7-DEIDENTIFIED NORTHSIDE 2464354 11SEP25.xlsx
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- Attached to
- Medical and Pharmacy Reinsurance
- Solicitation number
- RFP 2025-133
- Issued by
- Bexar County, Texas
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StopLoss
| UHC STOP LOSS MARKETING REPORT | |
| emp | |
| Customer Name: | NORTHSIDE INDEPENDENT SCHOOL DISTRICT |
| Policy Number(s): | 000906022 |
| Service Dates: | All |
| Paid Dates: | 01/01/2025 Through 08/31/2025 |
| Threshold: | $250,000.00 |
| Benefit Types Included: | Medical, Managed Pharmacy, Mental Health, Substance Abuse |
This report is based on Post Adjudicated Claims. Denied claims are not included in this report.
This report is not intended to be used for the filing of stop loss reimbursements from third party carriers. This report is designed to facilitate risk assessments and marketing only. Please reference the Stop Loss External Supplemental Report for claim submissions to reinsurers.
| *The Open/Closed Derived Claim Status is presented on this report is based on a systematic query of member claim history and may differ from the more detailed Medical Underwriter review that occurs during the group renewal process. | |||||||||||||||||||||||||||||||||
| SERVICE YEAR/MONTH | |||||||||||||||||||||||||||||||||
| CLAIMANT ID | CLAIMANT AGE BAND | GENDER | CLAIMANT COVERAGE STATUS | DIAGNOSIS CODE | DIAGNOSIS CATEGORY DESCRIPTION | TOTAL MEDICAL | TOTAL RX | TOTAL PAID | DERIVED CLAIM STATUS | TRIGGER IND | AHRQ CATEGORY/THERAPEUTIC CLASS | PLACE OF SERVICE SUMMARY/MAIL ORDER OR RETAIL | 2024-01 | 2024-02 | 2024-03 | 2024-04 | 2024-05 | 2024-06 | 2024-07 | 2024-08 | 2024-09 | 2024-10 | 2024-11 | 2024-12 | 2025-01 | 2025-02 | 2025-03 | 2025-04 | 2025-05 | 2025-06 | 2025-07 | 2025-08 | TOTALS |
| INDV_ID | Claimant_Age_Band | GENDER | ACTIVE_TERMED_STATUS | DIAG_DECM_CD | diagnosis_category | Sum_Net_Pd_Amt_Med | Sum_Net_Pd_Amt_RX | Sum_Net_Pd_Amt | CALC_OPEN_CLOSE | TRIGGER_IND | ahrq_thera | PL_OF_SRVC_SUM_DESC | net_paid_2024_01 | net_paid_2024_02 | net_paid_2024_03 | net_paid_2024_04 | net_paid_2024_05 | net_paid_2024_06 | net_paid_2024_07 | net_paid_2024_08 | net_paid_2024_09 | net_paid_2024_10 | net_paid_2024_11 | net_paid_2024_12 | net_paid_2025_01 | net_paid_2025_02 | net_paid_2025_03 | net_paid_2025_04 | net_paid_2025_05 | net_paid_2025_06 | net_paid_2025_07 | net_paid_2025_08 | TOTALS |
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | ABDOMINAL HERNIA | ACUTE-CARE INPATIENT FACILITY | $3,254.92 | $3,254.92 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | CARDIAC AND CIRCULATORY CONGEN | ACUTE-CARE OUTPATIENT FACILITY | $835.12 | $529.92 | $139.90 | $1,504.94 | |||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | CARDIAC AND CIRCULATORY CONGEN | OTHER OUTPATIENT PLACE OF SERVICE | $185.56 | $1,002.22 | $302.34 | $1,490.12 | |||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | CARDIAC AND CIRCULATORY CONGEN | ACUTE-CARE INPATIENT FACILITY | $35,579.44 | $22,951.09 | $22,234.23 | $80,764.76 | |||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | CARDIAC DYSRHYTHMIAS | ACUTE-CARE OUTPATIENT FACILITY | $12.64 | $12.64 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | GENITOURINARY CONGENITAL ANOMA | ACUTE-CARE INPATIENT FACILITY | $0.00 | $0.00 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | GENITOURINARY CONGENITAL ANOMA | ACUTE-CARE OUTPATIENT FACILITY | $260.68 | $134.22 | $394.90 | ||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | GLUCOCORTICOIDS | RETAIL | $4.23 | $4.23 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | HEART VALVE DISORDERS | ACUTE-CARE OUTPATIENT FACILITY | $2,814.91 | $2,814.91 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | IMMUNIZATIONS AND SCREENING FO | OFFICE/CLINIC | $755.84 | $755.84 