVAL OF EXTENSIVE SHOULDER JOINT TISSUE USING AN ENDOSCOPE,veterans affairs,,O,29196.97,2631.16,2631.16,5060.32,17518.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,202,ms-drg,BRONCHITIS AND ASTHMA WITH CC/MCC,veterans affairs,,I,17576.07,7140.60,7140.60,10944.39,10545.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70486,cpt,CT SCAN OF FACE WITHOUT CONTRAST,veterans affairs,,O,1343.10,94.47,94.47,526.43,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28232,cpt,"INCISION TO LENGTHEN TOE TENDON, OPEN PROCEDURE",veterans affairs,,O,17839.27,2584.52,2631.16,2631.16,10703.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",veterans affairs,,O,266.35,64.70,102.01,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",veterans affairs,,O,100.03,11.76,37.27,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,veterans affairs,,O,231.34,36.98,50.80,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,500,ms-drg,SOFT TISSUE PROCEDURES WITH MCC,veterans affairs,,I,53865.41,42959.71,42959.71,42959.71,32319.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36200,cpt,INSERTION OF CATHETER INTO AORTA,veterans affairs,,O,27608.66,2623.83,2623.83,2623.83,16565.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,veterans affairs,,O,256.35,58.45,59.62,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",veterans affairs,,O,12.72,0.71,4.02,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,389,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH CC,veterans affairs,,I,17143.70,5530.39,6157.31,18965.92,10286.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33274,cpt,INSERTION OR REPLACEMENT OF PERMANENT LEADLESS PACEMAKER INTO LOWER RIGHT CHAMBER OF HEART VIA CATHETER USING IMAGING GUIDANCE,veterans affairs,,O,58435.25,14913.94,15183.80,15183.80,35061.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0114,revCode,ROOM AND BOARD PRIVATE (ONE BED) PSYCHIATRIC,veterans affairs,,I,2332.29,629.26,629.26,3095.92,1399.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45330,cpt,DIAGNOSTIC EXAMINATION OF THE LOWER PORTION OF THE LARGE BOWEL USING AN ENDOSCOPE,veterans affairs,,O,3245.25,719.92,734.50,2991.30,1947.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45385,cpt,REMOVAL OF POLYPS OR GROWTHS OF LARGE BOWEL USING AN ENDOSCOPE WITH MECHANICAL SNARE,veterans affairs,,O,5444.73,938.10,957.22,3555.21,1559.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86148,cpt,PHOSPHOLIPID ANTIBODY (AUTOIMMUNE ANTIBODY) MEASUREMENT,veterans affairs,,O,87.30,12.69,16.07,46.36,52.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,13102,cpt,"COMPLICATED REPAIR OF WOUND OF TRUNK, EACH ADDITIONAL 5.0 CM OR LESS",veterans affairs,,O,18473.24,1304.93,1325.50,1325.50,11083.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",veterans affairs,,O,1091.80,160.12,162.46,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,veterans affairs,,O,30.49,2.32,2.37,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,veterans affairs,,O,345.14,124.25,182.59,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,103,ms-drg,HEADACHES WITHOUT MCC,veterans affairs,,I,23496.03,6310.95,6461.15,8860.70,14097.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",veterans affairs,,O,140.04,24.64,28.40,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",veterans affairs,,O,345.14,36.70,37.44,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",veterans affairs,,I,1997.14,545.14,545.14,19187.06,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85651,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, NON-AUTOMATED",veterans affairs,,O,13.78,1.69,4.27,10.34,8.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,683,ms-drg,RENAL FAILURE WITH CC,veterans affairs,,I,16493.28,2797.28,6717.54,9159.54,9895.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",veterans affairs,,O,56.26,6.34,6.47,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29824,cpt,PARTIAL REMOVAL OF COLLAR BONE AT SHOULDER USING AN ENDOSCOPE,veterans affairs,,O,30695.12,2631.25,5666.83,17497.02,18417.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77300,cpt,CALCULATION OF RADIATION THERAPY DOSE,veterans affairs,,O,290.12,59.69,117.87,266.76,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,286,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",veterans affairs,,I,55760.94,13702.32,14631.86,26072.17,33456.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43251,cpt,"REMOVAL OF POLYPS OR GROWTHS OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING AN ENDOSCOPE USING A MECHANICAL SNARE",veterans affairs,,O,6666.20,1457.56,1539.44,3664.49,3999.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43239,cpt,"BIOPSY OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE",veterans affairs,,O,4496.04,1078.59,1094.28,3374.38,1294.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43453,cpt,DILATION OF ESOPHAGUS WITH A GUIDED WIRE,veterans affairs,,O,4092.51,1539.44,1539.44,4141.35,2455.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9306,cpt,"INJECTION, PERTUZUMAB, 1 MG",veterans affairs,,O,54.32,13.67,424.56,11037.60,32.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",veterans affairs,,O,45.06,8.66,17.93,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45331,cpt,BIOPSY OF THE LOWER LARGE BOWEL USING AN ENDOSCOPE (SIGMOIDOSCOPY),veterans affairs,,O,4384.17,710.14,734.58,3810.64,2630.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",veterans affairs,,O,65.11,8.45,8.62,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,314,ms-drg,OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,veterans affairs,,I,33150.59,4847.80,15339.54,22580.00,19890.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52281,cpt,DILATION OF BLADDER CANAL (URETHRA) USING AN ENDOSCOPE,veterans affairs,,O,15500.95,1609.63,1639.19,5605.90,9300.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96361,cpt,"INFUSION INTO A VEIN FOR HYDRATION, EACH ADDITIONAL HOUR",veterans affairs,,O,62.51,14.38,36.20,62.51,37.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,326,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",veterans affairs,,I,81034.64,14456.39,35985.41,35985.41,48620.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",veterans affairs,,O,16.51,4.75,4.75,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,veterans affairs,,O,3055.12,202.94,208.17,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11404,cpt,"REMOVAL OF GROWTH (3.1 TO 4.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",veterans affairs,,O,18281.83,1325.18,1325.18,2707.98,10969.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82247,cpt,"BILIRUBIN LEVEL, TOTAL",veterans affairs,,O,41.28,4.92,23.15,25.21,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,veterans affairs,,O,42.58,4.32,7.20,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74150,cpt,CT SCAN OF ABDOMEN WITHOUT CONTRAST,veterans affairs,,O,1344.34,95.70,96.48,766.27,806.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93931,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF ONE ARM OR LIMITED,veterans affairs,,O,646.53,92.68,98.50,216.32,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",veterans affairs,,O,365.24,8.63,14.38,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",veterans affairs,,I,757.37,203.30,203.30,5591.21,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84112,cpt,CERVICOVAGINAL SECRETION OF PLACENTA PROTEIN,veterans affairs,,O,257.65,98.11,98.11,257.65,49.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",veterans affairs,,O,218.83,30.93,30.93,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",veterans affairs,,I,231.34,60.43,77.00,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9047,cpt,"INFUSION, ALBUMIN (HUMAN), 25%, 50 ML",veterans affairs,,O,105.55,1.06,1.06,204.13,63.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84166,cpt,"PROTEIN MEASUREMENT, BODY FLUID",veterans affairs,,O,61.34,6.87,17.83,30.15,20.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74230,cpt,IMAGING FOR EVALUATION OF SWALLOWING FUNCTION,veterans affairs,,O,831.61,156.22,159.41,623.71,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,308,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,veterans affairs,,I,28408.75,7603.87,8831.06,14046.88,17045.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,veterans affairs,,O,87.53,4.18,4.27,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36245,cpt,"INSERTION OF CATHETER INTO ABDOMINAL PELVIC OR LEG ARTERY, EACH FIRST ORDER BRANCH",veterans affairs,,O,25437.42,2540.45,2611.24,4685.12,15262.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27524,cpt,TREATMENT OF BROKEN KNEECAP WITH PLACEMENT OF STABILIZING DEVICE AND/OR REMOVAL OF KNEECAP,veterans affairs,,O,32549.38,5845.48,5845.48,11062.10,19529.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97116,cpt,"THERAPY PROCEDURE FOR WALKING TRAINING, EACH 15 MINUTES",veterans affairs,,O,183.82,20.21,22.21,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99401,cpt,"PREVENTIVE MEDICINE COUNSELING, APPROXIMATELY 15 MINUTES",veterans affairs,,O,175.06,23.49,64.76,64.76,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,veterans affairs,,I,75778.57,12009.61,13490.43,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,908,ms-drg,OTHER O.R. PROCEDURES FOR INJURIES WITH CC,veterans affairs,,I,61086.11,11576.87,11576.87,20349.19,36651.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,veterans affairs,,I,976.85,256.92,257.47,976.85,586.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50200,cpt,"NEEDLE BIOPSY OF KIDNEY, ACCESSED THROUGH THE SKIN",veterans affairs,,O,9979.95,1172.33,1272.96,3057.19,5987.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3241,cpt,"INJECTION, TEPROTUMUMAB-TRBW, 10 MG",veterans affairs,,O,773.58,321.88,321.88,321.88,464.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,512,ms-drg,"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",veterans affairs,,I,52854.47,10536.39,10557.92,14107.45,31712.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76775,cpt,LIMITED ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,veterans affairs,,O,412.67,92.59,98.50,216.32,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0413,revCode,"RESPIRATORY SERVICES, HYPERBARIC OXYGEN THERAPY",veterans affairs,,O,820.35,105.74,110.55,110.56,492.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9301,cpt,"INJECTION, OBINUTUZUMAB, 10 MG",veterans affairs,,O,257.60,46.78,70.29,193.20,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,492,ms-drg,"LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC",veterans affairs,,I,67922.69,18654.89,18654.89,21515.90,40753.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,veterans affairs,,O,188.17,19.53,59.64,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,veterans affairs,,O,3055.12,204.02,465.93,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",veterans affairs,,O,1680.75,111.66,573.64,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,501,ms-drg,SOFT TISSUE PROCEDURES WITH CC,veterans affairs,,I,78496.87,11464.77,12481.11,19965.84,47098.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,854,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,veterans affairs,,I,62688.63,11498.14,14489.33,66792.27,37613.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,522,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,veterans affairs,,I,74793.54,13792.29,14970.48,24762.00,44876.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,795,ms-drg,NORMAL NEWBORN,veterans affairs,,I,4390.63,2140.83,2140.83,4272.65,2634.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11043,cpt,REMOVAL OF SKIN AND/OR MUSCLE FIRST 20 SQ CM OR LESS,veterans affairs,,O,1958.01,473.85,513.40,1390.59,1174.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,veterans affairs,,I,14826.55,4677.51,6536.32,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77290,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 3 OR MORE TREATMENT AREAS OR ANY NUMBER OF TREATMENT AREAS WHERE SPECIAL TREATMENT IS INVOLVED",veterans affairs,,O,2073.43,311.07,317.08,1555.07,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,veterans affairs,,O,1590.91,567.62,753.27,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",veterans affairs,,O,127.54,21.16,21.62,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82533,cpt,"CORTISOL (HORMONE) MEASUREMENT, TOTAL",veterans affairs,,O,112.07,9.78,16.30,89.09,19.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",veterans affairs,,O,520.22,353.36,360.34,551.76,312.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,673,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,veterans affairs,,I,69347.05,21366.97,26528.80,39818.00,41608.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,veterans affairs,,O,51.39,9.33,14.12,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",veterans affairs,,I,405.73,85.84,95.96,95.96,243.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,veterans affairs,,O,287.62,77.37,78.63,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,veterans affairs,,O,203.82,49.80,50.80,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,veterans affairs,,O,101.45,12.63,14.60,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",veterans affairs,,O,369.82,61.44,98.50,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,veterans affairs,,O,188.17,66.99,106.83,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0440,revCode,OCCUPATIONAL THERAPY GENERAL,veterans affairs,,I,380.16,90.74,90.74,129.79,228.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91035,cpt,MONITORING AND RECORDING OF GASTROESOPHAGEAL REFLUX WITH PH ELECTRODE INSERTION INCLUDING ANALYSIS AND INTERPRETATION,veterans affairs,,O,6554.34,441.62,441.62,4025.12,3932.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99281,cpt,"EMERGENCY DEPARTMENT VISIT, SELF LIMITED OR MINOR PROBLEM",veterans affairs,,E,206.32,65.63,65.99,531.77,123.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,280,ms-drg,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",veterans affairs,,I,31302.10,10044.53,11344.79,76220.28,18781.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97605,cpt,"NEGATIVE PRESSURE WOUND THERAPY, SURFACE AREA LESS THAN OR EQUAL TO 50 SQUARE CENTIMETERS, PER SESSION",veterans affairs,,O,1881.44,329.77,329.77,540.81,1128.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81257,cpt,GENE ANALYSIS (ALPHA GLOBIN 1 AND ALPHA GLOBIN 2) FOR COMMON DELETIONS OR VARIANT,veterans affairs,,O,1006.34,102.26,102.26,193.14,603.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66982,cpt,COMPLEX REMOVAL OF CATARACT WITH INSERTION OF PROSTHETIC LENS,veterans affairs,,O,16910.08,1876.58,1908.57,4894.22,10146.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9607,cpt,"PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF CHRONIC TOTAL OCCLUSION, CORONARY ARTERY, CORONARY ARTERY BRANCH, OR CORONARY ARTERY BYPASS GRAFT, ANY COMBINATION OF DRUG-ELUTING INTRACORONARY STENT, A",veterans affairs,,O,81757.68,15183.80,15183.80,15183.80,49054.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64484,cpt,"INJECTIONS OF ANESTHETIC AND/OR STEROID DRUG INTO LOWER OR SACRAL SPINE NERVE ROOT USING IMAGING GUIDANCE, EACH ADDITIONAL LEVEL",veterans affairs,,O,7561.13,743.72,930.95,2728.97,4536.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49650,cpt,REPAIR OF GROIN HERNIA USING AN ENDOSCOPE,veterans affairs,,O,28365.62,4521.08,4606.08,22560.85,17019.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,125,ms-drg,OTHER DISORDERS OF THE EYE WITHOUT MCC,veterans affairs,,I,28405.68,6522.37,6522.37,6522.37,17043.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,veterans affairs,,O,1753.28,94.47,94.47,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93668,cpt,PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION PER SESSION,veterans affairs,,O,148.80,49.55,50.81,64.11,89.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82248,cpt,"BILIRUBIN LEVEL, DIRECT",veterans affairs,,O,41.28,3.01,5.02,31.89,5.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86258,cpt,DETECTION OF GLIADIN (DEAMIDATED) (DGP) ANTIBODY,veterans affairs,,O,28.83,5.59,12.05,30.55,17.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,veterans affairs,,O,521.47,92.78,96.49,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78816,cpt,NUCLEAR MEDICINE STUDY WITH CT IMAGING WHOLE BODY,veterans affairs,,O,8009.86,1290.20,1327.75,2705.32,4805.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,veterans affairs,,O,1159.26,202.49,206.42,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",veterans affairs,,O,94.14,7.61,7.77,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36593,cpt,DECLOTTING INFUSION OF IMPLANTED CENTRAL VENOUS ACCESS DEVICE OR CATHETER,veterans affairs,,O,19028.38,1098.56,1105.86,26758.83,11417.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,292,ms-drg,HEART FAILURE AND SHOCK WITH CC,veterans affairs,,I,17047.40,4692.10,6447.19,7821.94,10228.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0444,revCode,OCCUPATIONAL THERAPY EVALUATION OR REEVALUATION,veterans affairs,,I,555.24,137.54,137.54,137.54,333.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",veterans affairs,,O,147.58,21.05,91.34,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,veterans affairs,,I,1133.33,141.17,242.23,1464.70,680.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64636,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, EACH ADDITIONAL FACET JOINT",veterans affairs,,O,7684.84,1563.06,1588.50,4212.43,4610.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70487,cpt,CT SCAN OF FACE WITH CONTRAST,veterans affairs,,O,1526.37,159.37,159.37,376.11,915.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",veterans affairs,,I,238.84,62.82,81.31,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91010,cpt,MEASUREMENT OF ESOPHAGEAL SWALLOWING MOVEMENT,veterans affairs,,O,3386.38,370.13,674.87,2423.62,2031.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,272,ms-drg,OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,veterans affairs,,I,125452.44,16564.29,17584.66,17584.66,75271.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",veterans affairs,,O,734.07,19.80,734.07,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99284,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF HIGH SEVERITY,veterans affairs,,E,2880.28,490.23,514.19,2811.85,1728.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66984,cpt,"REMOVAL OF CATARACT WITH INSERTION OF LENS, SIMPLE",veterans affairs,,O,15729.98,1862.99,1908.79,5888.50,9437.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89320,cpt,"SEMEN EVALUATION VOLUME, SPERM COUNT, MOTILITY AND ANALYSIS",veterans affairs,,O,135.66,12.31,12.31,65.59,81.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49505,cpt,REPAIR OF GROIN HERNIA (5 YEARS OR OLDER),veterans affairs,,O,21433.72,3075.50,3130.07,3130.07,12860.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29807,cpt,REPAIR OF SHOULDER SOCKET CARTILAGE USING AN ENDOSCOPE,veterans affairs,,O,36519.46,5846.87,5846.87,5847.07,21911.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,veterans affairs,,O,53.76,5.92,6.04,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88720,cpt,MEASUREMENT OF BILIRUBIN,veterans affairs,,O,132.12,5.04,132.12,132.12,79.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0440,revCode,OCCUPATIONAL THERAPY GENERAL,veterans affairs,,O,264.26,74.09,74.09,97.63,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,veterans affairs,,O,3238.42,206.67,208.17,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82670,cpt,MEASUREMENT OF TOTAL ESTRADIOL (HORMONE),veterans affairs,,O,166.34,27.39,27.94,124.76,99.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,veterans affairs,,O,30.08,5.04,5.12,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77338,cpt,DESIGN AND CONSTRUCTION OF RADIATION TREATMENT DEVICE FOR HIGH PRECISION RADIATION THERAPY,veterans affairs,,O,2149.71,310.75,317.01,1660.65,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87902,cpt,ANALYSIS TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS,veterans affairs,,O,824.65,76.19,257.45,437.97,302.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97602,cpt,REMOVAL OF TISSUE FROM WOUNDS PER SESSION,veterans affairs,,O,908.09,156.44,159.62,934.81,544.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11046,cpt,"REMOVAL OF MUSCLE AND/OR TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",veterans affairs,,O,3414.96,473.85,513.40,1078.95,2048.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,19083,cpt,"BIOPSY OF BREAST ACCESSED THROUGH THE SKIN WITH ULTRASOUND GUIDANCE, FIRST LESION",veterans affairs,,O,8992.46,1299.03,1325.50,4302.59,5395.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70547,cpt,MRI SCAN OF BLOOD VESSELS OF NECK WITHOUT CONTRAST,veterans affairs,,O,3099.12,461.58,762.86,1817.95,1859.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0442,revCode,OCCUPATIONAL THERAPY HOURLY CHARGE,veterans affairs,,I,398.77,81.95,81.95,81.95,239.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,veterans affairs,,I,646.53,95.13,95.13,95.13,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,221,ms-drg,CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC,veterans affairs,,I,154961.74,29426.30,29426.30,29426.30,92977.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",veterans affairs,,O,151.64,21.05,160.73,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,veterans affairs,,I,1704.46,353.32,353.32,2409.63,1022.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,394,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,veterans affairs,,I,20150.20,5703.31,7014.27,10874.89,12090.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),veterans affairs,,O,60.03,6.83,11.98,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",veterans affairs,,O,231.34,36.97,50.80,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",veterans affairs,,I,944.41,228.70,309.89,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",veterans affairs,,O,1040.92,159.87,162.46,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,veterans affairs,,O,252.59,54.84,59.62,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",veterans affairs,,O,85.05,7.99,8.57,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11603,cpt,"REMOVAL OF MALIGNANT GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE TRUNK, ARMS, OR LEGS",veterans affairs,,O,2584.00,719.34,719.34,2673.34,1550.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,veterans affairs,,O,71.96,15.59,76.27,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,269,ms-drg,AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,veterans affairs,,I,126793.83,26601.95,29409.56,29409.56,76076.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,veterans affairs,,O,811.59,92.97,96.49,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0170,revCode,NURSERY GENERAL,veterans affairs,,I,1569.44,869.27,904.66,3331.37,941.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0121,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK,veterans affairs,,O,3195.82,717.96,717.96,1255.30,1917.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,545,ms-drg,CONNECTIVE TISSUE DISORDERS WITH MCC,veterans affairs,,I,48844.58,17493.50,17493.50,18019.79,29306.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45380,cpt,"COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE, WITH BIOPSY",veterans affairs,,O,4184.57,938.10,957.22,2906.08,1130.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70470,cpt,CT SCAN OF HEAD OR BRAIN BEFORE AND AFTER CONTRAST,veterans affairs,,O,2708.71,159.41,159.41,450.85,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",veterans affairs,,O,91.30,18.02,18.39,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24076,cpt,REMOVAL (LESS THAN 5 CENTIMETERS) MUSCLE GROWTH OF UPPER ARM OR ELBOW,veterans affairs,,O,19365.36,246.67,2283.41,2283.41,11619.