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | INTESTINAL OBSTRUCTION WITHOUT | ACUTE-CARE INPATIENT FACILITY | $123.92 | $123.92 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | LIVEBORN | ACUTE-CARE INPATIENT FACILITY | $98,960.00 | $231,550.00 | $286,440.00 | $2,481.95 | $619,431.95 | ||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | MEDICAL EXAMINATION/EVALUATION | OFFICE/CLINIC | $400.63 | $400.63 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | MEDICAL EXAMINATION/EVALUATION | ACUTE-CARE INPATIENT FACILITY | $21.25 | $21.25 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER AFTERCARE | ACUTE-CARE INPATIENT FACILITY | $0.00 | $143.98 | $105.08 | $78.81 | $327.87 | ||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER GASTROINTESTINAL DISORDE | ACUTE-CARE OUTPATIENT FACILITY | $37.90 | $122.05 | $159.95 | ||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER GASTROINTESTINAL DISORDE | ACUTE-CARE INPATIENT FACILITY | $0.00 | $103.63 | $52.54 | $156.17 | |||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER LOWER RESPIRATORY DISEAS | ACUTE-CARE INPATIENT FACILITY | $26.27 | $26.27 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER PERINATAL CONDITIONS | ACUTE-CARE INPATIENT FACILITY | $78.81 | $2,033.66 | $105.08 | $144.48 | $2,362.03 | ||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER PERINATAL CONDITIONS | ACUTE-CARE OUTPATIENT FACILITY | $131.48 | $131.48 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE INPATIENT FACILITY | $45.98 | $45.98 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE OUTPATIENT FACILITY | $12.64 | $12.64 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | OTHER SKIN DISORDERS | ACUTE-CARE OUTPATIENT FACILITY | $190.02 | $190.02 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | REHABILITATION CARE; FITTING O | ACUTE-CARE INPATIENT FACILITY | $0.00 | $26.27 | $78.81 | $117.71 | $222.79 | ||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | RESIDUAL CODES; UNCLASSIFIED | ACUTE-CARE INPATIENT FACILITY | $26.27 | $26.27 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | RESPIRATORY DISTRESS SYNDROME | ACUTE-CARE INPATIENT FACILITY | $11,865.40 | $26.27 | $134.22 | $12,025.89 | |||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | RETINAL DETACHMENTS; DEFECTS; | ACUTE-CARE INPATIENT FACILITY | $278.46 | $82.71 | $361.17 | ||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | SHORT GESTATION; LOW BIRTH WEI | OFFICE/CLINIC | $148.68 | $148.68 | |||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | SHORT GESTATION; LOW BIRTH WEI | ACUTE-CARE INPATIENT FACILITY | $277.25 | $168.51 | $445.76 | ||||||||||||||||||
| 2047599192 | < 1 | MALE | TERMED | Z38.01 | LIVEBORN | $745,286.62 | $4.23 | $745,290.85 | CLOSED | Y | UNKNOWN DIAGNOSIS | ACUTE-CARE INPATIENT FACILITY | $9,771.62 | $5,981.25 | $1,920.00 | $17,672.87 | |||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | ANTICOAGULANTS | RETAIL | $526.79 | $1,662.15 | $23.36 | $2,212.30 | ||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | ANTIDOTES | RETAIL | $72.99 | $72.99 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | ANTIFUNGALS | RETAIL | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | ANTINAUSEANTS | RETAIL | $20.15 | $20.15 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | BACTERIAL INFECTION; UNSPECIFI | ACUTE-CARE INPATIENT FACILITY | $243.48 | $243.48 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | CARDIAC DYSRHYTHMIAS | ACUTE-CARE INPATIENT FACILITY | $21.51 | $21.51 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | CEPHALOSPORINS | RETAIL | $2.50 | $1.02 | $3.52 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATION OF DEVICE; IMPLAN | ACUTE-CARE OUTPATIENT FACILITY | $9,509.66 | $9,509.66 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATION OF