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",veterans affairs,,O,35.00,2.32,2.37,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,veterans affairs,,O,502.71,78.63,247.49,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46221,cpt,REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING,veterans affairs,,O,3889.72,1284.30,1284.30,8613.19,2333.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,375,ms-drg,DIGESTIVE MALIGNANCY WITH CC,veterans affairs,,I,25598.48,8685.35,8685.35,8685.35,15359.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25111,cpt,"REMOVAL OF CYST AT WRIST, INITIAL OR PRIMARY",veterans affairs,,O,17783.77,1248.37,1268.02,4924.66,10670.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91110,cpt,IMAGING OF DIGESTIVE TRACT DONE FROM THE INSIDE OF THE DIGESTIVE TRACT,veterans affairs,,O,8014.48,729.69,729.69,729.69,4808.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82232,cpt,BETA-2 MICROGLOBULIN (PROTEIN) LEVEL,veterans affairs,,O,101.45,15.87,16.18,36.52,19.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",veterans affairs,,O,252.47,43.75,44.32,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,441,ms-drg,"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",veterans affairs,,I,27183.75,11619.11,13302.06,20379.28,16310.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1459,cpt,"INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G., LIQUID), 500 MG",veterans affairs,,O,90.06,10.62,10.62,54.25,54.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",veterans affairs,,O,241.34,30.35,30.94,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58573,cpt,"ABDOMINAL REMOVAL OF UTERUS (GREATER THAN 250 GRAMS), TUBES, AND/OR OVARIES USING AN ENDOSCOPE",veterans affairs,,O,30571.05,8058.10,8058.10,22624.41,18342.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,352,ms-drg,INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,veterans affairs,,I,37987.72,5489.60,8070.29,8070.29,22792.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87305,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ASPERGILLUS (FUNGUS),veterans affairs,,O,30.85,11.79,11.98,22.46,18.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",veterans affairs,,O,85.39,17.80,22.71,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,veterans affairs,,I,22023.98,6812.39,9249.83,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84480,cpt,"THYROID HORMONE, T3 MEASUREMENT, TOTAL",veterans affairs,,O,60.03,13.90,14.18,47.72,16.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",veterans affairs,,O,107.59,3.13,20.05,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,veterans affairs,,O,4852.19,224.32,325.67,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",veterans affairs,,I,142.55,29.95,86.13,151.10,85.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0322,revCode,"RADIOLOGY, DIAGNOSTIC ARTHROGRAPHY",veterans affairs,,O,1406.87,198.35,333.16,1118.46,844.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23071,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF SHOULDER AREA,veterans affairs,,O,19193.40,2282.87,2282.87,2291.84,11516.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,veterans affairs,,O,123.87,5.34,8.90,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,veterans affairs,,I,36086.42,12423.48,13791.10,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86870,cpt,IDENTIFICATION OF RED BLOOD CELL ANTIBODIES,veterans affairs,,O,303.20,21.62,179.06,263.51,181.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,552,ms-drg,MEDICAL BACK PROBLEMS WITHOUT MCC,veterans affairs,,I,21073.12,6620.86,9898.71,9898.71,12643.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,536,ms-drg,FRACTURES OF HIP AND PELVIS WITHOUT MCC,veterans affairs,,I,16125.10,5605.93,6104.00,6454.84,9675.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97112,cpt,"THERAPEUTIC PROCEDURE TO RE-EDUCATE BRAIN-TO-NERVE-TO-MUSCLE FUNCTION, EACH 15 MINUTES",veterans affairs,,O,183.82,24.23,28.48,137.87,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,200,ms-drg,PNEUMOTHORAX WITH CC,veterans affairs,,I,20169.50,7259.72,9226.03,12541.14,12101.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86301,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 19-9",veterans affairs,,O,101.45,14.76,20.81,25.21,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",veterans affairs,,I,3595.37,858.13,858.13,2535.33,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,veterans affairs,,I,84.46,20.40,25.00,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23430,cpt,ANCHORING OF BICEPS TENDON,veterans affairs,,O,33884.87,5667.02,5846.87,5846.87,20330.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75635,cpt,CT SCAN OF ABDOMINAL AORTA AND BOTH LEG ARTERIES WITH CONTRAST,veterans affairs,,O,1952.12,159.41,159.41,528.47,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",veterans affairs,,I,1952.12,434.32,546.92,1952.12,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",veterans affairs,,O,47.53,3.60,3.67,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86635,cpt,ANALYSIS FOR ANTIBODY TO COCCIDIOIDES (BACTERIA),veterans affairs,,O,93.19,11.47,11.47,11.52,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45990,cpt,DIAGNOSTIC EXAMINATION OF ANUS AND RECTUM UNDER ANESTHESIA,veterans affairs,,O,16231.89,2210.23,2210.23,2210.23,9739.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,veterans affairs,,O,56.62,7.92,8.08,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,253,ms-drg,OTHER VASCULAR PROCEDURES WITH CC,veterans affairs,,I,71874.05,17117.07,18488.29,31459.36,43124.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80076,cpt,LIVER FUNCTION BLOOD TEST PANEL,veterans affairs,,O,70.06,8.01,8.17,62.97,9.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",veterans affairs,,O,547.73,117.10,293.94,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55700,cpt,BIOPSY OF PROSTATE GLAND,veterans affairs,,O,15825.28,1612.35,1639.39,4133.17,1936.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,192,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,veterans affairs,,I,13026.11,3415.11,5083.42,5083.42,7815.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,veterans affairs,,O,647.78,92.97,94.47,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,329,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,veterans affairs,,I,114604.99,18176.89,25429.15,42391.95,68762.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64417,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO AXILLARY NERVE OF UPPER ARM AND SHOULDER,veterans affairs,,O,38520.39,5845.48,5845.48,13548.85,23112.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",veterans affairs,,O,91.30,6.24,10.56,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",veterans affairs,,O,647.78,98.50,98.50,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42104,cpt,REMOVAL OF GROWTH OF ROOF OF MOUTH WITHOUT SUTURING,veterans affairs,,O,21871.43,2514.21,2514.21,2514.21,13122.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,33286,cpt,REMOVAL OF HEART RHYTHM MONITOR FROM UNDER THE SKIN,veterans affairs,,O,7365.37,568.32,568.32,17558.91,4419.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,476,ms-drg,AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,veterans affairs,,I,23615.81,8992.79,8992.79,8992.79,14169.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,veterans affairs,,O,842.86,94.39,94.47,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64721,cpt,RELEASE AND/OR RELOCATION OF MEDIAN NERVE OF HAND,veterans affairs,,O,16541.64,1561.79,1588.74,14075.51,9924.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78227,cpt,NUCLEAR MEDICINE STUDY OF LIVER AND BILE DUCT SYSTEM WITH USE OF DRUGS,veterans affairs,,O,1620.71,439.39,445.84,1038.76,526.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,56740,cpt,REMOVAL OF FEMALE GENITAL GLAND OR CYST,veterans affairs,,O,22849.93,2373.69,2373.69,2373.69,13709.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64493,cpt,"INJECTIONS OF LOWER OR SACRAL SPINE FACET JOINT USING IMAGING GUIDANCE, SINGLE LEVEL",veterans affairs,,O,4480.53,1107.35,1129.63,2566.99,2688.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91037,cpt,MONITORING AND RECORDING OF ESOPHAGEAL FUNCTION THROUGH NASAL TUBE WITH ELECTRODE,veterans affairs,,O,3401.95,370.13,677.97,2397.37,2041.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,331,ms-drg,MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,veterans affairs,,I,49456.93,5489.60,12232.51,19473.00,29674.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L4386,cpt,"WALKING BOOT, NON-PNEUMATIC, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED ITEM THAT HAS BEEN TRIMMED, BENT, MOLDED, ASSEMBLED, OR OTHERWISE CUSTOMIZED TO FIT A SPECIFIC PA",veterans affairs,,O,646.53,179.87,182.79,222.75,387.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",veterans affairs,,O,223.91,73.72,96.96,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,veterans affairs,,I,16808.50,4145.69,9315.61,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78630,cpt,NUCLEAR MEDICINE STUDY OF CEREBROSPINAL FLUID FLOW AFTER INJECTION OF CONTRAST INTO LOWER SPINE,veterans affairs,,O,1598.64,445.94,445.94,445.94,959.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,439,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,veterans affairs,,I,19744.66,5026.91,6618.55,10330.99,11846.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,veterans affairs,,O,402.67,93.28,96.49,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,372,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,veterans affairs,,I,21464.09,6956.42,7647.34,12516.32,12878.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",veterans affairs,,O,117.54,25.46,59.62,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54150,cpt,REMOVAL OF FORESKIN OF USING CLAMP OR DEVICE,veterans affairs,,O,18204.46,1602.91,2226.17,2226.17,10922.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11055,cpt,"REMOVAL OF NONCANCER THICKENED SKIN GROWTH, 1 GROWTH",veterans affairs,,O,463.03,2630.53,2630.53,2630.53,277.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",veterans affairs,,O,20.05,1.78,3.02,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,661,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,veterans affairs,,I,33148.21,7514.39,7514.39,12545.11,19888.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83883,cpt,"NEPHELOMETRY, TEST METHOD USING LIGHT",veterans affairs,,O,93.19,13.33,13.60,69.89,16.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,698,ms-drg,OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,veterans affairs,,I,27219.24,6918.41,11436.80,18262.00,16331.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,veterans affairs,,O,3055.12,202.81,206.42,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84630,cpt,ZINC LEVEL,veterans affairs,,O,76.68,7.98,11.39,60.96,46.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49180,cpt,"NEEDLE BIOPSY OF ABDOMINAL CAVITY GROWTH, ACCESSED THROUGH THE SKIN",veterans affairs,,O,11548.67,999.86,1325.18,1325.18,6929.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9305,cpt,"INJECTION, PEMETREXED, NOT OTHERWISE SPECIFIED, 10 MG",veterans affairs,,O,280.11,3.19,19.84,76.83,168.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",veterans affairs,,O,2526.13,486.47,505.90,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",veterans affairs,,O,52.60,8.84,9.02,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",veterans affairs,,O,238.30,71.54,95.90,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,301,ms-drg,PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,veterans affairs,,I,21950.36,5520.16,5520.16,5520.16,13170.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27447,cpt,"REPAIR OF KNEE JOINT, LOWER OR UPPER PART OF JOINT, INSIDE AND OUTSIDE AREA",veterans affairs,,O,76738.27,10981.15,11252.12,59556.87,46042.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9041,cpt,"INJECTION, BORTEZOMIB (VELCADE), 0.1 MG",veterans affairs,,O,20.57,3.00,9.01,39.05,12.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,veterans affairs,,I,163.02,40.45,51.00,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,veterans affairs,,O,203.82,49.80,50.80,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37799,cpt,OTHER PROCEDURE ON BLOOD VESSEL,veterans affairs,,O,25554.94,3410.10,4314.31,13483.00,15332.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52601,cpt,REMOVAL OF PROSTATE GLAND USING AN ELECTROCAUTERY KNIFE THROUGH URETHRA WITH CONTROL OF BLEEDING USING AN ENDOSCOPE,veterans affairs,,O,21140.75,3922.58,4073.48,12709.61,12684.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0430,revCode,"OCCUPATIONAL THERAPY, GENERAL",veterans affairs,,I,194.27,39.00,39.00,54.36,116.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",veterans affairs,,O,50.72,5.89,6.01,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89321,cpt,SEMEN ANALYSIS FOR SPERM PRESENCE,veterans affairs,,O,70.78,12.05,12.05,72.90,42.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,veterans affairs,,O,10678.57,58.46,2589.90,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93454,cpt,INSERTION OF CATHETER FOR IMAGING OF HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,veterans affairs,,O,40037.22,2564.66,11955.48,18046.03,24022.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,veterans affairs,,O,31.24,2.94,8.57,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",veterans affairs,,O,100.04,20.74,59.62,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,veterans affairs,,I,1274.16,335.11,473.19,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84134,cpt,PREALBUMIN (PROTEIN) LEVEL,veterans affairs,,O,73.83,12.70,14.59,18.24,17.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24075,cpt,REMOVAL (LESS THAN 3 CENTIMETERS) TISSUE GROWTH BENEATH THE SKIN OF UPPER ARM OR ELBOW,veterans affairs,,O,20908.57,1325.18,1325.18,6095.44,12545.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,560,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",veterans affairs,,I,42178.02,11012.76,18039.67,18039.67,25306.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,veterans affairs,,O,80.09,1.66,10.33,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,521,ms-drg,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,veterans affairs,,I,91075.32,18634.25,21775.75,21775.75,54645.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,veterans affairs,,O,42.58,3.22,3.28,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",veterans affairs,,O,38.92,2.65,2.70,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9271,cpt,"INJECTION, PEMBROLIZUMAB, 1 MG",veterans affairs,,O,203.82,32.52,56.41,12292.00,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",veterans affairs,,O,801.60,189.21,189.21,802.81,480.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",veterans affairs,,O,117.61,12.87,12.87,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,veterans affairs,,I,30232.58,9248.60,9780.97,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,464,ms-drg,WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,veterans affairs,,I,45913.20,20544.81,20544.81,22898.76,27547.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",veterans affairs,,O,348.89,61.44,73.18,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84436,cpt,"THYROXINE (THYROID CHEMICAL), TOTAL",veterans affairs,,O,63.63,6.74,6.87,47.72,8.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,467,ms-drg,REVISION OF HIP OR KNEE REPLACEMENT WITH CC,veterans affairs,,I,100581.06,24495.86,24495.86,24495.86,60348.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",veterans affairs,,O,147.58,21.05,35.09,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,veterans affairs,,E,880.03,214.07,216.54,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,veterans affairs,,O,287.62,21.62,78.63,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",veterans affairs,,O,90.84,9.28,9.47,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",veterans affairs,,O,1724.51,97.60,678.61,959.65,801.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",veterans affairs,,E,1724.51,232.62,678.61,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",veterans affairs,,O,70.78,13.97,25.47,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,89051,cpt,BODY FLUID CELL COUNT WITH CELL IDENTIFICATION,veterans affairs,,O,42.58,5.49,5.60,30.20,6.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,veterans affairs,,O,38.92,4.65,4.75,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0260,cpt,"INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC AGENT, WITH OR WITHOUT ARTHROGRAPHY",veterans affairs,,O,2193.04,562.74,569.42,1003.01,1315.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83001,cpt,"GONADOTROPIN, FOLLICLE STIMULATING (REPRODUCTIVE HORMONE) LEVEL",veterans affairs,,O,103.81,18.28,18.58,77.86,21.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29876,cpt,REMOVAL OF JOINT LINING FROM TWO OR MORE KNEE JOINT COMPARTMENTS USING AN ENDOSCOPE,veterans affairs,,O,22731.95,2550.70,2630.85,8021.63,13639.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0434,revCode,"OCCUPATIONAL THERAPY, EVALUATION OR REEVALUATION",veterans affairs,,I,378.70,28.38,28.38,28.38,227.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,veterans affairs,,O,265.10,8.75,154.13,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,veterans affairs,,I,3055.12,718.09,718.09,718.09,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,veterans affairs,,O,45.06,3.98,6.63,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11423,cpt,"REMOVAL OF GROWTH (2.1 TO 3.0 CENTIMETERS) OF THE SCALP, NECK, HANDS, FEET, OR GENITALS",veterans affairs,,O,16719.52,1325.50,1325.50,1908.34,10031.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70498,cpt,CT SCAN OF BLOOD VESSELS OF NECK WITH CONTRAST,veterans affairs,,O,1952.12,144.93,160.51,1464.09,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,32408,cpt,"CORE NEEDLE BIOPSY OF LUNG OR CENTER CAVITY OF CHEST (MEDIASTINUM), ACCESSED THROUGH SKIN",veterans affairs,,O,4116.84,594.86,1325.50,1325.54,2470.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",veterans affairs,,I,551.43,162.47,162.47,1560.66,330.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,381,ms-drg,COMPLICATED PEPTIC ULCER WITH CC,veterans affairs,,I,26479.34,7578.10,7785.34,12742.06,15887.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,302,ms-drg,ATHEROSCLEROSIS WITH MCC,veterans affairs,,I,52673.47,7781.42,7781.42,7781.42,31604.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,veterans affairs,,I,124.70,13.59,25.47,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87522,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HEPATITIS C VIRUS, QUANTIFICATION",veterans affairs,,O,494.32,41.98,42.84,217.91,50.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",veterans affairs,,O,1434.39,436.85,444.73,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,313,ms-drg,CHEST PAIN,veterans affairs,,I,19828.75,4932.79,5325.46,5325.46,11897.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,veterans affairs,,O,252.59,75.92,76.80,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95813,cpt,"MEASUREMENT OF BRAIN WAVE ACTIVITY (EEG) EXTENDED MONITORING, 61-119 MINUTES",veterans affairs,,O,680.29,236.16,247.55,700.70,408.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70492,cpt,CT SCAN OF SOFT TISSUE OF NECK BEFORE AND AFTER CONTRAST,veterans affairs,,O,2112.19,159.37,159.37,1203.95,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",veterans affairs,,I,217.58,127.74,131.47,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,veterans affairs,,I,6.27,0.90,2.08,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,veterans affairs,,O,41.19,1.80,53.91,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93284,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, MULTIPLE LEAD DEFIBRILLATOR SYSTEM",veterans affairs,,O,349.06,30.94,33.69,33.69,209.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,177,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,veterans affairs,,I,32181.45,11429.58,12619.85,19783.18,19308.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",veterans affairs,,I,212.36,46.07,46.07,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,veterans affairs,,O,55.44,9.79,11.54,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,P9016,cpt,"RED BLOOD CELLS, LEUKOCYTES REDUCED, EACH UNIT",veterans affairs,,O,757.37,185.43,189.21,626.35,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62323,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL USING IMAGING GUIDANCE,veterans affairs,,O,2261.82,101.22,569.42,1670.02,672.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",veterans affairs,,I,316.91,22.36,22.36,258.58,190.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74220,cpt,X-RAY OF ESOPHAGUS WITH SINGLE CONTRAST,veterans affairs,,O,585.25,65.33,159.41,360.68,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C8908,cpt,"MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST FOLLOWED BY WITH CONTRAST, BREAST; BILATERAL",veterans affairs,,O,3191.43,324.07,325.59,3382.91,1914.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,veterans affairs,,O,95.55,14.26,143.79,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,42826,cpt,REMOVAL OF TONSILS PATIENT AGE 12 OR OVER,veterans affairs,,O,21996.72,2514.81,2514.81,16497.54,13198.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",veterans affairs,,O,184.32,70.33,106.12,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84311,cpt,CHEMICAL ANALYSIS USING SPECTROPHOTOMETRY (LIGHT),veterans affairs,,O,20.25,8.10,8.10,8.10,3.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77321,cpt,SPECIAL RADIATION THERAPY PLANNING FOR DELIVERY OF EXTERNAL RADIATION,veterans affairs,,O,396.41,290.00,311.73,420.19,361.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,640,ms-drg,"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",veterans affairs,,I,24682.45,5356.97,9155.20,14419.00,14809.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",veterans affairs,,O,92.99,21.05,35.09,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,veterans affairs,,I,16.88,6.25,6.25,10.23,10.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",veterans affairs,,O,183.82,20.70,22.96,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",veterans affairs,,O,647.78,98.50,98.50,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1745,cpt,"INJECTION, INFLIXIMAB, EXCLUDES BIOSIMILAR, 10 MG",veterans affairs,,O,282.56,34.04,34.04,75.44,169.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11721,cpt,REMOVAL OF TISSUE FROM 6 OR MORE FINGER OR TOE NAILS,veterans affairs,,O,303.44,50.80,50.80,3502.06,182.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,690,ms-drg,KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,veterans affairs,,I,16915.97,4140.71,6080.99,18732.02,10149.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,393,ms-drg,OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,veterans affairs,,I,34228.75,11585.36,11585.36,16485.12,20537.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",veterans affairs,,O,365.14,48.65,76.78,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85049,cpt,"PLATELET COUNT, AUTOMATED TEST",veterans affairs,,O,36.32,3.59,4.48,13.86,5.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,489,ms-drg,KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC,veterans affairs,,I,36478.63,9427.28,9427.28,9427.28,21887.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",veterans affairs,,I,799.31,175.61,175.61,484.84,479.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,178,ms-drg,RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,veterans affairs,,I,19678.73,7277.47,8405.35,14434.95,11807.