DEVICE; IMPLAN | ACUTE-CARE INPATIENT FACILITY | $102,320.81 | $102,320.81 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATION OF DEVICE; IMPLAN | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATION OF DEVICE; IMPLAN | OFFICE/CLINIC | $68.54 | $68.54 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATIONS OF SURGICAL PROC | ACUTE-CARE OUTPATIENT FACILITY | $639.88 | $96.03 | $18,149.69 | $18,885.60 | ||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATIONS OF SURGICAL PROC | LONG-TERM CARE FACILITY | $350.97 | $350.97 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATIONS OF SURGICAL PROC | OTHER OUTPATIENT PLACE OF SERVICE | -$8,693.29 | -$8,693.29 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | COMPLICATIONS OF SURGICAL PROC | ACUTE-CARE INPATIENT FACILITY | $2,512.21 | $2,512.21 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | CORONARY ATHEROSCLEROSIS AND O | ACUTE-CARE INPATIENT FACILITY | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | DIABETES MELLITUS WITH COMPLIC | ACUTE-CARE INPATIENT FACILITY | $24,851.00 | $289,555.44 | $1,034.78 | $315,441.22 | ||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | DIABETES MELLITUS WITH COMPLIC | INDEPENDENT LABORATORY | $7.17 | $7.17 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | DIABETIC THERAPY | RETAIL | $530.67 | $246.58 | $1,037.08 | $1,814.33 | ||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | DISORDERS OF LIPID METABOLISM | INDEPENDENT LABORATORY | $139.34 | $139.34 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | ESSENTIAL HYPERTENSION | OFFICE/CLINIC | $226.54 | $226.54 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | ESSENTIAL HYPERTENSION | LONG-TERM CARE FACILITY | $3,800.00 | $3,800.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | FAT SOLUBLE VITAMINS | RETAIL | $1.63 | $0.00 | $1.63 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | GANGRENE | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | GANGRENE | ACUTE-CARE INPATIENT FACILITY | $1,636.98 | $1,636.98 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | LIPOTROPICS | RETAIL | $0.00 | $47.40 | $47.40 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | MALAISE AND FATIGUE | LONG-TERM CARE FACILITY | $43.90 | $43.90 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | MEDICAL EXAMINATION/EVALUATION | ACUTE-CARE INPATIENT FACILITY | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | MUSCLE RELAXANTS | RETAIL | $3.54 | $3.54 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | NO STANDARD THERAPEUTIC CLASS CODE | RETAIL | $28.52 | $419.42 | $377.11 | $373.77 | $1,198.82 | |||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | NONINFECTIOUS GASTROENTERITIS | OFFICE/CLINIC | $83.36 | $83.36 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OPEN WOUNDS OF HEAD; NECK; AND | ACUTE-CARE OUTPATIENT FACILITY | $20.15 | $347.33 | $367.48 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER AFTERCARE | INDEPENDENT LABORATORY | $131.07 | $131.07 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER AFTERCARE | ACUTE-CARE OUTPATIENT FACILITY | $204.20 | $204.20 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER ANTIBIOTICS | RETAIL | $13.16 | $13.16 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER ANTIHYPERTENSIVES | RETAIL | $10.24 | $10.24 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER CARDIOVASCULAR PREPS | RETAIL | $2.74 | $12.35 | $15.09 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER CIRCULATORY DISEASE | ACUTE-CARE INPATIENT FACILITY | $99.86 | $99.86 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER DISEASES OF VEINS AND LY | OTHER OUTPATIENT PLACE OF SERVICE | $888.88 | $888.88 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER DISEASES OF VEINS AND LY | ACUTE-CARE INPATIENT FACILITY | $87.26 | $30.54 | $117.80 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER INJURIES AND CONDITIONS | ACUTE-CARE INPATIENT FACILITY | $399.76 | $399.76 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER LOWER RESPIRATORY DISEAS | ACUTE-CARE INPATIENT FACILITY | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER NERVOUS SYSTEM DISORDERS | OFFICE/CLINIC | $115.95 | $115.95 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER NERVOUS SYSTEM DISORDERS | ACUTE-CARE INPATIENT FACILITY | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER SCREENING FOR SUSPECTED | OTHER OUTPATIENT PLACE OF SERVICE | -$19.82 | -$19.82 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE OUTPATIENT FACILITY | $40.20 | $40.20 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE INPATIENT FACILITY | $17.21 | $17.21 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | OTHER THERAPEUTIC CLASS | RETAIL | $4.12 | $2.89 | $127.01 | $77.84 | $7.00 | $218.86 | ||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | PENICILLINS | RETAIL | $7.87 | $7.87 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | PERIPHERAL AND VISCERAL ATHERO | ACUTE-CARE INPATIENT FACILITY | $1,728.55 | $431.33 | $15,722.96 | $323.55 | $18,206.39 | |||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | PERIPHERAL AND VISCERAL ATHERO | ACUTE-CARE OUTPATIENT FACILITY | $444.71 | $780.26 | $711.88 | $1,936.85 | ||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | PLEURISY; PNEUMOTHORAX; PULMON | ACUTE-CARE INPATIENT FACILITY | $23.26 | $23.26 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | SEPTICEMIA (EXCEPT IN LABOR) | ACUTE-CARE OUTPATIENT FACILITY | $1,082.51 | $1,082.51 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | SKIN AND SUBCUTANEOUS TISSUE I | ACUTE-CARE OUTPATIENT FACILITY | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | SULFONAMIDES | RETAIL | $0.00 | $0.00 | $0.00 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | TETRACYCLINES | RETAIL | $11.62 | $11.62 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | THYROID DISORDERS | ACUTE-CARE INPATIENT FACILITY | $152.17 | $152.17 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | THYROID PREPS | RETAIL | $6.94 | $37.47 | $44.41 | |||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | UNKNOWN DIAGNOSIS | ACUTE-CARE INPATIENT FACILITY | $0.00 | $0.00 | ||||||||||||||||||||
| 457585427 | 55 - 59 | FEMALE | TERMED | E11.51 | DIABETES MELLITUS WITH COMPLIC | $470,361.77 | $5,711.95 | $476,073.72 | CLOSED | URINARY ANTIBACTERIALS | RETAIL | $10.44 | $5.58 | $16.02 | |||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | ALDOSTERONE ANTAGONISTS | RETAIL | $0.00 | $144.00 | $144.00 | $288.00 | ||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | DIABETIC THERAPY | RETAIL - SPECIALTY DRUG | $1,404.43 | $1,404.43 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | DIABETIC THERAPY | RETAIL | $39,097.99 | $85,460.92 | $42,730.46 | $42,730.46 | $42,730.46 | $85,460.92 | $42,730.46 | $380,941.67 | ||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | ELECTROLYTES & MISCELLANEOUS NUTRIENTS | RETAIL | $0.00 | $65.37 | $66.05 | $131.42 | ||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | FLUID AND ELECTROLYTE DISORDER | OFFICE/CLINIC | $76.86 | $76.86 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | MEDICAL EXAMINATION/EVALUATION | INDEPENDENT LABORATORY | $47.07 | $47.07 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | MEDICAL EXAMINATION/EVALUATION | OFFICE/CLINIC | $136.42 | $136.42 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | NONMALIGNANT BREAST CONDITIONS | OFFICE/CLINIC | $144.86 | $144.86 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | OTHER ENDOCRINE DISORDERS | OFFICE/CLINIC | $520.85 | $520.85 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | OTHER SCREENING FOR SUSPECTED | OFFICE/CLINIC | $321.02 | $63.97 | $169.16 | $554.15 | ||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | OTHER SCREENING FOR SUSPECTED | INDEPENDENT LABORATORY | $50.43 | $20.70 | $71.13 | |||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | THYROID DISORDERS | INDEPENDENT LABORATORY | $64.75 | $64.75 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | THYROID DISORDERS | OFFICE/CLINIC | $76.86 | $76.86 | ||||||||||||||||||||