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,veterans affairs,,O,252.59,55.19,59.62,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5111,cpt,"INJECTION, PEGFILGRASTIM-CBQV, BIOSIMILAR, (UDENYCA), 0.5 MG",veterans affairs,,O,1252.50,150.78,150.78,171.89,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,20610,cpt,ASPIRATION AND/OR INJECTION OF LARGE JOINT OR JOINT CAPSULE,veterans affairs,,O,784.37,233.55,360.41,2451.28,470.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59820,cpt,TREATMENT OF MISCARRIAGE DURING FIRST TRIMESTER,veterans affairs,,O,18205.61,2373.69,2373.69,13386.01,10923.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,veterans affairs,,O,80.09,5.66,9.44,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,veterans affairs,,I,1031.60,200.87,257.61,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,veterans affairs,,I,5986.20,1090.17,1090.17,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,veterans affairs,,I,50.02,8.77,8.77,39.77,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36561,cpt,"INSERTION OF CENTRAL VENOUS CATHETER AND IMPLANTED DEVICE FOR INFUSION BENEATH THE SKIN, PATIENT 5 YEARS OR OLDER",veterans affairs,,O,19538.26,2569.95,2633.20,14088.89,11722.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82525,cpt,COPPER LEVEL,veterans affairs,,O,71.96,7.48,12.41,53.97,14.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,605,ms-drg,"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",veterans affairs,,I,13265.14,6299.63,6612.52,9754.07,7959.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,602,ms-drg,CELLULITIS WITH MCC,veterans affairs,,I,27263.26,7119.45,9991.19,14531.98,16357.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62320,cpt,INJECTION OF SUBSTANCE INTO SPINAL CANAL OF UPPER OR MIDDLE BACK,veterans affairs,,O,1594.50,564.08,572.02,1436.46,956.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96401,cpt,ADMINISTRATION OF NON-HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY UNDER SKIN OR INTO MUSCLE,veterans affairs,,O,303.87,29.81,29.81,215.00,182.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,571,ms-drg,SKIN DEBRIDEMENT WITH CC,veterans affairs,,I,38108.94,11300.08,11300.08,11300.08,22865.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83516,cpt,"ANALYSIS OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, MULTIPLE STEP METHOD",veterans affairs,,O,55.44,9.63,11.53,41.58,13.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71275,cpt,CT SCAN OF BLOOD VESSELS OF CHEST WITH CONTRAST,veterans affairs,,O,1952.12,159.41,161.61,1464.09,188.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86705,cpt,HEPATITIS B CORE ANTIBODY (IGM) MEASUREMENT,veterans affairs,,O,100.03,11.53,11.77,75.02,13.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,veterans affairs,,O,195.07,21.19,21.62,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82172,cpt,APOLIPOPROTEIN LEVEL,veterans affairs,,O,84.93,8.09,21.09,63.70,24.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,432,ms-drg,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,veterans affairs,,I,38295.32,12117.39,13418.80,13418.80,22977.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0412,revCode,RESPIRATORY SERVICES INHALATION SERVICES,veterans affairs,,I,204.80,57.65,57.65,57.65,122.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",veterans affairs,,O,120.33,16.46,16.80,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,veterans affairs,,I,344.47,88.44,88.44,88.44,206.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,30520,cpt,RESHAPING OF NASAL CARTILAGE,veterans affairs,,O,40996.77,2514.81,2514.81,2514.89,24598.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,veterans affairs,,O,175.06,87.53,175.06,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78264,cpt,NUCLEAR MEDICINE STUDY OF STOMACH TO ASSESS EMPTYING,veterans affairs,,O,1630.73,338.97,343.48,1259.74,405.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28740,cpt,FUSION OF FOOT IN THE MIDFOOT REGION,veterans affairs,,O,45471.26,5845.48,5845.48,20996.90,27282.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74170,cpt,CT SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,veterans affairs,,O,2708.71,159.22,159.37,612.94,1625.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0770,revCode,"PREVENTIVE CARE SERVICES, GENERAL",veterans affairs,,O,175.06,23.49,64.76,166.01,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93922,cpt,"ULTRASOUND STUDY OF ARTERIES OF BOTH ARMS AND LEGS, LIMITED",veterans affairs,,O,437.43,101.00,102.01,328.07,262.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82668,cpt,ERYTHROPOIETIN (PROTEIN) LEVEL,veterans affairs,,O,148.64,17.37,18.79,23.49,22.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5122,cpt,"INJECTION, PEGFILGRASTIM-APGF, BIOSIMILAR, (NYVEPRIA), 0.5 MG",veterans affairs,,O,855.42,167.19,217.69,623.41,513.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L1830,cpt,"KNEE ORTHOSIS, IMMOBILIZER, CANVAS LONGITUDINAL, PREFABRICATED, OFF-THE-SHELF",veterans affairs,,O,405.73,68.25,68.25,232.04,243.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70496,cpt,CT SCAN OF BLOOD VESSELS OF HEAD WITH CONTRAST,veterans affairs,,O,1952.12,344.86,393.81,1464.09,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28820,cpt,AMPUTATION OF TOE AT JOINT BETWEEN THE FOREFOOT AND TOES,veterans affairs,,O,16545.00,2584.52,2630.53,2630.53,9927.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86256,cpt,MEASUREMENT OF ANTIBODY TO NONINFECTIOUS AGENT,veterans affairs,,O,71.96,12.05,12.05,12.62,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54161,cpt,"REMOVAL OF FORESKIN, PATIENT OLDER THAN 28 DAYS OF AGE",veterans affairs,,O,17685.68,1612.75,1639.58,1639.64,10611.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0105,cpt,COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK,veterans affairs,,O,3209.39,717.96,717.96,719.92,1925.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,312,ms-drg,SYNCOPE AND COLLAPSE,veterans affairs,,I,19356.82,5264.37,6350.94,7437.32,11614.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27680,cpt,RELEASE OF LEG AND/OR ANKLE TENDON,veterans affairs,,O,20970.77,2578.63,2631.16,2631.16,12582.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,197,ms-drg,INTERSTITIAL LUNG DISEASE WITH CC,veterans affairs,,I,12136.23,7534.12,7534.12,10498.11,7281.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0897,cpt,"INJECTION, DENOSUMAB, 1 MG",veterans affairs,,O,70.01,13.01,24.22,50.12,42.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,veterans affairs,,O,752.83,92.79,94.47,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",veterans affairs,,O,65.11,10.15,14.70,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,veterans affairs,,I,1386.23,364.58,476.41,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,897,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",veterans affairs,,I,20249.18,5831.92,6041.82,9701.00,12149.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70490,cpt,CT SCAN OF SOFT TISSUE OF NECK WITHOUT CONTRAST,veterans affairs,,O,1343.10,94.48,96.49,482.16,805.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86360,cpt,"T CELL COUNT AND RATIO, INCLUDING RATIO",veterans affairs,,O,220.61,25.26,46.98,125.75,132.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,24071,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF UPPER ARM OR ELBOW,veterans affairs,,O,20596.09,2107.80,2282.87,4391.53,12357.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93282,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, SINGLE LEAD DEFIBRILLATOR SYSTEM",veterans affairs,,O,233.84,30.94,30.94,175.38,140.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84207,cpt,VITAMIN B-6 LEVEL,veterans affairs,,O,134.49,18.96,142.55,142.55,80.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,veterans affairs,,O,60.16,9.91,12.09,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74160,cpt,CT SCAN OF ABDOMEN WITH CONTRAST,veterans affairs,,O,2112.19,159.41,160.51,2112.19,1267.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27658,cpt,"REPAIR OF LEG TENDON ON THE BACK SIDE OF THE LEG (FLEXOR), PRIMARY, WITHOUT GRAFT",veterans affairs,,O,21248.53,2631.16,2631.16,2631.16,12749.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62328,cpt,REMOVAL OF SPINAL FLUID WITH LOWER BACK SPINAL TAP FOR DIAGNOSTIC TEST USING IMAGING GUIDANCE,veterans affairs,,O,6696.73,1015.49,1015.49,1015.49,4018.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,veterans affairs,,O,113.25,11.78,14.27,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92920,cpt,"BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORONARY ARTERY OR BRANCH (ACCESSED THROUGH THE SKIN), EACH ADDITIONAL ARTERY OR BRANCH",veterans affairs,,O,56646.63,4554.88,4608.95,22653.36,33987.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52005,cpt,INSERTION OF CATHETER INTO URINARY DUCT (URETER) USING AN ENDOSCOPE THROUGH THE BLADDER AREA,veterans affairs,,O,15929.97,1594.04,2833.10,8382.60,9557.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,417,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,veterans affairs,,I,50962.36,13884.27,16852.66,16852.66,30577.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92921,cpt,"BALLOON DILATION OF NARROWED OR BLOCKED MAJOR CORONARY ARTERY OR BRANCH (ACCESSED THROUGH THE SKIN), SINGLE ARTERY OR BRANCH",veterans affairs,,O,70163.07,9197.64,9388.77,9388.77,42097.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,894,ms-drg,"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",veterans affairs,,I,15236.57,4413.56,4480.15,4480.15,9141.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80055,cpt,OBSTETRIC BLOOD TEST PANEL,veterans affairs,,O,101.30,96.77,96.77,96.77,19.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,659,ms-drg,KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,veterans affairs,,I,49964.58,11203.29,17521.95,17521.95,29978.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29822,cpt,LIMITED REMOVAL OF ABNORMAL SHOULDER JOINT TISSUE USING ENDOSCOPE,veterans affairs,,O,27841.82,2507.32,5846.87,20881.37,16705.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78582,cpt,NUCLEAR MEDICINE STUDY OF LUNG VENTILATION AND BLOOD CIRCULATION IN THE LUNGS,veterans affairs,,O,3241.45,445.84,445.84,1009.00,1944.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70336,cpt,MRI SCAN OF JAW JOINTS,veterans affairs,,O,1925.67,206.40,206.40,206.40,1155.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,veterans affairs,,O,42.58,6.02,6.14,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92611,cpt,FLUOROSCOPIC AND VIDEO RECORDED MOTION EVALUATION OF SWALLOWING FUNCTION,veterans affairs,,O,348.63,85.16,86.90,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74021,cpt,"X-RAY OF ABDOMEN, MINIMUM OF 3 VIEWS",veterans affairs,,O,410.17,61.80,98.50,307.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,veterans affairs,,O,2152.21,335.59,343.57,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73720,cpt,MRI SCAN OF LEG BEFORE AND AFTER CONTRAST,veterans affairs,,O,3055.12,325.59,325.59,1041.43,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83970,cpt,PARATHORMONE (PARATHYROID HORMONE) LEVEL,veterans affairs,,O,145.10,29.21,41.28,112.09,48.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31240,cpt,REMOVAL OF NASAL BREATHING PASSAGES USING AN ENDOSCOPE,veterans affairs,,O,36517.82,2514.21,2514.21,2514.21,21910.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9228,cpt,"INJECTION, IPILIMUMAB, 1 MG",veterans affairs,,O,624.02,124.58,827.27,827.27,374.41
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,371,ms-drg,MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,veterans affairs,,I,34493.37,11008.95,12164.75,12164.75,20696.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0481,revCode,"CARDIOLOGY, CARDIAC CATHETERIZATION LABORATORY",veterans affairs,,I,7779.76,1512.62,1512.62,1512.62,4667.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84460,cpt,"LIVER ENZYME (SGPT), LEVEL",veterans affairs,,O,31.24,4.67,5.30,13.71,6.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,veterans affairs,,O,401.42,94.39,96.48,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93571,cpt,"ULTRASOUND EVALUATION OF HEART BLOOD VESSEL DURING DIAGNOSIS OR TREATMENT, INITIAL VESSEL",veterans affairs,,O,40842.66,4536.44,4610.05,4610.05,24505.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29827,cpt,REPAIR OF SHOULDER ROTATOR CUFF USING AN ENDOSCOPE,veterans affairs,,O,38417.80,5736.03,5845.48,17014.63,23050.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50435,cpt,REPLACEMENT OF KIDNEY DRAINAGE CATHETER ACCESSED THROUGH THE SKIN WITH IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION,veterans affairs,,O,6267.51,1629.55,1629.55,2445.94,3760.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5112,cpt,"INJECTION, TRASTUZUMAB-DTTB, BIOSIMILAR, (ONTRUZANT), 10 MG",veterans affairs,,O,297.75,13.43,126.02,2873.58,178.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9144,cpt,"INJECTION, DARATUMUMAB, 10 MG AND HYALURONIDASE-FIHJ",veterans affairs,,O,148.31,44.88,44.88,48.33,88.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,veterans affairs,,O,792.84,92.74,94.47,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",veterans affairs,,O,93.77,21.35,37.45,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",veterans affairs,,O,151.46,8.03,13.39,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,776,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,veterans affairs,,I,14024.63,2935.28,5731.79,9541.48,8414.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43244,cpt,TYING OF DILATED VEINS OF STOMACH AND/OR ESOPHAGUS USING A FLEXIBLE ENDOSCOPE,veterans affairs,,O,5449.41,1441.59,1539.44,1539.44,3269.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",veterans affairs,,O,41.28,5.10,5.22,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64718,cpt,RELEASE AND/OR RELOCATION OF ULNAR NERVE AT ELBOW,veterans affairs,,O,18467.33,1563.58,1588.88,14075.51,11080.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,veterans affairs,,O,547.73,91.89,288.47,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,246,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS,veterans affairs,,I,112798.01,18912.25,20488.02,59595.14,67678.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83605,cpt,LACTIC ACID LEVEL,veterans affairs,,O,71.96,5.48,11.57,53.97,13.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,570,ms-drg,SKIN DEBRIDEMENT WITH MCC,veterans affairs,,I,75025.56,18584.20,20523.09,22387.93,45015.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29881,cpt,REMOVAL OF KNEE CARTILAGE USING AN ENDOSCOPE,veterans affairs,,O,21489.40,2516.47,2630.53,7609.83,3025.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,veterans affairs,,O,31.88,2.63,4.38,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77373,cpt,STEREOTACTIC BODY RADIATION THERAPY 1 OR MORE LESIONS USING IMAGING GUIDANCE,veterans affairs,,O,4630.63,693.07,1562.30,3534.90,1844.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",veterans affairs,,O,47.53,8.48,8.65,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64635,cpt,"DESTRUCTION OF LOWER OR SACRAL SPINAL FACET JOINT NERVES USING IMAGING GUIDANCE, SINGLE FACET JOINT",veterans affairs,,O,7687.98,1563.06,1588.50,2892.60,4612.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87799,cpt,"DETECTION TEST BY NUCLEIC ACID FOR ORGANISM, QUANTIFICATION",veterans affairs,,O,264.26,35.66,42.84,174.31,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52356,cpt,CRUSHING OF STONE IN URINARY DUCT (URETER) WITH STENT USING AN ENDOSCOPE,veterans affairs,,O,26186.13,3916.85,3991.54,10931.90,15711.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",veterans affairs,,O,52.60,5.67,9.44,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,193,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH MCC,veterans affairs,,I,28507.68,8334.78,9410.03,17274.09,17104.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",veterans affairs,,O,1997.14,273.93,444.63,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93308,cpt,FOLLOW-UP OR LIMITED ULTRASOUND EXAMINATION OF HEART,veterans affairs,,O,440.18,84.89,206.42,440.18,264.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",veterans affairs,,O,175.06,87.53,175.06,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,57288,cpt,CREATION OF SLING AROUND BLADDER CANAL (URETHRA) TO CONTROL LEAKAGE,veterans affairs,,O,34340.73,4097.25,8032.54,23328.10,20604.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62370,cpt,ELECTRONIC ANALYSIS REPROGRAMMING AND REFILL OF SPINAL CANAL DRUG INFUSION PUMP BY PHYSICIAN,veterans affairs,,O,2663.70,244.51,244.51,245.80,1598.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36902,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT AND BALLOON DILATION OF DIALYSIS SEGMENT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",veterans affairs,,O,17042.54,4518.00,4547.07,17456.98,10225.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80202,cpt,VANCOMYCIN (ANTIBIOTIC) LEVEL,veterans affairs,,O,92.78,13.27,13.54,27.34,15.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9025,cpt,"INJECTION, AZACITIDINE, 1 MG",veterans affairs,,O,14.99,0.42,6.63,6.63,8.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,veterans affairs,,O,770.33,202.50,206.42,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36907,cpt,"BALLOON DILATION OF DIALYSIS SEGMENT, ACCESSED THROUGH THE SKIN, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",veterans affairs,,O,22996.23,2589.90,2589.90,10133.54,13797.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0802,revCode,INPATIENT RENAL DIALYSIS INPATIENT PERITONEAL (NON-CAPD),veterans affairs,,I,396.41,308.39,308.39,308.39,237.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23120,cpt,PARTIAL REMOVAL OF COLLAR BONE,veterans affairs,,O,44226.23,5846.87,5846.87,11569.09,26535.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82784,cpt,GAMMAGLOBULIN (IMMUNE SYSTEM PROTEIN) MEASUREMENT,veterans affairs,,O,69.59,9.12,9.30,52.19,10.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",veterans affairs,,O,285.11,61.44,76.78,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",veterans affairs,,I,190.07,49.10,49.10,190.07,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97530,cpt,"THERAPEUTIC ACTIVITIES TO IMPROVE FUNCTION, WITH ONE-ON-ONE CONTACT BETWEEN PATIENT AND PROVIDER, EACH 15 MINUTES",veterans affairs,,O,176.32,30.07,30.40,132.24,105.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,310,ms-drg,CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,veterans affairs,,I,15215.00,3354.50,4413.69,6648.19,9129.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27425,cpt,"RELEASE OF LIGAMENTS OF KNEE JOINT, OPEN PROCEDURE",veterans affairs,,O,37444.64,11252.12,11252.12,11252.12,22466.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29826,cpt,SHAVING OF PART OF SHOULDER BONE AND REPAIR OF LIGAMENT USING AN ENDOSCOPE,veterans affairs,,O,33765.02,2631.25,5666.83,16721.96,6904.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,66991,cpt,EXTRACAPSULAR REMOVAL OF CATARACT WITH INSERTION OF ARTIFICIAL LENS AND INSERTION OF DRAINAGE DEVICE IN FRONT CHAMBER OF EYE,veterans affairs,,O,9278.04,2229.79,3757.14,3757.14,5566.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,617,ms-drg,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",veterans affairs,,I,39556.14,7942.02,13549.76,33689.17,23733.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,veterans affairs,,O,93.19,5.27,44.64,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",veterans affairs,,O,348.89,46.07,76.80,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,veterans affairs,,I,48.06,11.46,12.88,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49422,cpt,REMOVAL OF ABDOMINAL CAVITY CATHETER,veterans affairs,,O,18151.83,2586.52,4543.19,4543.19,10891.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,veterans affairs,,O,3595.37,280.86,333.16,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,veterans affairs,,O,3055.12,204.02,206.42,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",veterans affairs,,O,90.84,3.51,20.81,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,veterans affairs,,O,67.58,8.51,8.68,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,49653,cpt,REPAIR OF TRAPPED HERNIA USING AN ENDOSCOPE,veterans affairs,,O,27581.12,4577.80,4577.80,4577.95,16548.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,veterans affairs,,I,12315.58,3063.82,4962.82,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,veterans affairs,,O,6833.06,1646.56,2214.00,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",veterans affairs,,O,5902.67,335.59,1182.27,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73723,cpt,MRI SCAN OF LEG JOINT BEFORE AND AFTER CONTRAST,veterans affairs,,O,3471.56,325.59,325.59,3471.56,2082.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82390,cpt,CERULOPLASMIN (PROTEIN) LEVEL,veterans affairs,,O,71.96,2.18,10.74,26.69,43.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99285,cpt,"EMERGENCY DEPARTMENT VISIT, PROBLEM WITH SIGNIFICANT THREAT TO LIFE OR FUNCTION",veterans affairs,,E,5953.08,743.91,810.16,3773.70,3571.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43450,cpt,DILATION OF ESOPHAGUS UNGUIDED,veterans affairs,,O,3953.80,1077.08,1094.54,3964.17,2372.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93567,cpt,INJECTION FOR IMAGING OF AORTA ABOVE HEART VALVE WITH REVIEW BY RADIOLOGIST,veterans affairs,,O,28827.81,2623.46,2623.46,2623.46,17296.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",veterans affairs,,I,2293.53,512.55,512.55,903.80,1376.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,620,ms-drg,O.R. PROCEDURES FOR OBESITY WITH CC,veterans affairs,,I,51507.32,12021.01,12021.01,13161.36,30904.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,208,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,veterans affairs,,I,75679.94,16342.73,17980.51,23209.18,45407.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",veterans affairs,,O,113.79,13.73,30.43,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",veterans affairs,,O,96.29,17.55,35.09,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,veterans affairs,,O,252.59,4.78,4.78,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,veterans affairs,,O,3055.12,205.61,208.17,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86606,cpt,ANALYSIS FOR ANTIBODY TO ASPERGILLUS (FUNGUS),veterans affairs,,O,100.27,15.05,15.05,15.05,60.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86612,cpt,ANALYSIS FOR ANTIBODY TO BLASTOMYCES (FUNGUS),veterans affairs,,O,93.19,12.90,12.90,12.90,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",veterans affairs,,O,36.32,4.04,4.29,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92523,cpt,EVALUATION OF SPEECH SOUND PRODUCTION WITH EVALUATION OF LANGUAGE COMPREHENSION AND EXPRESSION,veterans affairs,,O,523.82,219.37,219.37,219.37,314.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",veterans affairs,,O,365.14,61.44,76.78,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),veterans affairs,,O,50.01,5.20,14.39,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86480,cpt,"TUBERCULOSIS TEST, GAMMA INTERFERON",veterans affairs,,O,350.39,39.08,61.98,262.79,72.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82610,cpt,CYSTATIN C (ENZYME INHIBITOR) LEVEL,veterans affairs,,O,89.65,18.15,18.52,67.24,53.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,287,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC",veterans affairs,,I,42121.79,7205.02,8147.85,13887.33,25273.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,300,ms-drg,PERIPHERAL VASCULAR DISORDERS WITH CC,veterans affairs,,I,16027.98,6756.27,7552.55,12036.47,9616.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,veterans affairs,,O,3580.43,810.94,825.93,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77280,cpt,"OBTAINING DATA NEEDED TO DEVELOP THE OPTIMAL RADIATION TREATMENT, 1 TREATMENT AREA",veterans affairs,,O,1099.23,114.80,117.87,873.89,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,25246,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF WRIST JOINT,veterans affairs,,O,5068.82,980.42,980.42,980.42,3041.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74175,cpt,CT SCAN OF BLOOD VESSELS OF ABDOMEN WITH CONTRAST,veterans affairs,,O,1952.12,159.41,159.41,547.34,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84165,cpt,"PROTEIN MEASUREMENT, SERUM",veterans affairs,,O,116.79,7.81,10.74,87.59,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,veterans affairs,,I,5902.00,1055.41,1542.80,28002.03,3541.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,50590,cpt,SHOCK WAVE CRUSHING OF KIDNEY STONES,veterans affairs,,O,24173.14,2776.54,2832.77,19924.89,14503.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,veterans affairs,,O,184.32,70.33,106.13,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,veterans affairs,,O,3055.12,206.42,206.42,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",veterans affairs,,O,212.59,22.86,23.33,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,veterans affairs,,O,647.78,92.64,94.47,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),veterans affairs,,O,65.11,4.25,8.41,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0170,revCode,NURSERY GENERAL,webtpa,,I,1569.44,869.27,2579.77,3331.37,941.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96416,cpt,PROLONGED CHEMOTHERAPY INFUSION INTO A VEIN BY PORTABLE OR IMPLANTED PUMP MORE THAN 8 HOURS,veterans affairs,,O,567.74,115.42,293.94,567.74,340.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9119,cpt,"INJECTION, CEMIPLIMAB-RWLC, 1 MG",veterans affairs,,O,82.58,26.92,26.92,26.92,49.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",veterans affairs,,O,245.09,61.44,76.78,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,veterans affairs,,I,78211.42,12813.14,15001.57,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,91112,cpt,TRANSIT AND PRESSURE MEASUREMENT OF STOMACH THROUGH COLON WITH WIRELESS CAPSULE,veterans affairs,,O,1776.38,206.04,730.88,1332.29,1065.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29888,cpt,REPAIR OF ANTERIOR CRUCIATE LIGAMENT OF KNEE WITH ASSISTANCE OF AN ENDOSCOPE,veterans affairs,,O,54316.68,5757.05,5845.48,14778.63,32590.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,veterans affairs,,O,298.87,98.24,100.25,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86381,cpt,MEASUREMENT OF MITOCHONDRIAL ANTIBODY,veterans affairs,,O,63.63,8.37,25.45,25.45,38.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,808,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,veterans affairs,,I,33019.93,13774.56,14909.46,18365.56,19811.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,43249,cpt,"BALLOON DILATION OF ESOPHAGUS, STOMACH, AND/OR UPPER SMALL BOWEL USING A FLEXIBLE ENDOSCOPE, LESS THAN 3.0 CM",veterans affairs,,O,5156.78,1469.46,1469.46,4819.09,3094.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,64415,cpt,INJECTION OF ANESTHETIC AGENT AND/OR STEROID INTO BRACHIAL NERVE BUNDLE OF ARM,veterans affairs,,O,33058.65,2631.25,4239.02,11631.36,19835.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21933,cpt,"REMOVAL OF GROWTH OF MUSCLE OF BACK OR LOWER SIDES, 5.0 CM OR MORE",veterans affairs,,O,19820.30,2226.69,2283.41,2283.41,11892.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82656,cpt,DETECTION OF PANCREATIC ELASTASE (ENZYME) IN STOOL,veterans affairs,,O,236.36,11.30,11.53,177.27,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,392,ms-drg,"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",veterans affairs,,I,18651.52,4921.84,5991.13,10503.74,11190.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",veterans affairs,,I,734.07,127.47,127.47,583.58,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27405,cpt,PRIMARY REPAIR OF TORN LIGAMENT OR JOINT CAPSULE AT OUTSIDE PART OF KNEE,veterans affairs,,O,27902.49,5666.83,5666.83,5666.83,16741.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36223,cpt,INSERTION OF CATHETER INTO INTRACRANIAL ARTERY ON ONE SIDE OF NECK FOR DIAGNOSIS OR TREATMENT INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION,veterans affairs,,O,33170.52,2564.86,4542.11,4542.11,19902.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,23350,cpt,INJECTION OF DYE FOR X-RAY IMAGING OF SHOULDER JOINT,veterans affairs,,O,5340.22,795.73,980.42,4000.22,3204.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",veterans affairs,,I,145.15,30.77,45.32,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86160,cpt,"MEASUREMENT OF COMPLEMENT (IMMUNE SYSTEM PROTEINS), ANTIGEN,",veterans affairs,,O,50.72,7.45,12.00,38.04,14.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93312,cpt,INSERTION OF PROBE IN ESOPHAGUS FOR HEART ULTRASOUND EXAMINATION INCLUDING INTERPRETATION AND REPORT,veterans affairs,,O,1858.32,408.83,444.63,1435.55,1114.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93461,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART FOR IMAGING OF BLOOD VESSELS AND/OR GRAFTS INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,veterans affairs,,O,20929.99,2614.76,2614.76,2614.76,12557.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,veterans affairs,,O,67.58,5.08,5.18,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27570,cpt,MANIPULATION OF KNEE JOINT UNDER ANESTHESIA,veterans affairs,,O,13902.50,1248.60,1268.02,10424.46,8341.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12001,cpt,"REPAIR OF WOUND (2.5 CENTIMETERS OR LESS) OF THE SCALP, NECK, UNDERARMS, TRUNK, ARMS AND/OR LEGS",veterans affairs,,O,17703.03,159.63,227.83,227.83,10621.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96360,cpt,HYDRATION INFUSION INTO A VEIN 31 MINUTES TO 1 HOUR,veterans affairs,,O,237.59,106.92,185.08,237.59,142.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,75625,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF ABDOMINAL AORTA,veterans affairs,,O,10678.57,95.85,2632.58,8249.20,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,565,ms-drg,OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,veterans affairs,,I,25304.21,7376.60,7376.60,7376.60,15182.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29877,cpt,REMOVAL OR SHAVING OF KNEE JOINT CARTILAGE USING AN ENDOSCOPE,veterans affairs,,O,20747.46,2550.50,2596.33,7792.87,12448.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",veterans affairs,,I,826.60,176.29,176.29,176.29,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87116,cpt,CULTURE FOR ACID-FAST BACILLI,veterans affairs,,O,113.25,10.59,10.80,84.94,12.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45350,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (SIGMOIDOSCOPE),veterans affairs,,O,3810.64,935.38,938.17,3292.25,2286.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,veterans affairs,,O,323.88,75.26,76.80,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,veterans affairs,,I,84785.32,12190.37,13214.13,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,12032,cpt,"REPAIR OF WOUND (2.6 TO 7.5 CENTIMETERS) OF THE SCALP, UNDERARMS, TRUNK, ARMS, AND/OR LEGS",veterans affairs,,O,3919.67,159.22,1022.26,9370.59,2351.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,veterans affairs,,O,862.88,61.44,94.45,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",veterans affairs,,O,635.27,137.73,317.01,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,veterans affairs,,O,351.40,51.44,83.14,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97124,cpt,"THERAPEUTIC MASSAGE TO 1 OR MORE AREAS, EACH 15 MINUTES",veterans affairs,,O,107.40,27.68,28.24,28.24,64.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,veterans affairs,,O,560.24,92.59,98.50,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,559,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",veterans affairs,,I,51945.44,12828.44,12828.44,12828.44,31167.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46020,cpt,INSERTION OF DRAIN (SETON) INTO ANUS,veterans affairs,,O,19436.21,2270.69,2270.69,2270.69,11661.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,webtpa,,O,3683.73,275.00,768.96,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86304,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 125",veterans affairs,,O,101.45,14.76,20.81,76.09,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86335,cpt,"IMMUNOLOGIC ANALYSIS TECHNIQUE ON BODY FLUID, OTHER FLUIDS WITH CONCENTRATION",veterans affairs,,O,212.36,23.13,29.35,29.47,34.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55876,cpt,INSERTION OF RADIATION THERAPY DEVICES IN PROSTATE GLAND FOR RADIATION THERAPY GUIDANCE,veterans affairs,,O,27054.40,2670.10,2670.10,16970.47,16232.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",veterans affairs,,O,238.84,35.53,76.79,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0008,cpt,ADMINISTRATION OF INFLUENZA VIRUS VACCINE,veterans affairs,,O,105.03,8.42,20.50,36.70,42.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9217,cpt,"LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG",veterans affairs,,O,1007.94,158.30,172.56,1001.47,604.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,veterans affairs,,I,18614.53,3748.00,10666.39,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,884,ms-drg,ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,veterans affairs,,I,19200.53,9086.43,10997.54,10997.54,11520.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",veterans affairs,,O,315.99,85.00,198.74,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,557,ms-drg,"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",veterans affairs,,I,27652.12,7322.56,8463.48,8463.48,16591.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,100,ms-drg,SEIZURES WITH MCC,veterans affairs,,I,27764.15,6132.00,13326.03,14577.74,16658.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",veterans affairs,,O,13.80,2.61,3.17,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",veterans affairs,,O,1252.50,103.81,103.81,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0720,revCode,LABOR ROOM/DELIVERY GENERAL,veterans affairs,,I,150.64,21.34,21.34,4826.59,90.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78451,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE SINGLE STUDY,veterans affairs,,O,2714.96,1182.27,1182.27,1182.27,1628.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,229,ms-drg,OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC,veterans affairs,,I,87009.82,20597.74,22664.85,22664.85,52205.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28118,cpt,REMOVAL OF HEEL BONE,veterans affairs,,O,31022.88,2578.63,5846.87,15484.76,18613.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,10005,cpt,"FINE NEEDLE ASPIRATION BIOPSY USING ULTRASOUND GUIDANCE, FIRST GROWTH",veterans affairs,,O,2576.47,558.51,573.64,1932.35,1545.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93459,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND/OR GRAFTS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,veterans affairs,,O,28921.96,2582.89,2623.46,5906.55,17353.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,veterans affairs,,O,1481.91,158.58,161.61,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,52310,cpt,"REMOVAL OF FOREIGN BODY, STONE, OR STENT FROM BLADDER CANAL (URETHRA) OR BLADDER USING AN ENDOSCOPE",veterans affairs,,O,18156.04,1619.97,2833.10,2833.10,10893.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",veterans affairs,,O,468.95,93.59,96.49,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,veterans affairs,,O,67.58,3.47,5.78,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36821,cpt,"RELOCATION OF ARM VEIN WITH CONNECTION TO ARM ARTERY, OPEN PROCEDURE, ANY SITE AS SEPARATE PROCEDURE",veterans affairs,,O,21470.01,2569.92,2632.58,10309.61,12882.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,29825,cpt,RELEASE OR REMOVAL OF SHOULDER SCAR TISSUE USING AN ENDOSCOPE,veterans affairs,,O,29814.55,2596.65,2596.65,14706.90,17888.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,veterans affairs,,I,752.83,203.26,203.26,719.74,451.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,809,ms-drg,MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,veterans affairs,,I,46992.19,7372.16,8757.81,9364.35,28195.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,473,ms-drg,CERVICAL SPINAL FUSION WITHOUT CC/MCC,veterans affairs,,I,73180.56,15169.99,17581.85,74397.72,43908.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",veterans affairs,,O,650.28,61.44,94.46,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37221,cpt,"INSERTION OF STENTS IN ARTERY IN ONE SIDE OF GROIN, ENDOVASCULAR, ACCESSED THROUGH THE SKIN OR OPEN PROCEDURE",veterans affairs,,O,79435.82,14297.99,15180.19,15180.19,47661.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0283,cpt,"ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE",veterans affairs,,O,98.78,7.87,8.92,101.74,59.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0420,revCode,"PHYSICAL THERAPY, GENERAL",veterans affairs,,I,183.82,35.02,35.02,172.26,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93288,cpt,"EVALUATION OF PARAMETERS OF LEADLESS, SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM WITH QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS, REVIEW, AND REPORT",veterans affairs,,O,338.89,30.54,33.69,76.59,203.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",veterans affairs,,O,502.71,78.63,243.47,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,355,ms-drg,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,veterans affairs,,I,28107.26,9817.04,9817.04,13607.72,16864.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,veterans affairs,,I,3055.12,691.95,691.95,3172.84,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21931,cpt,REMOVAL (3 CENTIMETERS OR GREATER) TISSUE GROWTH BENEATH THE SKIN OF BACK OR FLANK,veterans affairs,,O,19815.20,1325.34,1325.34,5743.86,11889.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58661,cpt,REMOVAL OF OVARIES AND/OR TUBES USING AN ENDOSCOPE,veterans affairs,,O,27191.57,4592.49,4592.49,23996.68,16314.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,veterans affairs,,O,348.63,85.16,86.90,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92507,cpt,"TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR HEARING PROCESSING DISORDER",veterans affairs,,O,264.26,74.09,74.09,97.63,158.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",veterans affairs,,O,2069.24,93.35,128.94,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9035,cpt,"INJECTION, BEVACIZUMAB, 10 MG",veterans affairs,,O,286.90,69.72,69.72,69.72,172.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,L3925,cpt,"FINGER ORTHOSIS, PROXIMAL INTERPHALANGEAL (PIP)/DISTAL INTERPHALANGEAL (DIP), NON TORSION JOINT/SPRING, EXTENSION/FLEXION, MAY INCLUDE SOFT INTERFACE MATERIAL, PREFABRICATED, OFF-THE-SHELF",veterans affairs,,O,190.07,51.87,51.87,51.87,114.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0269,cpt,"PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTERIAL ACCESS SITE, POST SURGICAL OR INTERVENTIONAL PROCEDURE (E.G., ANGIOSEAL PLUG, VASCULAR PLUG)",veterans affairs,,O,62806.84,6858.72,11808.74,11808.74,37684.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C9602,cpt,"PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH DRUG ELUTING INTRACORONARY STENT, WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH",veterans affairs,,O,89872.77,14944.85,15180.19,15180.19,53923.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),veterans affairs,,O,91.30,14.31,19.31,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,veterans affairs,,O,3055.12,203.12,208.17,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q0138,cpt,"INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE)",veterans affairs,,O,4.99,0.54,7.83,138.02,2.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1569,cpt,"INJECTION, IMMUNE GLOBULIN, (GAMMAGARD LIQUID), NON-LYOPHILIZED, (E.G., LIQUID), 500 MG",veterans affairs,,O,90.46,32.41,44.46,45.23,54.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,369,ms-drg,MAJOR ESOPHAGEAL DISORDERS WITH CC,veterans affairs,,I,18183.53,5934.09,7530.55,7530.55,10910.12
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,veterans affairs,,O,183.82,19.97,23.08,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,veterans affairs,,O,383.02,34.82,329.77,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17250,cpt,APPLICATION OF CHEMICAL TO STOP TISSUE REGROWTH IN WOUND,veterans affairs,,O,703.02,157.08,159.58,777.14,421.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",veterans affairs,,O,112.55,10.48,10.54,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,veterans affairs,,O,351.40,81.48,83.14,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,veterans affairs,,I,108746.38,30644.47,33518.29,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,811,ms-drg,RED BLOOD CELL DISORDERS WITH MCC,veterans affairs,,I,26952.43,9206.49,10593.98,16010.05,16171.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46260,cpt,REMOVAL OF MULTIPLE INTERNAL AND EXTERNAL HEMORRHOID GROUPS,veterans affairs,,O,18904.18,2231.78,2271.23,4726.84,11342.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74246,cpt,X-RAY OF UPPER DIGESTIVE TRACT WITH DOUBLE CONTRAST,veterans affairs,,O,513.11,156.86,161.61,384.83,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,234,ms-drg,CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC,veterans affairs,,I,205358.74,31986.81,35584.94,50803.66,123215.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",veterans affairs,,O,125.04,27.28,59.62,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93458,cpt,INSERTION OF CATHETER IN LEFT HEART FOR IMAGING OF BLOOD VESSELS AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,veterans affairs,,O,27089.15,2439.68,4608.95,18837.56,16253.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9055,cpt,"INJECTION, CETUXIMAB, 10 MG",veterans affairs,,O,245.09,18.02,18.02,70.14,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,veterans affairs,,O,4054.33,319.17,325.67,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,veterans affairs,,O,130.11,30.48,39.26,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36901,cpt,"INSERTION OF NEEDLE AND/OR CATHETER INTO DIALYSIS CIRCUIT, WITH IMAGING INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION",veterans affairs,,O,15374.12,2544.37,2589.90,4389.29,9224.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72197,cpt,MRI SCAN OF PELVIS BEFORE AND AFTER CONTRAST,veterans affairs,,O,3055.12,320.47,325.67,2360.08,391.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74183,cpt,MRI SCAN OF ABDOMEN BEFORE AND AFTER CONTRAST,veterans affairs,,O,4054.33,322.67,325.63,3040.75,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5118,cpt,"INJECTION, BEVACIZUMAB-BVZR, BIOSIMILAR, (ZIRABEV), 10 MG",veterans affairs,,O,200.00,27.06,72.49,150.00,120.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45378,cpt,DIAGNOSTIC COLONOSCOPY OF LARGE BOWEL USING A FLEXIBLE ENDOSCOPE,veterans affairs,,O,3222.12,719.92,734.58,2251.40,867.43
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,veterans affairs,,O,3055.12,202.50,206.37,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9177,cpt,"INJECTION, ENFORTUMAB VEDOTIN-EJFV, 0.25 MG",veterans affairs,,O,136.34,1048.36,1048.36,1048.36,81.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,veterans affairs,,O,94.38,2.18,10.74,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,veterans affairs,,O,1869.58,206.26,465.98,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,580,ms-drg,"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",veterans affairs,,I,52656.26,7319.59,12634.12,18388.00,31593.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86146,cpt,BETA 2 GLYCOPROTEIN 1 ANTIBODY (AUTOANTIBODY) MEASUREMENT,veterans affairs,,O,138.03,9.70,25.45,73.30,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55040,cpt,REMOVAL OF FLUID ACCUMULATION IN ONE TESTICLE AND SPERM RESERVOIR,veterans affairs,,O,18318.75,3130.82,3130.82,6021.28,10991.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",veterans affairs,,O,331.50,12.98,13.24,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,785,ms-drg,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,veterans affairs,,I,14108.83,5205.40,6775.56,10198.00,8465.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,31231,cpt,DIAGNOSTIC EXAMINATION OF NASAL PASSAGES USING AN ENDOSCOPE,veterans affairs,,O,282.74,249.40,2514.21,2514.21,169.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95810,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB,veterans affairs,,O,4318.19,810.94,825.93,3335.80,975.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82550,cpt,"CREATINE KINASE (CARDIAC ENZYME) LEVEL, TOTAL",veterans affairs,,O,60.16,6.38,6.51,45.12,7.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",veterans affairs,,I,990.43,191.36,191.36,787.39,594.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,857,ms-drg,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,veterans affairs,,I,58450.53,13402.18,14737.36,19974.44,35070.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",veterans affairs,,O,650.28,61.44,98.50,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,206,ms-drg,OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,veterans affairs,,I,26545.25,6727.00,6727.00,10067.42,15927.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,674,ms-drg,OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,veterans affairs,,I,60019.19,15090.19,16669.65,23273.88,36011.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",veterans affairs,,O,154.76,24.25,284.42,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97163,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 45 MINUTES",veterans affairs,,O,298.47,56.42,96.35,145.02,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,veterans affairs,,I,19710.37,4922.26,7633.06,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36558,cpt,"INSERTION OF CENTRAL VENOUS CATHETER FOR INFUSION, PATIENT 5 YEARS OR OLDER, TUNNELED",veterans affairs,,O,20661.93,2586.12,3566.01,6323.15,12397.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86147,cpt,CARDIOLIPIN ANTIBODY (TISSUE ANTIBODY) MEASUREMENT,veterans affairs,,O,330.33,24.94,25.45,262.61,29.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,veterans affairs,,O,647.78,94.48,98.50,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,390,ms-drg,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,veterans affairs,,I,12721.53,4148.74,4487.68,6879.39,7632.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,veterans affairs,,I,26926.14,6286.85,7320.87,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,58558,cpt,BIOPSY OF LINING OF UTERUS AND/OR REMOVAL OF POLYP USING AN ENDOSCOPE,veterans affairs,,O,24068.17,2373.69,2373.69,19315.13,14440.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11045,cpt,"REMOVAL OF SKIN AND TISSUE, EACH ADDITIONAL 20.0 SQ CM OR LESS",veterans affairs,,O,3583.92,323.18,329.77,2066.83,2150.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,veterans affairs,,O,45.13,4.38,45.13,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82785,cpt,IGE (IMMUNE SYSTEM PROTEIN) LEVEL,veterans affairs,,O,69.59,7.80,16.46,52.19,41.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,55874,cpt,INJECTION OF BIODEGRADABLE MATERIAL NEXT TO PROSTATE,veterans affairs,,O,27054.40,4079.31,4155.41,16970.47,16232.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83520,cpt,MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE,veterans affairs,,O,43.18,10.79,17.27,32.39,25.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11981,cpt,INSERTION OF DRUG DELIVERY IMPLANT INTO TISSUE,veterans affairs,,O,40615.05,2631.16,2631.16,5776.91,24369.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,21554,cpt,REMOVAL OF (5 CENTIMETERS OR GREATER) MUSCLE GROWTH OF NECK OR FRONT OF CHEST,veterans affairs,,O,20809.89,2244.32,2283.14,11082.03,12485.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",veterans affairs,,O,212.36,14.48,44.32,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93283,cpt,"EVALUATION, TESTING AND PROGRAMMING ADJUSTMENT OF DEFIBRILLATOR WITH ANALYSIS, REVIEW AND REPORT, DUAL LEAD DEFIBRILLATOR SYSTEM",veterans affairs,,O,288.87,30.93,30.93,32.32,173.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,veterans affairs,,O,90.02,12.05,13.63,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,37766,cpt,"MULTIPLE INCISIONS FOR REMOVAL OF VARICOSE VEINS OF ARM OR LEG, GREATER THAN 20 INCISIONS",veterans affairs,,O,24542.50,3410.10,3473.76,5064.25,14725.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87536,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HIV-1 VIRUS, QUANTIFICATION",veterans affairs,,O,519.10,54.18,85.10,295.89,311.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36471,cpt,INJECTION OF CHEMICAL AGENT INTO MULTIPLE INCOMPETENT VEINS OF ONE LEG,veterans affairs,,O,2606.20,1345.28,2589.90,4314.46,1563.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",veterans affairs,,O,114.43,3.13,20.05,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,28120,cpt,PARTIAL REMOVAL OF FOOT OR HEEL BONE FOR BONE INFECTION IN THE MID HINDFOOT AREA,veterans affairs,,O,34724.90,2630.53,2630.53,11395.58,20834.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,164,ms-drg,MAJOR CHEST PROCEDURES WITH CC,veterans affairs,,I,103938.91,16060.55,18100.64,25897.15,62363.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77336,cpt,CONTINUING RADIATION THERAPY CONSULTATION PER WEEK,veterans affairs,,O,306.38,103.42,117.87,306.38,135.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,54840,cpt,REMOVAL OF FLUID ACCUMULATION IN SPERM RESERVOIR,veterans affairs,,O,20218.00,2833.10,2833.10,5719.05,12130.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93460,cpt,INSERTION OF CATHETER IN RIGHT AND LEFT HEART AND LEFT LOWER HEART INCLUDING IMAGING INTERPRETATION AND SUPERVISION AND INJECTION,veterans affairs,,O,19198.81,2406.74,2614.45,13237.60,11519.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,27687,cpt,LENGTHENING OF CALF MUSCLE,veterans affairs,,O,18786.36,2631.16,2631.16,13419.43,11271.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73115,cpt,RADIOLOGICAL SUPERVISION AND INTERPRETATION X-RAY OF WRIST JOINT,veterans affairs,,O,1253.05,333.16,333.16,333.16,751.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86334,cpt,IMMUNOLOGIC ANALYSIS TECHNIQUE ON SERUM (IMMUNOFIXATION),veterans affairs,,O,132.12,15.79,22.34,99.09,26.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82378,cpt,CARCINOEMBRYONIC ANTIGEN (CEA) PROTEIN LEVEL,veterans affairs,,O,143.17,18.59,18.96,107.38,85.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92526,cpt,TREATMENT OF SWALLOWING AND/OR ORAL FEEDING FUNCTION,veterans affairs,,O,407.71,81.87,81.87,134.77,244.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",veterans affairs,,O,422.68,79.93,247.55,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,377,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH MCC,veterans affairs,,I,46517.09,11486.77,12781.99,18787.25,27910.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,561,ms-drg,"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",veterans affairs,,I,28538.09,6566.77,11690.41,13087.98,17122.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,veterans affairs,,O,5902.67,923.22,1173.21,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83003,cpt,HUMAN GROWTH HORMONE LEVEL,veterans affairs,,O,101.45,16.34,16.67,16.67,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,768,ms-drg,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,veterans affairs,,I,15836.34,3774.13,8412.07,17446.29,9501.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,812,ms-drg,RED BLOOD CELL DISORDERS WITHOUT MCC,veterans affairs,,I,17513.39,3290.25,6831.08,22466.97,10508.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",veterans affairs,,O,105.03,12.96,20.50,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83655,cpt,LEAD LEVEL,webtpa,,O,60.16,11.87,30.08,45.12,14.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,682,ms-drg,RENAL FAILURE WITH MCC,veterans affairs,,I,26508.25,6362.98,10937.98,16941.00,15904.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96402,cpt,HORMONAL ANTI-NEOPLASTIC CHEMOTHERAPY ADMINISTRATION BENEATH THE SKIN OR INTO MUSCLE,veterans affairs,,O,132.54,29.82,59.62,118.07,79.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97018,cpt,APPLICATION OF HOT WAX BATH TO 1 OR MORE AREAS,veterans affairs,,O,83.78,3.34,3.87,38.08,50.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,805,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,webtpa,,I,14483.73,3890.14,9908.71,11041.35,8690.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73650,cpt,"X-RAY OF HEEL, MINIMUM OF 2 VIEWS",webtpa,,O,254.50,44.02,120.05,149.69,152.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87301,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR ADENOVIRUS ENTERIC TYPES 40/41,webtpa,,O,60.03,7.19,31.82,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85379,cpt,"COAGULATION FUNCTION MEASUREMENT, D-DIMER; QUANTITATIVE",webtpa,,O,122.56,1.48,61.28,91.92,11.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,286,ms-drg,"CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC",webtpa,,I,55760.94,13702.32,20776.53,26072.17,33456.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,webtpa,,O,184.32,70.33,570.48,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",webtpa,,O,369.82,61.44,235.51,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",webtpa,,O,1434.39,436.85,760.23,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",webtpa,,O,468.95,93.59,234.48,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,38222,cpt,BIOPSY AND ASPIRATION OF BONE MARROW SAMPLE FOR DIAGNOSIS,webtpa,,O,6833.06,1646.56,5030.76,5030.76,4099.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,389,ms-drg,GASTROINTESTINAL OBSTRUCTION WITH CC,webtpa,,I,17143.70,5530.39,18965.92,18965.92,10286.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87045,cpt,STOOL CULTURE,webtpa,,O,80.09,5.66,42.45,60.07,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82270,cpt,STOOL ANALYSIS FOR BLOOD TO SCREEN FOR COLON TUMORS,webtpa,,O,31.88,2.63,15.94,23.91,5.15
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,webtpa,,O,752.83,92.79,376.42,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86735,cpt,ANALYSIS FOR ANTIBODY TO MUMPS VIRUS,webtpa,,O,50.01,5.20,25.01,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),webtpa,,O,126.23,10.13,63.12,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",webtpa,,O,158.29,56.98,80.36,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99282,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MILD TO MODERATE SEVERITY,webtpa,,E,292.62,111.66,146.31,292.62,175.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0430,revCode,"OCCUPATIONAL THERAPY, GENERAL",webtpa,,O,212.21,71.36,1618.35,1618.35,127.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,webtpa,,O,83.76,6.73,41.88,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0731,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG), HOLTER MONITOR",webtpa,,O,266.35,64.70,266.36,266.36,159.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,176,ms-drg,PULMONARY EMBOLISM WITHOUT MCC,webtpa,,I,19404.23,4326.04,23340.67,23340.67,11642.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,webtpa,,O,647.78,94.48,323.89,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,webtpa,,O,213.87,28.75,106.94,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",webtpa,,O,650.28,61.44,325.14,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73660,cpt,"X-RAY OF TOES, MINIMUM OF 2 VIEWS",webtpa,,O,245.09,61.44,122.55,173.76,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",webtpa,,O,647.78,98.50,323.89,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83880,cpt,NATRIURETIC PEPTIDE (HEART AND BLOOD VESSEL PROTEIN) LEVEL,webtpa,,O,130.11,30.48,68.96,97.58,46.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87427,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR SHIGA-LIKE TOXIN (BACTERIAL TOXIN),webtpa,,O,60.03,6.83,31.82,45.02,14.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,872,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,webtpa,,I,19710.37,4922.26,12962.95,15349.31,11826.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,880,ms-drg,ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,webtpa,,I,18614.53,3748.00,10861.30,10861.30,11168.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17110,cpt,"DESTRUCTION OF SKIN GROWTH, 1-14 GROWTHS",webtpa,,O,1015.48,95.84,228.48,507.74,609.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,470,ms-drg,MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC,webtpa,,I,75778.57,12009.61,54405.24,55745.62,45467.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",webtpa,,O,52.60,8.84,26.30,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86235,cpt,"MEASUREMENT OF ANTIBODY FOR ASSESSMENT OF AUTOIMMUNE DISORDER, ANY METHOD",webtpa,,O,45.06,8.66,23.88,33.80,21.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,webtpa,,O,76.68,5.83,38.34,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",webtpa,,O,252.47,44.06,123.32,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72195,cpt,MRI SCAN OF PELVIS WITHOUT CONTRAST,webtpa,,O,1869.58,206.26,990.88,1017.53,1121.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97166,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 45 MINUTES",webtpa,,O,281.36,90.50,140.68,217.35,168.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",webtpa,,O,100.04,20.74,49.39,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",webtpa,,O,3595.37,208.18,2655.45,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",webtpa,,O,502.71,78.63,251.36,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,webtpa,,I,84785.32,12190.37,37237.76,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87046,cpt,"STOOL CULTURE, ADDITIONAL PATHOGENS",webtpa,,O,52.60,5.67,27.88,39.45,11.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",webtpa,,O,92.99,21.05,43.87,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),webtpa,,O,53.08,5.52,26.54,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",webtpa,,O,94.14,7.61,44.41,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,webtpa,,O,3595.37,280.86,1797.69,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,webtpa,,O,560.24,92.59,296.93,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,45398,cpt,BANDING OF HEMORRHOIDS USING A FLEXIBLE ENDOSCOPE (COLONOSCOPE),webtpa,,O,3857.66,938.20,1754.47,3733.00,2314.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,webtpa,,O,3055.12,206.42,1527.56,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76801,cpt,ABDOMINAL ULTRASOUND OF PREGNANT UTERUS (LESS THAN 14 WEEKS 0 DAYS) SINGLE OR FIRST FETUS,webtpa,,O,401.42,94.39,200.71,301.07,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,webtpa,,O,175.06,87.53,87.53,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,webtpa,,O,419.99,136.22,207.78,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1950,cpt,"INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER 3.75 MG",webtpa,,O,4121.85,885.75,885.75,1474.18,2473.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,webtpa,,O,2599.91,94.47,1377.95,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,webtpa,,O,323.88,75.26,161.94,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,webtpa,,O,3055.12,204.02,1527.56,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73218,cpt,MRI SCAN OF ARM WITHOUT CONTRAST,webtpa,,O,3055.12,202.50,1619.21,1642.85,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",webtpa,,O,91.30,6.24,45.65,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",webtpa,,O,151.46,8.03,75.73,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,788,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC,webtpa,,I,14986.74,7771.24,10724.94,10724.94,8992.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",webtpa,,O,270.00,64.89,99.73,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,webtpa,,O,4054.33,319.17,2027.17,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,785,ms-drg,CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC,webtpa,,I,14108.83,5205.40,9797.03,10198.00,8465.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73010,cpt,X-RAY OF SHOULDER BLADE,webtpa,,O,267.61,46.08,120.42,120.42,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,637,ms-drg,DIABETES WITH MCC,webtpa,,I,30232.58,9248.60,24377.03,24377.03,18139.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72040,cpt,"X-RAY OF SPINE OF NECK, 2 OR 3 VIEWS",webtpa,,O,362.65,61.08,192.20,271.99,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,460,ms-drg,SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC,webtpa,,I,119532.08,24196.90,50636.45,77295.91,71719.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76856,cpt,"ULTRASOUND OF PELVIS, COMPLETE, NOT PREGNANCY RELATED",webtpa,,O,691.54,93.84,326.20,326.20,414.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,webtpa,,O,287.62,21.62,207.87,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70551,cpt,MRI SCAN OF BRAIN WITHOUT CONTRAST,webtpa,,O,3055.12,205.61,1527.56,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),webtpa,,O,41.28,5.08,20.64,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0260,revCode,INTRAVENOUS (IV) THERAPY,webtpa,,O,345.14,124.25,447.03,447.03,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0441,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,webtpa,,O,348.63,85.16,174.32,261.47,209.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",webtpa,,O,135.66,25.29,67.83,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,webtpa,,O,45.13,4.38,20.99,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,419,ms-drg,LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,webtpa,,I,40465.41,9645.93,26459.17,26459.17,24279.25
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73564,cpt,"X-RAY OF KNEE, 4 OR MORE VIEWS",webtpa,,O,377.65,61.44,188.83,283.24,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",webtpa,,O,67.24,14.75,33.62,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,776,ms-drg,POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,webtpa,,I,14024.63,2935.28,7925.75,9541.48,8414.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",webtpa,,O,70.06,8.29,37.13,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,190,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,webtpa,,I,17945.73,6102.59,8232.65,13290.63,10767.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77334,cpt,"RADIATION TREATMENT DEVICES, DESIGN AND CONSTRUCTION, COMPLEX",webtpa,,O,635.27,137.73,285.87,635.27,364.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",webtpa,,O,365.14,61.44,182.57,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",webtpa,,O,650.28,61.44,325.14,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,webtpa,,O,45.06,3.98,22.53,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",webtpa,,O,162.48,33.29,159.61,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",webtpa,,I,944.41,228.70,16242.45,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",webtpa,,O,147.58,21.05,73.79,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",webtpa,,O,267.61,46.08,133.81,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",webtpa,,O,1997.14,430.17,998.57,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,603,ms-drg,CELLULITIS WITHOUT MCC,webtpa,,I,18651.11,4387.85,10126.34,10126.34,11190.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",webtpa,,O,419.99,46.79,46.79,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82950,cpt,BLOOD GLUCOSE (SUGAR) LEVEL AFTER RECEIVING DOSE OF GLUCOSE,webtpa,,O,38.92,4.65,19.46,29.20,5.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",webtpa,,O,120.33,16.46,60.17,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",webtpa,,O,348.89,53.55,174.45,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,webtpa,,O,95.55,14.26,21.26,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0321,revCode,RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY,webtpa,,O,10678.57,58.46,852.76,4635.47,6407.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,webtpa,,O,188.17,19.53,223.95,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",webtpa,,O,422.68,79.93,652.50,652.50,253.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70330,cpt,X-RAY OF JAW JOINTS ON BOTH SIDES OF THE FACE,webtpa,,O,362.65,192.20,192.20,212.05,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",webtpa,,O,56.26,6.34,28.13,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11102,cpt,"BIOPSY OF RELATED SKIN GROWTH, FIRST GROWTH",webtpa,,O,1091.80,160.12,236.10,596.78,655.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,webtpa,,O,9.11,0.50,4.63,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,webtpa,,O,178.08,50.28,89.04,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",webtpa,,O,1680.75,111.66,1483.22,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,795,ms-drg,NORMAL NEWBORN,webtpa,,I,4390.63,2140.83,2714.34,4272.65,2634.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,webtpa,,O,93.19,5.27,46.60,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",webtpa,,O,212.36,14.48,109.37,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,webtpa,,O,521.47,92.78,260.74,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",webtpa,,O,70.78,13.97,35.39,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73130,cpt,"X-RAY OF HAND, MINIMUM OF 3 VIEWS",webtpa,,O,348.89,46.07,184.91,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80069,cpt,KIDNEY FUNCTION BLOOD TEST PANEL,webtpa,,O,67.58,8.51,33.79,50.69,10.21
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72052,cpt,"X-RAY OF UPPER SPINE, 6 OR MORE VIEWS",webtpa,,O,622.77,61.44,330.07,423.49,373.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",webtpa,,O,130.95,13.50,60.90,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72146,cpt,MRI SCAN OF MIDDLE SPINAL CANAL WITHOUT CONTRAST,webtpa,,O,3055.12,204.02,1619.21,2291.34,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,webtpa,,I,4152.82,995.38,16397.13,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71111,cpt,"X-RAY OF BOTH SIDES OF THE RIBS INCLUDING THE CHEST, MINIMUM OF 4 VIEWS",webtpa,,O,377.65,61.44,188.83,188.83,226.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,webtpa,,O,42.51,2.00,10.46,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",webtpa,,O,252.47,43.75,133.81,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",webtpa,,O,149.83,34.39,74.92,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",webtpa,,O,373.90,92.59,186.95,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0101,cpt,CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION,webtpa,,O,313.23,66.78,166.01,166.01,187.94
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",webtpa,,O,147.58,21.05,73.79,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9445,cpt,"PATIENT EDUCATION, NOT OTHERWISE CLASSIFIED, NON-PHYSICIAN PROVIDER, INDIVIDUAL, PER SESSION",webtpa,,O,117.54,58.77,58.77,124.59,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84144,cpt,PROGESTERONE (REPRODUCTIVE HORMONE) LEVEL,webtpa,,O,101.45,3.58,50.73,80.65,24.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,webtpa,,O,792.84,92.74,408.32,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",webtpa,,O,50.01,4.43,16.07,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83002,cpt,"GONADOTROPIN, LUTEINIZING (REPRODUCTIVE HORMONE) LEVEL",webtpa,,O,250.10,18.15,125.05,187.58,21.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,882,ms-drg,NEUROSES EXCEPT DEPRESSIVE,webtpa,,I,14589.21,3863.55,11557.84,11557.84,8753.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93281,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT MULTIPLE LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",webtpa,,O,257.60,30.44,136.53,136.53,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,webtpa,,O,31.24,2.94,14.74,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76881,cpt,COMPLETE ULTRASOUND SCAN OF JOINT,webtpa,,O,402.67,93.28,213.42,302.00,241.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,305,ms-drg,HYPERTENSION WITHOUT MCC,webtpa,,I,20034.03,4988.82,14023.04,14265.77,12020.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87177,cpt,SMEAR FOR PARASITES,webtpa,,O,123.87,5.34,65.65,92.90,10.46
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",webtpa,,O,47.53,3.60,19.88,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99283,cpt,EMERGENCY DEPARTMENT VISIT FOR PROBLEM OF MODERATE SEVERITY,webtpa,,E,880.03,214.07,268.42,737.60,528.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73718,cpt,MRI SCAN OF LEG WITHOUT CONTRAST,webtpa,,O,3055.12,206.42,1527.56,2291.34,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,191,ms-drg,CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,webtpa,,I,14826.55,4677.51,6822.67,9219.13,8895.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,webtpa,,O,2289.17,554.60,1857.15,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",webtpa,,O,285.11,61.44,146.84,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",webtpa,,O,96.29,17.55,45.42,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",webtpa,,O,183.82,20.70,91.91,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",webtpa,,O,290.00,66.00,110.76,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",webtpa,,O,48.36,3.92,24.18,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,473,ms-drg,CERVICAL SPINAL FUSION WITHOUT CC/MCC,webtpa,,I,73180.56,15169.99,74397.72,74397.72,43908.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",webtpa,,O,85.05,7.99,85.76,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,280,ms-drg,"ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC",webtpa,,I,31302.10,10044.53,76220.28,76220.28,18781.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,386,ms-drg,INFLAMMATORY BOWEL DISEASE WITH CC,webtpa,,I,31061.59,21206.08,21206.08,21206.08,18636.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,webtpa,,O,41.19,1.80,885.75,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,webtpa,,O,1481.91,158.58,381.78,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",webtpa,,O,13.80,2.61,6.90,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0771,revCode,"PREVENTIVE CARE SERVICES, VACCINE ADMINISTRATION",webtpa,,O,105.03,12.96,360.33,360.33,63.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,481,ms-drg,HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,webtpa,,I,78211.42,12813.14,32607.35,32607.35,46926.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,webtpa,,O,78.05,7.37,29.07,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,webtpa,,O,3055.12,203.12,1619.21,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",webtpa,,O,20.05,1.78,9.33,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",webtpa,,O,348.89,61.44,174.45,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0114,revCode,ROOM AND BOARD PRIVATE (ONE BED) PSYCHIATRIC,webtpa,,I,2332.29,629.26,3095.92,3095.92,1399.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97165,cpt,"EVALUATION FOR OCCUPATIONAL THERAPY, TYPICALLY 30 MINUTES",webtpa,,O,223.91,73.72,111.96,167.93,134.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,webtpa,,O,2687.44,201.24,1424.34,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,webtpa,,O,30.49,2.32,20.84,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,webtpa,,O,252.59,55.19,896.82,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0740,revCode,"ELECTROENCEPHALOGRAM (EEG), GENERAL",webtpa,,O,826.60,239.39,497.06,849.89,495.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,832,ms-drg,OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,webtpa,,I,13166.47,3172.81,9094.35,9094.35,7899.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,46221,cpt,REMOVAL OF EXTERNAL HEMORRHOIDS BY RUBBER BANDING,webtpa,,O,3889.72,1284.30,2282.89,8613.19,2333.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",webtpa,,O,35.00,2.32,21.39,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",webtpa,,O,10827.72,2513.53,11305.69,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70544,cpt,MRI SCAN OF BLOOD VESSELS OF HEAD WITHOUT CONTRAST,webtpa,,O,3008.85,207.30,1504.43,1817.95,1805.31
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72080,cpt,"X-RAY OF MIDDLE AND LOWER SPINE, 2 VIEWS",webtpa,,O,266.35,51.50,133.18,199.76,89.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82164,cpt,ANGIOTENSIN L - CONVERTING ENZYME (ACE) LEVEL,webtpa,,O,101.45,12.63,50.73,76.09,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",webtpa,,O,2069.24,93.35,1360.53,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",webtpa,,O,1997.14,273.93,998.57,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,webtpa,,O,547.73,91.89,12032.56,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,webtpa,,O,203.82,49.80,103.16,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,291,ms-drg,HEART FAILURE AND SHOCK WITH MCC,webtpa,,I,22023.98,6812.39,7793.90,19794.73,13214.39
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70360,cpt,X-RAY OF SOFT TISSUE OF NECK,webtpa,,O,240.10,61.44,120.05,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,602,ms-drg,CELLULITIS WITH MCC,webtpa,,I,27263.26,7119.45,7119.45,14531.98,16357.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73560,cpt,"X-RAY OF KNEE, 1 OR 2 VIEWS",webtpa,,O,245.09,44.06,122.55,245.09,147.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77065,cpt,DIAGNOSTIC MAMMOGRAPHY OF 1 BREAST,webtpa,,O,287.62,77.37,148.13,287.62,92.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87255,cpt,VIRUS ISOLATION,webtpa,,O,123.87,33.18,61.94,79.34,39.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,webtpa,,O,351.40,81.48,175.70,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,webtpa,,O,113.25,11.78,56.63,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",webtpa,,O,365.14,48.65,193.52,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",webtpa,,O,25.94,5.08,12.97,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87493,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CLOSTRIDIUM DIFFICILE, AMPLIFIED PROBE TECHNIQUE",webtpa,,O,100.03,11.76,50.02,93.18,43.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,webtpa,,I,1386.23,364.58,8667.14,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",webtpa,,O,107.59,3.13,53.80,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",webtpa,,O,184.32,70.33,90.85,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",webtpa,,O,19.52,4.40,9.35,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,617,ms-drg,"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",webtpa,,I,39556.14,7942.02,33689.17,33689.17,23733.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,webtpa,,O,502.71,78.63,251.36,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,webtpa,,O,80.09,1.66,40.05,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,11042,cpt,REMOVAL OF SKIN AND TISSUE FIRST 20 SQ CM OR LESS,webtpa,,O,1446.95,312.71,529.57,2038.77,868.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",webtpa,,O,151.64,21.05,75.82,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,621,ms-drg,O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC,webtpa,,I,48014.63,10223.98,32094.15,32094.15,28808.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82397,cpt,ANALYSIS USING CHEMILUMINESCENT TECHNIQUE (LIGHT AND CHEMICAL )REACTION,webtpa,,O,51.39,9.33,25.70,25.70,30.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80306,cpt,"TESTING FOR PRESENCE OF DRUG, READ BY INSTRUMENT ASSISTED OBSERVATION",webtpa,,O,513.19,16.80,256.60,384.89,20.16
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",webtpa,,O,117.61,12.87,58.81,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",webtpa,,O,377.65,43.63,188.83,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76700,cpt,"ULTRASOUND OF ABDOMEN, COMPLETE",webtpa,,O,1029.19,93.54,500.04,771.89,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,439,ms-drg,DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,webtpa,,I,19744.66,5026.91,7942.57,10330.99,11846.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,webtpa,,O,50.01,3.11,25.76,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0940,revCode,MEDICAL REHABILITATION DAY PROGRAM GENERAL,webtpa,,O,316.37,49.55,533.63,533.63,189.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,webtpa,,O,4852.19,224.32,2426.10,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,16020,cpt,DRESSING CHANGE AND/OR REMOVAL OF BURN TISSUE (LESS THAN 5% TOTAL BODY SURFACE),webtpa,,O,738.64,157.08,219.47,553.98,443.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",webtpa,,O,4.12,1.10,3.41,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",webtpa,,O,107.59,3.13,53.80,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,189,ms-drg,PULMONARY EDEMA AND RESPIRATORY FAILURE,webtpa,,I,27884.18,6142.25,11818.76,29913.08,16730.51
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",webtpa,,O,108.49,21.05,54.25,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",webtpa,,O,65.11,8.45,32.56,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",webtpa,,O,5902.67,335.59,4189.65,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,webtpa,,O,101.33,11.74,50.67,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0111,revCode,ROOM AND BOARD PRIVATE (ONE BED) MEDICAL/SURGICAL/GYN,webtpa,,I,10170.64,7119.45,7119.45,7119.45,6102.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,webtpa,,O,1893.35,157.27,2363.57,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",webtpa,,O,281.00,8.75,2323.27,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,webtpa,,O,3055.12,206.42,1573.39,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86706,cpt,HEPATITIS B SURFACE ANTIBODY MEASUREMENT,webtpa,,O,94.38,2.18,47.19,70.79,12.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,787,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH CC,webtpa,,I,18030.21,6935.18,9602.48,13885.01,10818.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",webtpa,,O,31.88,3.63,101.32,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,806,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,webtpa,,I,14560.83,3337.55,9618.77,10044.87,8736.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93880,cpt,ULTRASOUND SCANNING OF BLOOD FLOW (OUTSIDE THE BRAIN) ON BOTH SIDES OF HEAD AND NECK,webtpa,,O,754.07,203.12,377.04,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",webtpa,,O,754.07,158.88,392.42,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,webtpa,,O,3238.42,206.67,2221.34,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,747,ms-drg,"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",webtpa,,I,13357.82,9350.47,9350.47,9350.47,8014.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,webtpa,,O,811.59,92.97,405.80,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,webtpa,,I,12315.58,3063.82,7647.19,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73562,cpt,"X-RAY OF KNEE, 3 VIEWS",webtpa,,O,240.10,61.44,127.25,180.08,144.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,webtpa,,O,383.02,34.82,823.50,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1040,cpt,"INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG",webtpa,,O,105.67,41.27,103.80,103.80,63.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0770,revCode,"PREVENTIVE CARE SERVICES, GENERAL",webtpa,,O,175.06,23.49,166.01,166.01,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",webtpa,,O,91.30,18.02,45.65,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9299,cpt,"INJECTION, NIVOLUMAB, 1 MG",webtpa,,O,113.79,13.73,11136.78,11136.78,68.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0200,revCode,INTENSIVE CARE UNIT GENERAL,webtpa,,I,5986.20,1090.17,10815.28,73077.52,3591.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,webtpa,,O,231.34,36.98,115.67,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,webtpa,,O,41.26,8.55,22.77,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,webtpa,,O,3055.12,202.94,1527.56,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,866,ms-drg,VIRAL ILLNESS WITHOUT MCC,webtpa,,I,15194.06,2895.07,9493.84,10253.00,9116.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,webtpa,,O,183.82,19.97,551.46,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",webtpa,,O,71.96,7.91,35.98,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77386,cpt,"INTENSITY MODULATED RADIATION THERAPY DELIVERY, COMPLEX",webtpa,,O,2526.13,486.47,1104.59,2008.27,579.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,webtpa,,O,647.78,92.64,323.88,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0302,revCode,"LABORATORY, IMMUNOLOGY",webtpa,,O,474.96,237.48,237.48,237.48,284.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86300,cpt,"IMMUNOLOGIC ANALYSIS FOR DETECTION OF TUMOR ANTIGEN, QUANTITATIVE; CA 15-3",webtpa,,O,90.84,3.51,45.42,72.22,24.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93280,cpt,"EVALUATION, TESTING, AND PROGRAMMING ADJUSTMENT OF PERMANENT DUAL LEAD PACEMAKER SYSTEM WITH PHYSICIAN ANALYSIS, REVIEW, AND REPORT",webtpa,,O,241.34,30.35,124.29,137.56,144.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",webtpa,,O,231.34,36.97,220.47,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72148,cpt,MRI SCAN OF LOWER SPINAL CANAL,webtpa,,O,3055.12,204.95,1527.56,3055.12,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),webtpa,,O,91.30,14.31,45.65,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73700,cpt,CT SCAN OF LEG WITHOUT CONTRAST,webtpa,,O,1479.41,92.59,739.71,1109.56,887.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",webtpa,,O,411.42,47.57,205.71,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76999,cpt,OTHER ULTRASOUND PROCEDURE,webtpa,,O,252.59,75.92,126.30,216.32,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,194,ms-drg,SIMPLE PNEUMONIA AND PLEURISY WITH CC,webtpa,,I,17457.81,5769.18,6740.47,9679.00,10474.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93970,cpt,ULTRASOUND SCAN OF VEINS OF BOTH ARMS OR LEGS INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,webtpa,,O,1159.26,202.49,555.25,555.25,695.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,webtpa,,I,36086.42,12423.48,21592.54,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,webtpa,,O,183.82,20.77,1046.31,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",webtpa,,O,331.50,12.98,165.75,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,webtpa,,O,101.33,21.90,50.67,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71250,cpt,CT SCAN OF CHEST WITHOUT CONTRAST,webtpa,,O,1753.28,94.47,929.24,1314.96,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,62322,cpt,INJECTION OF SUBSTANCE INTO LOWER SPINE CANAL,webtpa,,O,1590.91,567.62,1568.12,1568.12,678.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,webtpa,,O,298.87,98.24,149.44,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",webtpa,,O,348.89,56.80,174.45,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0120,revCode,ROOM AND BOARD SEMIPRIVATE (TWO BEDS) GENERAL,webtpa,,I,1274.16,335.11,10140.45,10140.45,764.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,853,ms-drg,INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,webtpa,,I,108746.38,30644.47,43759.90,73192.72,65247.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87338,cpt,"QUALITATIVE OR SEMIQUANTITATIVE DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HELICOBACTER PYLORI IN STOOL, MULTIPLE-STEP METHOD",webtpa,,O,365.24,8.63,188.10,290.36,16.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,webtpa,,O,96.77,32.33,48.39,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,520,ms-drg,BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,webtpa,,I,40151.49,11585.32,31059.69,31059.69,24090.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73522,cpt,"X-RAY OF BOTH HIPS WITH PELVIS, 3-4 VIEWS",webtpa,,O,376.41,61.44,193.86,282.31,225.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,786,ms-drg,CESAREAN SECTION WITHOUT STERILIZATION WITH MCC,webtpa,,I,26502.24,8570.18,8570.18,31953.68,15901.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",webtpa,,O,83.33,15.97,41.67,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,390,ms-drg,GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,webtpa,,I,12721.53,4148.74,6695.75,6879.39,7632.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",webtpa,,O,114.43,3.13,57.22,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86762,cpt,ANALYSIS FOR ANTIBODY TO RUBELLA (GERMAN MEASLES VIRUS),webtpa,,O,50.01,5.20,25.01,37.51,16.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",webtpa,,O,38.92,2.65,12.50,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",webtpa,,O,238.30,71.54,256.87,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",webtpa,,O,226.34,61.44,113.17,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",webtpa,,O,47.53,8.48,23.77,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72114,cpt,X-RAY LOWER AND SACRAL SPINE INCLUDING BENDING VIEWS MINIMUM 6 VIEWS,webtpa,,O,862.88,61.44,431.44,647.16,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82365,cpt,INFRARED ANALYSIS OF STONE,webtpa,,O,73.14,12.65,38.76,38.76,15.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,885,ms-drg,PSYCHOSES,webtpa,,I,16808.50,4145.69,8699.53,15572.15,10085.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0762,revCode,SPECIALTY SERVICES OBSERVATION HOURS,webtpa,,O,16.28,2.44,4798.21,4798.21,9.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,webtpa,,O,56.62,7.92,26.30,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93925,cpt,ULTRASOUND STUDY OF ARTERIES AND ARTERIAL GRAFTS OF BOTH LEGS,webtpa,,O,770.33,202.50,385.17,577.75,462.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",webtpa,,O,1858.47,98.50,1165.65,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",webtpa,,O,175.06,87.53,87.53,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71271,cpt,LOW DOSE CT SCAN OF CHEST FOR LUNG CANCER SCREENING,webtpa,,O,351.40,92.60,180.97,279.36,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,webtpa,,O,842.86,94.39,446.72,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81000,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, NON-AUTOMATED",webtpa,,O,12.72,0.71,6.74,9.54,7.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83519,cpt,"MEASUREMENT OF SUBSTANCE USING IMMUNOASSAY TECHNIQUE, BY RADIOIMMUNOASSAY",webtpa,,O,209.99,16.56,19.78,166.94,125.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,webtpa,,O,414.89,93.99,195.71,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86765,cpt,ANALYSIS FOR ANTIBODY TO RUBEOLA (MEASLES VIRUS),webtpa,,O,50.01,5.20,25.01,37.51,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,644,ms-drg,ENDOCRINE DISORDERS WITH CC,webtpa,,I,20353.94,6922.12,23799.96,23799.96,12212.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",webtpa,,O,1936.99,855.66,855.66,855.66,1162.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",webtpa,,O,312.63,61.44,156.32,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86003,cpt,"MEASUREMENT OF ANTIBODY (IGE) TO ALLERGIC SUBSTANCE, CRUDE ALLERGEN EXTRACT, EACH",webtpa,,O,41.28,5.10,13.59,25.10,24.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,webtpa,,O,3055.12,202.81,1527.56,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,17000,cpt,"DESTRUCTION OF PRECANCER SKIN GROWTH, 1 GROWTH",webtpa,,O,1040.92,159.87,253.87,596.78,624.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",webtpa,,O,140.04,24.64,55.53,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,768,ms-drg,VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,webtpa,,I,15836.34,3774.13,10237.37,17446.29,9501.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,webtpa,,O,351.40,51.44,273.24,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0333,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION RADIATION THERAPY,webtpa - medicare advantage,,O,1893.35,157.27,840.49,2363.57,1136.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,432,ms-drg,CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,wellcare (centene) medicare advantage,,I,38295.32,12117.39,12117.39,13418.80,22977.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,worker's comp,,I,1031.60,200.87,296.26,1031.60,618.96
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87086,cpt,"BACTERIAL COLONY COUNT, URINE",worker's comp,,O,71.96,7.91,57.20,100.29,9.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88300,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, LIMITED EXAMINATION",worker's comp,,O,93.19,26.27,69.89,93.19,55.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",worker's comp,,I,212.36,46.07,412.31,412.31,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,worker's comp,,O,183.82,20.77,99.09,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77066,cpt,DIAGNOSTIC MAMMOGRAPHY OF BOTH BREASTS,worker's comp,,O,298.87,98.24,224.15,298.87,118.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82043,cpt,URINE MICROALBUMIN (PROTEIN) LEVEL,worker's comp,,O,67.58,3.47,50.68,67.58,6.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86038,cpt,SCREENING TEST FOR AUTOIMMUNE DISORDER,worker's comp,,O,60.16,9.91,47.82,47.82,14.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72170,cpt,"X-RAY OF PELVIS, 1 OR 2 VIEWS",worker's comp,,O,240.10,27.64,35.71,213.76,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70491,cpt,CT SCAN OF SOFT TISSUE OF NECK WITH CONTRAST,worker's comp,,O,1481.91,158.58,1111.43,1111.43,190.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9181,cpt,"INJECTION, ETOPOSIDE, 10 MG",worker's comp,,O,4.37,0.99,2.56,8.01,2.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,worker's comp,,I,6.27,0.90,132.14,132.14,3.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1644,cpt,"INJECTION, HEPARIN SODIUM, PER 1000 UNITS",worker's comp,,O,8.17,0.89,6.13,14.63,4.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99212,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 10 MINUTES",worker's comp,,O,190.94,53.23,143.21,255.21,114.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86376,cpt,MICROSOMAL ANTIBODIES (AUTOANTIBODY) MEASUREMENT,worker's comp,,O,95.55,14.26,31.88,143.79,17.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76819,cpt,ULTRASOUND SCAN OF FETUS,worker's comp,,O,647.78,92.97,514.98,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",worker's comp,,O,1997.14,273.93,1497.86,4430.42,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88173,cpt,EVALUATION OF FINE NEEDLE ASPIRATE WITH INTERPRETATION AND REPORT,worker's comp,,O,109.71,43.44,87.22,87.22,65.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87510,cpt,"DETECTION TEST FOR GARDNERELLA VAGINALIS (BACTERIA), DIRECT PROBE TECHNIQUE",worker's comp,,O,107.59,3.13,80.69,107.59,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80061,cpt,"BLOOD TEST, LIPIDS (CHOLESTEROL AND TRIGLYCERIDES)",worker's comp,,O,151.46,8.03,113.59,151.46,15.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36416,cpt,PUNCTURE OF SKIN FOR COLLECTION OF BLOOD SAMPLE,worker's comp,,O,11.79,2.31,8.84,11.79,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3370,cpt,"INJECTION, VANCOMYCIN HCL, 500 MG",worker's comp,,O,70.84,21.28,51.93,66.54,42.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93005,cpt,ROUTINE ELECTROCARDIOGRAM (EKG) WITH TRACING USING AT LEAST 12 LEADS,worker's comp,,O,231.34,36.98,178.71,218.25,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",worker's comp,,O,2069.24,93.35,386.69,1464.09,1241.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80053,cpt,"BLOOD TEST, COMPREHENSIVE GROUP OF BLOOD CHEMICALS",worker's comp,,O,91.30,6.24,68.48,102.57,12.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",worker's comp,,I,3595.37,858.13,2356.06,2535.33,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,worker's comp,,I,1704.46,353.32,2384.27,2409.63,1022.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3475,cpt,"INJECTION, MAGNESIUM SULFATE, PER 500 MG",worker's comp,,O,16.70,0.37,2.69,34.06,10.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0480,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",worker's comp,,O,192.85,42.50,140.55,171.65,115.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9552,cpt,"FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDY DOSE, UP TO 45 MILLICURIES",worker's comp,,O,1645.73,583.80,1234.30,1234.30,987.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87186,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), MICRODILUTION OR AGAR DILUTION",worker's comp,,O,47.53,8.48,37.79,37.79,10.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87076,cpt,BACTERIAL CULTURE FOR ANAEROBIC ISOLATES,worker's comp,,O,96.38,8.00,72.29,72.29,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82951,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, 3 SPECIMENS",worker's comp,,O,117.61,12.87,88.21,90.86,15.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97113,cpt,"WATER POOL THERAPY WITH THERAPEUTIC EXERCISES TO 1 OR MORE AREAS, EACH 15 MINUTES",worker's comp,,O,140.04,24.64,99.09,105.03,84.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",worker's comp,,O,369.82,61.44,213.83,462.34,221.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,worker's comp,,O,41.19,1.80,14.58,885.75,24.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93798,cpt,"OUTPATIENT HEART REHABILITATION WITH ELECTROCARDIOGRAM (ECG) MONITORING, QUALITY HEALTH CARE PROFESSIONAL SERVICES",worker's comp,,O,184.32,70.33,146.53,184.32,125.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81001,cpt,"MANUAL URINALYSIS TEST WITH EXAMINATION USING MICROSCOPE, AUTOMATED",worker's comp,,O,13.80,2.61,10.35,40.11,8.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72141,cpt,MRI SCAN OF UPPER SPINAL CANAL WITHOUT CONTRAST,worker's comp,,O,3055.12,206.42,1909.45,3055.12,245.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76870,cpt,ULTRASOUND SCAN OF SCROTUM,worker's comp,,O,560.24,92.59,445.39,445.39,336.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",worker's comp,,O,217.58,10.34,163.19,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",worker's comp,,O,5902.67,335.59,5657.55,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83021,cpt,"HEMOGLOBIN ANALYSIS AND MEASUREMENT, CHROMATOGRAPHY",worker's comp,,O,130.95,13.50,104.10,104.10,21.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86140,cpt,MEASUREMENT C-REACTIVE PROTEIN FOR DETECTION OF INFECTION OR INFLAMMATION,worker's comp,,O,67.58,5.08,53.72,53.72,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0403,revCode,OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY,worker's comp,,O,351.40,51.44,201.86,273.24,210.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0279,cpt,"DIAGNOSTIC DIGITAL BREAST TOMOSYNTHESIS, UNILATERAL OR BILATERAL (LIST SEPARATELY IN ADDITION TO 77065 OR 77066)",worker's comp,,O,127.54,21.16,95.66,112.74,76.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93306,cpt,"ULTRASOUND EXAMINATION OF HEART INCLUDING COLOR-DEPICTED BLOOD FLOW RATE, DIRECTION, AND VALVE FUNCTION",worker's comp,,O,1997.14,430.17,1497.86,1997.14,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82728,cpt,FERRITIN (BLOOD PROTEIN) LEVEL,worker's comp,,O,90.02,12.05,71.56,95.42,16.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87147,cpt,"IDENTIFICATION OF ORGANISMS BY IMMUNOLOGIC ANALYSIS, OTHER THAN IMMUNOFLUORESCENCE METHOD",worker's comp,,O,25.94,5.08,19.46,19.46,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0450,revCode,"EMERGENCY ROOM, GENERAL",worker's comp,,I,944.41,228.70,584.83,16242.45,566.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73610,cpt,"X-RAY OF ANKLE, MINIMUM OF 3 VIEWS",worker's comp,,O,348.89,53.55,217.72,277.37,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74176,cpt,CT SCAN OF ABDOMEN AND PELVIS WITHOUT CONTRAST,worker's comp,,O,2687.44,201.24,2076.05,2687.44,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96372,cpt,"INJECTION BENEATH THE SKIN OR INTO MUSCLE FOR THERAPY, DIAGNOSIS, OR PREVENTION",worker's comp,,O,100.04,20.74,74.09,98.78,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84702,cpt,"GONADOTROPIN, CHORIONIC (REPRODUCTIVE HORMONE) LEVEL",worker's comp,,O,67.24,14.75,50.43,50.43,17.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0482,cpt,"DRUG TEST(S), DEFINITIVE, UTILIZING (1) DRUG IDENTIFICATION METHODS ABLE TO IDENTIFY INDIVIDUAL DRUGS AND DISTINGUISH BETWEEN STRUCTURAL ISOMERS (BUT NOT NECESSARILY STEREOISOMERS), INCLUDING, BUT NOT",worker's comp,,O,315.99,85.00,236.99,298.11,189.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73721,cpt,MRI SCAN OF LEG JOINT,worker's comp,,O,3055.12,202.94,517.17,2291.34,243.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,378,ms-drg,GASTROINTESTINAL HEMORRHAGE WITH CC,worker's comp,,I,26926.14,6286.85,19456.59,19456.59,16155.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36415,cpt,INSERTION OF NEEDLE INTO VEIN FOR COLLECTION OF BLOOD SAMPLE,worker's comp,,O,31.24,2.94,23.43,33.11,18.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5108,cpt,"INJECTION, PEGFILGRASTIM-JMDB, BIOSIMILAR, (FULPHILA), 0.5 MG",worker's comp,,O,1252.50,103.81,939.38,1520.52,751.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",worker's comp,,O,238.30,71.54,114.72,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0471,revCode,"AUDIOLOGY, DIAGNOSTIC",worker's comp,,I,217.58,127.74,163.18,230.63,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76830,cpt,ULTRASOUND PELVIS THROUGH VAGINA,worker's comp,,O,842.86,94.39,632.15,632.15,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83550,cpt,IRON BINDING CAPACITY,worker's comp,,O,106.28,8.57,82.10,82.10,10.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0103,cpt,PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA),worker's comp,,O,91.30,14.31,68.48,91.30,54.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0921,revCode,"OTHER DIAGNOSTIC SERVICES, PERIPHERAL VASCULAR LABORATORY",worker's comp,,O,754.07,158.88,674.04,754.07,452.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86430,cpt,RHEUMATOID FACTOR ANALYSIS,worker's comp,,O,42.58,6.02,33.85,33.85,7.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82977,cpt,GLUTAMYLTRANSFERASE (LIVER ENZYME) LEVEL,worker's comp,,O,42.58,4.32,33.85,33.85,8.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83690,cpt,LIPASE (FAT ENZYME) LEVEL,worker's comp,,O,52.60,6.75,39.45,39.45,8.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85384,cpt,FIBRINOGEN (FACTOR 1) ACTIVITY MEASUREMENT,worker's comp,,O,56.26,7.19,75.59,75.59,11.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2710,cpt,"INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG",worker's comp,,O,4.27,1.25,61.34,61.34,2.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84439,cpt,"THYROXINE (THYROID CHEMICAL), FREE",worker's comp,,O,52.60,8.84,39.45,52.60,10.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2795,cpt,"INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG",worker's comp,,O,0.59,0.15,0.45,13.96,0.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86308,cpt,SCREENING TEST FOR MONONUCLEOSIS (MONO),worker's comp,,O,41.28,5.08,30.96,30.96,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81050,cpt,URINE VOLUME MEASUREMENT,worker's comp,,O,30.08,3.63,22.56,23.24,4.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",worker's comp,,O,1858.47,98.50,260.76,1880.84,1115.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83540,cpt,IRON LEVEL,worker's comp,,O,41.28,5.78,31.89,41.28,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85018,cpt,"BLOOD COUNT, HEMOGLOBIN",worker's comp,,O,35.00,2.32,36.57,36.57,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96375,cpt,"INJECTION OF DIFFERENT DRUG OR SUBSTANCE INTO A VEIN FOR THERAPY, DIAGNOSIS, OR PREVENTION",worker's comp,,O,93.77,21.35,70.33,121.55,56.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,worker's comp,,I,752.83,203.26,500.41,719.74,451.70
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93289,cpt,"EVALUATION OF DEFIBRILLATOR INCLUDING CONNECTION, RECORDING AND DISCONNECTION",worker's comp,,O,218.83,30.93,90.65,218.83,131.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70553,cpt,MRI SCAN OF BRAIN BEFORE AND AFTER CONTRAST,worker's comp,,O,4054.33,319.17,3040.75,3040.75,384.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93017,cpt,EXERCISE OR DRUG-INDUCED HEART AND BLOOD VESSEL STRESS TEST WITH EKG TRACING AND MONITORING,worker's comp,,O,502.71,78.63,388.34,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74177,cpt,CT SCAN OF ABDOMEN AND PELVIS WITH CONTRAST,worker's comp,,O,3595.37,280.86,2696.53,3703.23,453.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3010,cpt,"INJECTION, FENTANYL CITRATE, 0.1 MG",worker's comp,,O,82.61,19.42,61.96,82.61,49.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87640,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS (BACTERIA), AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,132.12,25.53,99.09,132.12,25.37
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71046,cpt,"X-RAY OF CHEST, 2 VIEWS",worker's comp,,O,365.14,61.44,167.82,344.48,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2469,cpt,"INJECTION, PALONOSETRON HCL, 25 MCG",worker's comp,,O,96.29,11.40,13.50,96.29,57.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1894,cpt,"INTRODUCER/SHEATH, OTHER THAN GUIDING, OTHER THAN INTRACARDIAC ELECTROPHYSIOLOGICAL, NON-LASER",worker's comp,,O,327.67,47.93,70.57,303.94,196.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,355,ms-drg,HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,worker's comp,,I,28107.26,9817.04,13607.72,13607.72,16864.36
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,247,ms-drg,PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC,worker's comp,,I,84785.32,12190.37,74298.44,74298.44,50871.19
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1650,cpt,"INJECTION, ENOXAPARIN SODIUM, 10 MG",worker's comp,,O,21.39,7.39,64.18,64.18,12.83
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1642,cpt,"INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS",worker's comp,,O,2.49,0.02,1.87,2.03,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87389,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HIV-1 ANTIGEN AND HIV-1 AND HIV-2 ANTIBODIES,worker's comp,,O,101.33,11.74,76.00,76.00,28.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86403,cpt,SCREENING TEST FOR PRESENCE OF ANTIBODY,worker's comp,,O,55.44,9.79,41.58,41.58,13.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2405,cpt,"INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG",worker's comp,,O,19.52,4.40,14.64,19.56,11.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82565,cpt,BLOOD CREATININE LEVEL,worker's comp,,O,30.08,5.04,22.56,30.08,6.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78815,cpt,NUCLEAR MEDICINE STUDY FROM SKULL BASE TO MID-THIGH WITH CT SCAN,worker's comp,,O,7543.40,1294.20,5657.55,5657.55,4526.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85730,cpt,"COAGULATION ASSESSMENT BLOOD TEST, PLASMA OR WHOLE BLOOD",worker's comp,,O,50.72,5.89,38.04,50.72,7.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85610,cpt,"BLOOD TEST, CLOTTING TIME",worker's comp,,O,36.32,4.04,27.24,36.32,5.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9500,cpt,"TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDY DOSE",worker's comp,,O,734.07,114.82,550.55,778.11,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72050,cpt,"X-RAY OF UPPER SPINE, 4 OR 5 VIEWS",worker's comp,,O,650.28,61.44,325.14,487.71,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86901,cpt,BLOOD TYPING FOR RH (D) ANTIGEN,worker's comp,,O,83.76,6.73,62.82,88.78,16.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80074,cpt,ACUTE HEPATITIS PANEL,worker's comp,,O,213.87,28.75,160.40,170.03,56.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87660,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), DIRECT PROBE TECHNIQUE",worker's comp,,O,114.43,3.13,85.83,85.83,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1713,cpt,ANCHOR/SCREW FOR OPPOSING BONE-TO-BONE OR SOFT TISSUE-TO-BONE (IMPLANTABLE),worker's comp,,O,8588.52,489.94,6695.48,15283.15,5153.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81015,cpt,URINALYSIS USING MICROSCOPE,worker's comp,,O,45.13,4.38,33.85,129.65,27.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,worker's comp,,I,5902.00,1055.41,11883.29,28002.03,3541.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88342,cpt,"SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE, INITIAL PROCEDURE",worker's comp,,O,419.99,46.79,333.89,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87651,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STREP (STREPTOCOCCUS, GROUP A), AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,149.83,34.39,112.37,112.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83735,cpt,MAGNESIUM LEVEL,worker's comp,,O,65.11,6.57,48.83,48.83,7.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87340,cpt,DETECTION TEST BY IMMUNOASSAY TECHNIQUE FOR HEPATITIS B SURFACE ANTIGEN,worker's comp,,O,80.09,1.66,60.07,60.07,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1769,cpt,GUIDE WIRE,worker's comp,,O,338.79,40.02,58.61,304.82,203.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86617,cpt,CONFIRMATION TEST FOR ANTIBODY TO BORRELIA BURGDORFERI (LYME DISEASE BACTERIA),worker's comp,,O,35.39,15.26,26.55,29.04,21.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1885,cpt,"INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG",worker's comp,,O,39.88,13.23,29.66,39.82,23.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73030,cpt,"X-RAY OF SHOULDER, MINIMUM OF 2 VIEWS",worker's comp,,O,267.61,46.08,200.71,267.61,160.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85041,cpt,"RED BLOOD CELL COUNT, AUTOMATED TEST",worker's comp,,O,20.05,1.78,15.94,15.94,3.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0401,revCode,OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY,worker's comp,,O,287.62,21.62,224.15,298.87,172.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",worker's comp,,O,10827.72,2513.53,6761.61,11305.69,6496.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77063,cpt,SCREENING DIGITAL TOMOGRAPHY OF BOTH BREASTS,worker's comp,,O,195.07,21.19,146.30,167.23,117.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82962,cpt,BLOOD GLUCOSE (SUGAR) TEST PERFORMED BY HAND-HELD INSTRUMENT,worker's comp,,O,42.58,3.22,31.93,42.58,3.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",worker's comp,,O,365.14,48.65,48.65,344.48,219.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0250,revCode,PHARMACY GENERAL,worker's comp,,O,9.11,0.50,12.56,78.37,5.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72020,cpt,"X-RAY OF SPINE, 1 VIEW",worker's comp,,O,240.10,72.01,180.07,180.07,54.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71260,cpt,CT SCAN OF CHEST WITH CONTRAST,worker's comp,,O,1880.84,106.44,1410.63,1937.27,188.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0351,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, HEAD SCAN",worker's comp,,I,2599.91,780.60,1949.93,1949.93,1559.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0690,cpt,"INJECTION, CEFAZOLIN SODIUM, 500 MG",worker's comp,,O,65.06,17.18,48.82,65.39,39.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,59025,cpt,FETAL NON-STRESS TEST,worker's comp,,O,265.10,8.75,198.83,265.10,159.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87150,cpt,"IDENTIFICATION OF ORGANISMS BY GENETIC ANALYSIS, AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,92.99,21.05,69.74,69.74,55.79
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,871,ms-drg,SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,worker's comp,,I,36086.42,12423.48,21133.66,22304.00,21651.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0350,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, GENERAL",worker's comp,,O,3595.37,208.18,2416.52,3595.37,2157.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74018,cpt,"X-RAY OF ABDOMEN, 1 VIEW",worker's comp,,O,285.11,61.44,213.83,285.11,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76705,cpt,LIMITED ULTRASOUND SCAN OF ABDOMEN,worker's comp,,O,752.83,92.79,564.62,598.49,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0611,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) BRAIN/BRAIN STEM,worker's comp,,O,3238.42,206.67,3040.75,3040.75,1943.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76770,cpt,COMPLETE ULTRASOUND SCAN BEHIND ABDOMINAL CAVITY,worker's comp,,O,792.84,92.74,594.63,594.63,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86850,cpt,SCREENING TEST FOR RED BLOOD CELL ANTIBODIES,worker's comp,,O,93.19,5.27,69.89,98.78,52.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0370,revCode,ANESTHESIA GENERAL,worker's comp,,O,694.00,180.07,491.05,964.08,416.40
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,80048,cpt,"BLOOD TEST, BASIC GROUP OF BLOOD CHEMICALS (CALCIUM, TOTAL)",worker's comp,,O,70.06,8.29,52.55,70.06,9.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,worker's comp,,O,188.17,19.53,93.78,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0480,revCode,"CARDIOLOGY, GENERAL",worker's comp,,I,1997.14,545.14,19187.06,19187.06,1198.28
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84550,cpt,"URIC ACID LEVEL, BLOOD",worker's comp,,O,50.01,4.43,95.73,95.73,5.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85027,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST",worker's comp,,O,56.26,6.34,42.20,56.26,7.61
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",worker's comp,,O,231.34,36.97,178.71,220.47,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0131,cpt,"INJECTION, ACETAMINOPHEN, 10 MG",worker's comp,,O,1.42,0.39,1.08,5.77,0.85
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2704,cpt,"INJECTION, PROPOFOL, 10 MG",worker's comp,,O,4.12,1.10,3.09,15.01,2.47
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87641,cpt,"DETECTION TEST BY NUCLEIC ACID FOR STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTANT (MRSA BACTERIA), AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,96.29,17.55,68.13,90.84,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72125,cpt,CT SCAN OF UPPER SPINE WITHOUT CONTRAST,worker's comp,,O,1753.28,96.00,207.68,437.62,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81003,cpt,AUTOMATED URINALYSIS TEST,worker's comp,,O,42.51,2.00,31.88,31.88,2.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76942,cpt,ULTRASONIC GUIDANCE IMAGING SUPERVISION AND INTERPRETATION FOR INSERTION OF NEEDLE,worker's comp,,O,252.59,96.03,200.80,200.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96367,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, ADDITIONAL SEQUENTIAL INFUSION, 1 HOUR OR LESS",worker's comp,,O,125.04,27.28,93.78,125.04,75.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0274,revCode,"MEDICAL/SURGICAL SUPPLIES AND DEVICES, PROSTHETIC/ORTHOTIC DEVICES",worker's comp,,O,51.68,6.81,16.48,2026.64,31.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0920,revCode,"OTHER DIAGNOSTIC SERVICES, GENERAL",worker's comp,,O,281.00,8.75,198.82,2461.37,168.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88311,cpt,PREPARATION OF TISSUE FOR EXAMINATION BY REMOVING ANY CALCIUM PRESENT,worker's comp,,O,46.00,18.36,34.50,34.50,27.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,784,ms-drg,CESAREAN SECTION WITH STERILIZATION WITH CC,worker's comp,,I,14784.88,6415.40,20022.84,20022.84,8870.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86803,cpt,HEPATITIS C ANTIBODY MEASUREMENT,worker's comp,,O,113.25,11.78,84.94,84.94,16.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1170,cpt,"INJECTION, HYDROMORPHONE, UP TO 4 MG",worker's comp,,O,82.88,8.42,123.33,123.33,49.73
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0330,cpt,"INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG",worker's comp,,O,88.56,20.43,67.45,88.56,53.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,92551,cpt,AIR TONE CONDUCTION HEARING ASSESSMENT SCREENING,worker's comp,,O,217.58,10.34,163.19,217.58,130.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87040,cpt,BACTERIAL BLOOD CULTURE,worker's comp,,O,76.04,10.15,59.28,59.28,12.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87081,cpt,SCREENING TEST FOR PATHOGENIC ORGANISMS,worker's comp,,O,45.06,3.98,75.07,75.07,8.65
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85025,cpt,"COMPLETE BLOOD CELL COUNT (RED CELLS, WHITE BLOOD CELL, PLATELETS), AUTOMATED TEST AND AUTOMATED DIFFERENTIAL WHITE BLOOD CELL COUNT",worker's comp,,O,94.14,7.61,70.60,99.78,9.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99211,cpt,OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT THAT MAY NOT REQUIRE PRESENCE OF HEALTHCARE PROFESSIONAL,worker's comp,,O,96.77,32.33,72.58,96.77,58.06
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77047,cpt,MRI SCAN OF BOTH BREASTS WITHOUT CONTRAST,worker's comp,,O,1605.13,202.29,1203.85,1203.85,963.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99291,cpt,"CRITICAL CARE DELIVERY CRITICALLY ILL OR INJURED PATIENT, FIRST 30-74 MINUTES",worker's comp,,E,1724.51,232.62,232.62,1289.86,1034.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76817,cpt,VAGINAL ULTRASOUND OF PREGNANT UTERUS,worker's comp,,O,647.78,94.48,514.98,647.78,113.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85014,cpt,RED BLOOD CELL CONCENTRATION MEASUREMENT,worker's comp,,O,30.49,2.32,35.62,35.62,2.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85045,cpt,"RED BLOOD COUNT, AUTOMATED TEST",worker's comp,,O,38.92,3.91,29.19,41.25,4.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87491,cpt,"DETECTION TEST BY NUCLEIC ACID FOR CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88305,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, INTERMEDIATE COMPLEXITY",worker's comp,,O,252.47,44.06,200.71,200.71,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0301,revCode,"LABORATORY, CHEMISTRY",worker's comp,,O,31.88,3.63,22.56,108.34,19.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83036,cpt,HEMOGLOBIN A1C LEVEL,worker's comp,,O,76.68,5.83,57.51,76.68,11.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73080,cpt,"X-RAY OF ELBOW, MINIMUM OF 3 VIEWS",worker's comp,,O,312.63,61.44,248.54,248.54,187.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84425,cpt,VITAMIN B-1 (THIAMINE) LEVEL,worker's comp,,O,138.03,20.16,103.52,109.73,82.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82570,cpt,CREATININE LEVEL TO TEST FOR KIDNEY FUNCTION OR MUSCLE INJURY,worker's comp,,O,50.01,3.11,79.71,79.71,6.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,83615,cpt,LACTATE DEHYDROGENASE (ENZYME) LEVEL,worker's comp,,O,53.76,5.92,84.94,84.94,7.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,807,ms-drg,VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,worker's comp,,I,12315.58,3063.82,7000.10,7647.19,7389.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73220,cpt,MRI SCAN OF ARM BEFORE AND AFTER CONTRAST,worker's comp,,O,3055.12,320.47,2428.82,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0636,revCode,PHARMACY - EXTENSION OF 025X DRUGS REQUIRING DETAILED CODING,worker's comp,,I,48.06,11.46,42.53,49.03,28.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",worker's comp,,I,734.07,127.47,583.58,583.58,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2175,cpt,"INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG",worker's comp,,O,85.94,24.92,125.38,125.38,51.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",worker's comp,,O,85.05,7.99,66.61,110.69,51.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84403,cpt,"TESTOSTERONE (HORMONE) LEVEL, TOTAL",worker's comp,,O,135.66,25.29,101.75,135.66,30.35
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95806,cpt,"UNATTENDED SLEEP STUDY WITH RECORDING OF HEART RATE, OXYGEN, RESPIRATORY AIRFLOW AND EFFORT",worker's comp,,O,1695.75,59.68,1348.12,1348.12,1017.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96415,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, EACH ADDITIONAL HOUR",worker's comp,,O,117.54,25.46,88.15,369.00,70.52
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70220,cpt,"X-RAY OF PARANASAL SINUS, COMPLETE, MINIMUM OF 3 VIEWS",worker's comp,,O,362.65,72.01,271.99,271.99,217.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J3480,cpt,"INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ",worker's comp,,O,2.49,0.19,0.54,1.30,1.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77067,cpt,SCREENING MAMMOGRAPHY OF BOTH BREASTS,worker's comp,,O,351.40,81.48,263.55,301.25,97.78
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74178,cpt,CT SCAN OF ABDOMEN AND PELVIS BEFORE AND AFTER CONTRAST,worker's comp,,O,4852.19,224.32,427.82,3639.14,386.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1200,cpt,"INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG",worker's comp,,O,4.22,1.00,2.80,78.49,2.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97161,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 20 MINUTES",worker's comp,,O,199.37,74.90,141.07,149.53,119.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73221,cpt,MRI SCAN OF ARM JOINT WITHOUT CONTRAST,worker's comp,,O,3055.12,202.81,2291.34,2428.82,244.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0942,revCode,MEDICAL REHABILITATION DAY PROGRAM EDUCATION/TRAINING,worker's comp,,O,175.06,87.53,131.30,175.06,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,74181,cpt,MRI SCAN OF ABDOMEN WITHOUT CONTRAST,worker's comp,,O,3055.12,206.42,2291.34,2360.08,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93350,cpt,"ULTRASOUND EXAMINATION OF THE HEART PERFORMED DURING REST, EXERCISE, AND/OR DRUG-INDUCED STRESS WITH INTERPRETATION AND REPORT",worker's comp,,O,1434.39,436.85,1075.79,1140.34,860.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,worker's comp,,I,84.46,20.40,236.01,236.01,50.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A4565,cpt,SLINGS; MEDICAL AND SURGICAL SUPPLIES - VARIOUS MEDICAL SUPPLIES INCLUDING TAPES AND SURGICAL DRESSINGS,worker's comp,,O,22.60,4.56,16.48,25.00,13.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1776,cpt,JOINT DEVICE (IMPLANTABLE),worker's comp,,O,3788.11,198.44,2403.18,18412.83,2272.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87480,cpt,"DETECTION TEST FOR CANDIDA SPECIES (YEAST), DIRECT PROBE TECHNIQUE",worker's comp,,O,107.59,3.13,80.69,80.69,23.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0610,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) GENERAL,worker's comp,,O,3055.12,203.12,2161.64,2428.82,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99152,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE (5 YEARS OR OLDER), INITIAL 15 MINUTES",worker's comp,,O,50.02,5.00,37.51,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76641,cpt,COMPLETE ULTRASOUND SCAN OF 1 BREAST,worker's comp,,O,414.89,93.99,311.17,311.17,248.93
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0170,revCode,NURSERY GENERAL,worker's comp,,I,1569.44,869.27,3331.37,3331.37,941.66
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82150,cpt,AMYLASE (ENZYME) LEVEL,worker's comp,,O,50.72,6.35,38.04,38.04,7.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0360,revCode,"OPERATING ROOM SERVICES, GENERAL",worker's comp,,I,1356.71,52.51,11876.89,11876.89,814.03
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0214,revCode,CORONARY CARE UNIT INTERMEDIATE CCU,worker's comp,,I,4152.82,995.38,3208.06,16397.13,2491.69
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,95811,cpt,SLEEP MONITORING OF PATIENT (6 YEARS OR OLDER) IN SLEEP LAB WITH CONTINUED PRESSURED RESPIRATORY ASSISTANCE BY MASK OR BREATHING TUBE,worker's comp,,O,3580.43,810.94,2685.32,3238.64,2148.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,worker's comp,,I,124.70,13.59,117.78,124.70,74.82
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2250,cpt,"INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG",worker's comp,,O,41.06,11.36,30.79,41.06,24.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86800,cpt,THYROGLOBULIN (THYROID PROTEIN) ANTIBODY MEASUREMENT,worker's comp,,O,71.96,15.59,57.20,76.27,18.71
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0391,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS ADMINISTRATION (E.G., TRANSFUSIONS)",worker's comp,,I,551.43,162.47,1560.66,1560.66,330.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76816,cpt,"ULTRASOUND RE-EVALUATION OF PREGNANT UTERUS, PER FETUS",worker's comp,,O,647.78,98.50,514.98,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",worker's comp,,O,502.71,78.63,388.34,532.87,301.63
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88313,cpt,SPECIAL STAINED SPECIMEN SLIDES TO EXAMINE TISSUE INCLUDING INTERPRETATION AND REPORT,worker's comp,,O,119.15,50.94,94.72,94.72,71.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72110,cpt,"X-RAY OF LOWER AND SACRAL SPINE, MINIMUM OF 4 VIEWS",worker's comp,,O,650.28,61.44,516.97,516.97,111.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0270,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES GENERAL,worker's comp,,O,41.26,8.55,30.36,4130.10,24.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0720,revCode,LABOR ROOM/DELIVERY GENERAL,worker's comp,,I,150.64,21.34,3274.49,4826.59,90.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76805,cpt,"ULTRASOUND SCAN OF PREGNANT UTERUS (14 WEEKS OR MORE), SINGLE OR FIRST FETUS",worker's comp,,O,468.95,93.59,372.81,804.09,112.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72072,cpt,"X-RAY OF MIDDLE SPINE, 3 VIEWS",worker's comp,,O,377.65,43.63,43.67,283.24,116.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,81256,cpt,GENE ANALYSIS (HEMOCHROMATOSIS) COMMON VARIANTS,worker's comp,,O,355.11,121.73,282.31,355.11,213.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9370,cpt,VINCRISTINE SULFATE 1 MG INJ,worker's comp,,O,58.11,8.53,49.70,49.70,34.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9579,cpt,"INJECTION, GADOLINIUM-BASED MAGNETIC RESONANCE CONTRAST AGENT, NOT OTHERWISE SPECIFIED (NOS), PER ML",worker's comp,,O,16.23,1.83,12.90,17.20,9.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",worker's comp,,I,5902.67,1024.93,4692.62,4692.62,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96365,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, 1 HOUR OR LESS",worker's comp,,O,345.14,75.82,225.67,365.84,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88177,cpt,"PAP TEST, EVALUATION OF FINE NEEDLE ASPIRATE, IMMEDIATE, EACH ADDITIONAL EVALUATION EPISODE",worker's comp,,O,49.54,27.92,39.38,81.12,29.72
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86900,cpt,BLOOD GROUP TYPING (ABO),worker's comp,,O,126.23,10.13,94.67,126.23,121.20
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96411,cpt,ADMINISTRATION OF ADDITIONAL NEW DRUG OR SUBSTANCE INTO VEIN USING PUSH TECHNIQUE,worker's comp,,O,252.59,54.84,189.44,189.44,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0710,revCode,RECOVERY ROOM GENERAL,worker's comp,,O,3683.73,275.00,2748.21,5218.57,2210.24
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76642,cpt,LIMITED ULTRASOUND SCAN OF 1 BREAST,worker's comp,,O,323.88,75.26,242.91,257.48,194.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1160,cpt,"INJECTION, DIGOXIN, UP TO 0.5 MG",worker's comp,,O,84.29,63.22,63.22,63.22,50.57
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0612,revCode,MAGNETIC RESONANCE TECHNOLOGY (MRT) SPINAL CORD/SPINE,worker's comp,,O,3055.12,204.02,2291.34,3055.12,1833.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0312,revCode,LABORATORY PATHOLOGY HISTOLOGY,worker's comp,,O,419.99,136.22,333.89,445.18,251.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78452,cpt,NUCLEAR MEDICINE STUDY OF VESSELS OF HEART USING DRUGS OR EXERCISE MULTIPLE STUDIES,worker's comp,,O,5902.67,923.22,4427.00,5568.56,1385.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0390,revCode,"ADMINISTRATION, PROCESSING AND STORAGE FOR BLOOD AND BLOOD COMPONENTS GENERAL",worker's comp,,I,757.37,203.30,5591.21,5591.21,454.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9070,cpt,CYCLOPHOSPHAMIDE 100 MG INJ,worker's comp,,O,252.59,4.78,189.44,194.80,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84481,cpt,"THYROID HORMONE, T3 MEASUREMENT, FREE",worker's comp,,O,108.88,10.16,86.56,86.56,19.92
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0324,revCode,"RADIOLOGY, DIAGNOSTIC CHEST X-RAY",worker's comp,,I,238.84,62.82,179.13,301.99,143.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88175,cpt,"PAP TEST, AUTOMATED THIN LAYER PREPARATION; AUTOMATED SYSTEM AND MANUAL RESCREENING",worker's comp,,O,83.33,15.97,62.50,62.51,31.30
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0431,revCode,OCCUPATIONAL THERAPY VISIT CHARGE,worker's comp,,O,183.82,19.97,169.00,551.46,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87591,cpt,"DETECTION TEST BY NUCLEIC ACID FOR NEISSERIA GONORRHOEAE (GONORRHOEAE BACTERIA), AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,147.58,21.05,110.69,147.58,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96366,cpt,"INFUSION INTO A VEIN FOR THERAPY, PREVENTION, OR DIAGNOSIS, EACH ADDITIONAL HOUR",worker's comp,,O,345.14,36.70,59.07,258.86,207.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0361,revCode,"OPERATING ROOM SERVICES, MINOR SURGERY",worker's comp,,O,1680.75,111.66,2458.41,2458.41,1008.45
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87102,cpt,FUNGAL CULTURE (MOLD OR YEAST),worker's comp,,O,65.11,4.25,48.83,48.83,9.89
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70543,cpt,"MRI SCAN OF BONE OF EYE SOCKET, FACE, AND/OR NECK BEFORE AND AFTER CONTRAST",worker's comp,,O,2237.24,324.67,1677.93,2371.47,1342.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88304,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY LOW COMPLEXITY",worker's comp,,O,212.36,14.48,159.27,159.27,127.42
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99213,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT VISIT, TYPICALLY 15 MINUTES",worker's comp,,O,270.00,64.89,214.77,254.67,162.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97035,cpt,"APPLICATION OF ULTRASOUND TO 1 OR MORE AREAS, EACH 15 MINUTES",worker's comp,,O,112.55,10.48,89.48,89.48,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,70450,cpt,CT OF HEAD WITHOUT CONTRAST,worker's comp,,O,2599.91,94.47,307.96,1949.93,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,S9443,cpt,"LACTATION CLASSES, NON-PHYSICIAN PROVIDER, PER SESSION",worker's comp,,O,175.06,87.53,131.30,185.56,105.04
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0780,cpt,"INJECTION, PROCHLORPERAZINE, UP TO 10 MG",worker's comp,,O,84.30,3.36,62.44,62.66,50.58
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73502,cpt,"X-RAY OF HIP WITH PELVIS, 2-3 VIEWS",worker's comp,,O,226.34,61.44,179.94,179.94,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97140,cpt,"MANUAL (PHYSICAL) THERAPY TECHNIQUES TO 1 OR MORE REGIONS, EACH 15 MINUTES",worker's comp,,O,246.35,17.59,174.31,184.76,147.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87624,cpt,"DETECTION TEST BY NUCLEIC ACID FOR HUMAN PAPILLOMAVIRUS (HPV), HIGH-RISK TYPES",worker's comp,,O,108.49,21.05,81.37,81.37,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",worker's comp,,O,734.07,19.80,1234.30,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9060,cpt,"INJECTION, CISPLATIN, POWDER OR SOLUTION, 10 MG",worker's comp,,O,20.12,5.00,57.69,57.69,12.07
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,795,ms-drg,NORMAL NEWBORN,worker's comp,,I,4390.63,2140.83,4272.65,4272.65,2634.38
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84402,cpt,"TESTOSTERONE (HORMONE) LEVEL, FREE",worker's comp,,O,70.78,13.97,53.09,70.78,29.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7040,cpt,"INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)",worker's comp,,O,157.91,56.85,118.43,157.91,94.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,77080,cpt,"BONE DENSITY MEASUREMENT OF THE CORE OR CENTRAL SKELETON (E.G., HIPS, PELVIS, SPINE)",worker's comp,,O,373.90,92.59,280.43,280.43,111.11
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86200,cpt,MEASUREMENT OF ANTIBODY FOR RHEUMATOID ARTHRITIS ASSESSMENT,worker's comp,,O,50.00,8.06,39.75,39.75,15.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86787,cpt,ANALYSIS FOR ANTIBODY TO VARICELLA-ZOSTER VIRUS (CHICKEN POX),worker's comp,,O,53.08,5.52,39.81,39.81,15.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99214,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 25 MINUTES",worker's comp,,O,290.00,66.00,378.37,378.37,174.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,328,ms-drg,"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",worker's comp,,I,48722.60,11664.12,45539.96,45539.96,29233.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0110,revCode,ROOM AND BOARD PRIVATE (ONE BED) GENERAL,worker's comp,,I,1386.23,364.58,1039.67,8667.14,831.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,36591,cpt,COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE,worker's comp,,O,187.57,14.84,129.17,193.51,112.54
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C1725,cpt,"CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE, INFUSION/PERFUSION CAPABILITY)",worker's comp,,O,2861.88,440.55,2459.23,2459.23,1717.13
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0460,revCode,"PULMONARY FUNCTION, GENERAL",worker's comp,,I,142.55,29.95,106.91,151.10,85.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87205,cpt,SPECIAL GRAM OR GIEMSA STAIN FOR MICROORGANISM,worker's comp,,O,87.53,4.18,65.65,65.65,5.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76815,cpt,"ULTRASOUND OF PREGNANT UTERUS, 1 OR MORE FETUS(ES)",worker's comp,,O,647.78,98.50,514.98,514.98,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7120,cpt,"RINGERS LACTATE INFUSION, UP TO 1000 CC",worker's comp,,O,162.48,33.29,121.86,162.48,97.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0335,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION -IV,worker's comp,,O,547.73,91.89,192.26,12032.56,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0482,revCode,"CARDIOLOGY, STRESS TEST",worker's comp,,I,990.43,191.36,787.39,787.39,594.26
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0320,revCode,"RADIOLOGY, DIAGNOSTIC GENERAL CLASSIFICATION",worker's comp,,I,302.21,52.32,299.30,528.83,181.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J9301,cpt,"INJECTION, OBINUTUZUMAB, 10 MG",worker's comp,,O,257.60,46.78,193.20,193.20,154.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96417,cpt,INFUSION OF DIFFERENT CHEMOTHERAPY DRUG OR SUBSTANCE INTO A VEIN UP TO 1 HOUR,worker's comp,,O,256.35,58.45,192.26,192.26,153.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73110,cpt,"X-RAY OF WRIST, MINIMUM OF 3 VIEWS",worker's comp,,O,348.89,56.80,246.86,246.86,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88360,cpt,"MICROSCOPIC GENETIC ANALYSIS OF TUMOR, MANUAL",worker's comp,,O,331.51,119.35,263.55,263.55,198.91
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87075,cpt,"BACTERIAL CULTURE, ANY SOURCE, EXCEPT BLOOD, ANAEROBIC",worker's comp,,O,90.84,9.28,68.13,68.13,11.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87661,cpt,"DETECTION TEST BY NUCLEIC ACID FOR TRICHOMONAS VAGINALIS (GENITAL PARASITE), AMPLIFIED PROBE TECHNIQUE",worker's comp,,O,151.64,21.05,113.73,160.73,41.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0730,revCode,"ELECTROCARDIOGRAM (EKG), ELECTROENCEPHALOGRAM (EEG)",worker's comp,,I,231.34,60.43,173.50,231.34,138.80
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84153,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, TOTAL",worker's comp,,O,91.30,18.02,68.48,91.30,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82746,cpt,"FOLIC ACID LEVEL, SERUM",worker's comp,,O,65.11,10.15,51.76,51.76,17.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99215,cpt,"ESTABLISHED PATIENT OFFICE OR OTHER OUTPATIENT, VISIT TYPICALLY 40 MINUTES",worker's comp,,O,569.98,60.00,427.48,427.48,341.99
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88172,cpt,EVALUATION OF FINE NEEDLE ASPIRATE,worker's comp,,O,416.45,133.14,331.07,331.07,249.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0402,revCode,OTHER IMAGING SERVICES ULTRASOUND,worker's comp,,O,647.78,92.64,391.10,804.09,388.67
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87070,cpt,"BACTERIAL CULTURE, ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC",worker's comp,,O,65.11,8.45,48.83,48.83,10.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72100,cpt,"X-RAY OF LOWER AND SACRAL SPINE, 2 OR 3 VIEWS",worker's comp,,O,411.42,47.57,47.57,308.57,111.56
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,worker's comp,,O,50.02,4.84,37.52,44.00,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1265,cpt,"INJECTION, DOPAMINE HCL, 40 MG",worker's comp,,O,9.60,7.20,7.20,7.20,5.76
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,88307,cpt,"PATHOLOGY EXAMINATION OF TISSUE USING A MICROSCOPE, MODERATELY HIGH COMPLEXITY",worker's comp,,O,298.47,66.35,223.85,301.44,179.08
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84703,cpt,GONADOTROPIN (REPRODUCTIVE HORMONE) ANALYSIS,worker's comp,,O,78.05,7.37,62.05,62.05,8.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0750,revCode,GASTROINTESTINAL (GI) SERVICES GENERAL,worker's comp,,O,2289.17,554.60,1320.48,1949.84,1373.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0280,revCode,ONCOLOGY GENERAL,worker's comp,,O,203.82,49.80,152.86,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99204,cpt,"NEW PATIENT OFFICE OR OTHER OUTPATIENT VISIT, 45-59 MINUTES",worker's comp,,O,300.00,109.46,453.13,453.13,180.00
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,93971,cpt,ULTRASOUND SCAN OF VEINS OF ONE ARM OR LEG OR LIMITED INCLUDING ASSESSMENT OF COMPRESSION AND FUNCTIONAL MANEUVERS,worker's comp,,O,811.59,92.97,608.69,608.69,486.95
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0272,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES STERILE,worker's comp,,O,112.55,9.00,1270.41,1270.41,67.53
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97535,cpt,"TRAINING FOR SELF-CARE OR HOME MANAGEMENT, EACH 15 MINUTES",worker's comp,,O,212.59,22.86,169.00,169.01,127.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87181,cpt,"EVALUATION OF ANTIMICROBIAL DRUG (ANTIBIOTIC, ANTIFUNGAL, ANTIVIRAL), AGAR DILUTION METHOD",worker's comp,,O,16.51,4.75,12.38,12.38,3.17
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,76536,cpt,ULTRASOUND SCAN OF HEAD AND NECK SOFT TISSUE,worker's comp,,O,521.47,92.78,391.10,391.10,312.88
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0943,revCode,MEDICAL REHABILITATION DAY PROGRAM CARDIAC REHABILITATION,worker's comp,,O,184.32,70.33,146.53,570.48,110.59
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84154,cpt,"PSA (PROSTATE SPECIFIC ANTIGEN) MEASUREMENT, FREE",worker's comp,,O,135.66,14.84,22.99,101.75,21.62
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86812,cpt,"IMMUNOLOGIC ANALYSIS FOR AUTOIMMUNE DISEASE, A, B, OR C, SINGLE ANTIGEN",worker's comp,,O,101.45,25.33,80.65,80.65,60.87
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1100,cpt,"INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG",worker's comp,,O,7.91,1.68,5.94,13.32,4.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96523,cpt,IRRIGATION OF IMPLANTED VENOUS ACCESS DRUG DELIVERY DEVICE,worker's comp,,O,203.82,49.80,152.86,152.87,122.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J2785,cpt,"INJECTION, REGADENOSON, 0.1 MG",worker's comp,,O,154.76,24.25,126.98,284.42,92.86
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0258,revCode,PHARMACY IVSOLUTIONS,worker's comp,,O,122.03,31.49,86.35,151.09,73.22
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J0171,cpt,"INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG",worker's comp,,O,5.83,0.81,1.18,3.70,3.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0310,revCode,"LABORATORY, PATHOLOGY GENERAL CLASSIFICATION",worker's comp,,O,252.47,43.75,189.35,298.47,151.48
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,worker's comp,,O,383.02,34.82,749.38,823.50,229.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97167,cpt,"EVALUATION OF OCCUPATIONAL THERAPY ESTABLISHED PLAN OF CARE, TYPICALLY 60 MINUTES",worker's comp,,O,356.40,83.75,283.34,283.34,213.84
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1437,cpt,"INJECTION, FERRIC DERISOMALTOSE, 10 MG",worker's comp,,O,85.39,17.80,7538.02,7538.02,51.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85652,cpt,"RED BLOOD CELL SEDIMENTATION RATE, TO DETECT INFLAMMATION, AUTOMATED",worker's comp,,O,38.92,2.65,30.93,30.93,3.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82306,cpt,VITAMIN D-3 LEVEL,worker's comp,,O,101.33,21.90,76.00,101.33,34.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,96413,cpt,"ADMINISTRATION OF CHEMOTHERAPY INTO VEIN, 1 HOUR OR LESS",worker's comp,,O,547.73,117.10,410.80,547.73,328.64
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,Q5119,cpt,"INJECTION, RITUXIMAB-PVVR, BIOSIMILAR, (RUXIENCE), 10 MG",worker's comp,,O,226.96,170.22,170.22,170.22,136.18
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0371,revCode,ANESTHESIA INCIDENT TO RADIOLOGY,worker's comp,,I,50.02,8.77,39.77,39.77,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0761,revCode,SPECIALTY SERVICES TREATMENT ROOM,worker's comp,,I,163.02,40.45,427.48,737.50,97.81
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,C2628,cpt,"CATHETER, OCCLUSION",worker's comp,,O,405.17,139.86,303.88,303.88,243.10
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82607,cpt,CYANOCOBALAMIN (VITAMIN B-12) LEVEL,worker's comp,,O,73.83,11.51,58.69,73.83,17.74
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,82952,cpt,"BLOOD GLUCOSE (SUGAR) TOLERANCE TEST, EACH ADDITIONAL BEYOND 3 SPECIMENS",worker's comp,,O,48.36,3.92,36.27,37.36,9.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87077,cpt,BACTERIAL CULTURE FOR AEROBIC ISOLATES,worker's comp,,O,56.62,7.92,43.41,43.41,9.50
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,71045,cpt,"X-RAY OF CHEST, 1 VIEW",worker's comp,,O,238.84,35.53,35.53,189.88,90.68
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,73630,cpt,"X-RAY OF FOOT, MINIMUM OF 3 VIEWS",worker's comp,,O,348.89,61.44,217.72,261.67,209.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0278,revCode,MEDICAL/SURGICAL SUPPLIES AND DEVICES OTHER IMPLANTS,worker's comp,,O,1205.09,132.64,1236.88,15283.15,723.05
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0300,revCode,"LABORATORY, GENERAL CLASSIFICATION",worker's comp,,I,145.15,30.77,563.45,563.45,87.09
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J7050,cpt,"INFUSION, NORMAL SALINE SOLUTION, 250 CC",worker's comp,,O,158.29,56.98,118.43,158.29,94.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,J1453,cpt,"INJECTION, FOSAPREPITANT, 1 MG",worker's comp,,O,7.49,1.49,5.42,24.00,4.49
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,86780,cpt,"ANALYSIS FOR ANTIBODY, TREPONEMA PALLIDUM",worker's comp,,O,331.50,12.98,248.63,248.63,198.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,99153,cpt,"USE OF A DRUG TO INDUCE DEPRESSION OF CONSCIOUSNESS BY PHYSICIAN PERFORMING A PROCEDURE, EACH ADDITIONAL 15 MINUTES",worker's comp,,O,50.02,5.17,37.52,37.52,30.01
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0331,revCode,RADIOLOGY THERAPEUTIC AND/OF CHEMOTHERAPY ADMINISTRATION CHEMOTHERAPY ADMINISTRATION - INJECTION,worker's comp,,O,252.59,55.19,189.44,896.82,151.55
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84156,cpt,"TOTAL PROTEIN LEVEL, URINE",worker's comp,,O,47.53,3.60,67.61,67.61,4.32
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,84443,cpt,"BLOOD TEST, THYROID STIMULATING HORMONE (TSH)",worker's comp,,O,120.33,16.46,90.25,90.25,19.75
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,72156,cpt,MRI SCAN OF UPPER SPINAL CANAL BEFORE AND AFTER CONTRAST,worker's comp,,O,4054.33,324.17,3223.19,3223.19,2432.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",worker's comp,,O,183.82,20.70,130.07,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0352,revCode,"COMPUTERIZED AXIAL TOMOGRAPHY (CAT)SCAN, BODY SCAN",worker's comp,,I,1952.12,434.32,1464.09,1952.12,1171.27
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,85460,cpt,"FETAL HEMOGLOBIN OR RED BLOOD CELLS MEASUREMENT FOR ASSESSMENT OF FETAL-MATERNAL CIRCULATION, DIFFERENTIAL LYSIS",worker's comp,,O,251.28,7.76,199.76,199.76,150.77
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,87635,cpt,AMPLIFED DNA OR RNA PROBE DETECTION OF SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (COVID-19) ANTIGEN,worker's comp,,O,178.08,50.28,133.56,133.56,60.34
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,78315,cpt,NUCLEAR MEDICINE STUDY OF BONE TAKEN AT DIFFERENT TIMES,worker's comp medicare advantage,,O,2152.21,335.59,335.59,777.36,1291.33
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0342,revCode,"NUCLEAR MEDICINE, THERAPEUTIC",worker's comp medicare advantage,,O,2703.71,220.75,225.27,225.27,1622.23
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,207,ms-drg,RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,worker's comp medicare advantage,,I,183013.56,35773.89,35773.89,40158.29,109808.14
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97110,cpt,"THERAPEUTIC EXERCISE TO DEVELOP STRENGTH, ENDURANCE, RANGE OF MOTION, AND FLEXIBILITY, EACH 15 MINUTES",worker's comp medicare advantage,,O,183.82,20.70,21.86,137.87,25.97
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0343,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC RADIOPHARMACEUTICALS",worker's comp medicare advantage,,O,734.07,19.80,19.80,1320.10,440.44
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0424,revCode,"PHYSICAL THERAPY, EVALUATION OR REEVALUATION",worker's comp medicare advantage,,O,238.30,71.54,94.81,256.87,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,A9517,cpt,"IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER MILLICURIE",worker's comp medicare advantage,,O,100.04,19.80,19.80,23.29,60.02
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0421,revCode,PHYSICAL THERAPY VISIT CHARGE,worker's comp medicare advantage,,O,183.82,20.77,21.86,1046.31,110.29
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0341,revCode,"NUCLEAR MEDICINE, DIAGNOSTIC",worker's comp medicare advantage,,O,5902.67,335.59,335.59,5657.55,3541.60
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,0510,revCode,CLINIC GENERAL,worker's comp medicare advantage,,O,188.17,19.53,105.78,223.95,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,97162,cpt,"EVALUATION FOR PHYSICAL THERAPY, TYPICALLY 30 MINUTES",worker's comp medicare advantage,,O,238.30,63.70,94.81,178.73,142.98
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,G0463,cpt,HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT,worker's comp medicare advantage,,O,188.17,66.99,105.78,199.46,112.90
2023-12-28,7a7fa8f0-a5d1-11ee-94f7-31f997679bf5,Comanche County Memorial Hospital,73-6061037,79005,cpt,ORAL ADMINISTRATION OF RADIOACTIVE MATERIAL THERAPY AGENT,worker's comp medicare advantage,,O,2703.71,220.75,225.27,225.27,1622.23