| 182442602 | 50 - 54 | FEMALE | ACTIVE | E27.8 | OTHER ENDOCRINE DISORDERS | $1,692.95 | $382,854.54 | $384,547.49 | OPEN | THYROID PREPS | RETAIL | $0.00 | $41.33 | $47.69 | $89.02 | ||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | ANTIHISTAMINES | RETAIL | $27.91 | $27.91 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | CARDIAC DYSRHYTHMIAS | ACUTE-CARE OUTPATIENT FACILITY | $15.51 | $15.51 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | CEPHALOSPORINS | RETAIL | $18.10 | $9.41 | $27.51 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | COLD AND COUGH PREPARATIONS | RETAIL | $0.00 | $14.91 | $14.91 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | COMPLICATIONS OF SURGICAL PROC | OFFICE/CLINIC | $1,084.50 | $1,084.50 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | DIABETES MELLITUS WITHOUT COMP | INDEPENDENT LABORATORY | $25.16 | $25.16 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | DIAGNOSTICS | RETAIL | $62.44 | $62.37 | $124.81 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | DISORDERS OF LIPID METABOLISM | OFFICE/CLINIC | $70.46 | $70.46 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | ERYTHROMYCINS | RETAIL | $0.00 | $0.00 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | GLUCOCORTICOIDS | RETAIL | $30.01 | $18.85 | $48.86 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | INFLUENZA | ACUTE-CARE OUTPATIENT FACILITY | $1,061.11 | $1,061.11 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | LAXATIVES | RETAIL | $138.80 | $138.80 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | LIPOTROPICS | RETAIL | $28.30 | $34.56 | $62.86 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | LYMPHADENITIS | OFFICE/CLINIC | $54.82 | $917.48 | $972.30 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MAINTENANCE CHEMOTHERAPY; RADI | OFFICE/CLINIC | $16,963.20 | $12,323.49 | $34,314.85 | $17,692.06 | $17,824.81 | $65,186.28 | $128,790.05 | $34,233.32 | $274.20 | $327,602.26 | ||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MAINTENANCE CHEMOTHERAPY; RADI | OTHER OUTPATIENT PLACE OF SERVICE | -$16,944.19 | -$16,944.19 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MAINTENANCE CHEMOTHERAPY; RADI | INDEPENDENT LABORATORY | $2,700.00 | $3,500.00 | $3,500.00 | $3,500.00 | $13,200.00 | |||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MALIGNANT NEOPLASM WITHOUT SPE | OFFICE/CLINIC | $2,809.05 | $2,809.05 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MALIGNANT NEOPLASM WITHOUT SPE | OTHER OUTPATIENT PLACE OF SERVICE | -$5,591.38 | -$5,591.38 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MALIGNANT NEOPLASM WITHOUT SPE | ACUTE-CARE OUTPATIENT FACILITY | $5,852.38 | $46.28 | $8,479.75 | $14,378.41 | ||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MALIGNANT NEOPLASM WITHOUT SPE | ACUTE-CARE INPATIENT FACILITY | $15.51 | $15.51 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MISCELLANEOUS | RETAIL | $85.08 | $103.90 | $188.98 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | MUSCLE RELAXANTS | RETAIL | $32.44 | $32.44 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER AND UNSPECIFIED BENIGN N | INDEPENDENT LABORATORY | $61.39 | $61.39 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER NERVOUS SYSTEM DISORDERS | INDEPENDENT LABORATORY | $26.14 | $26.14 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER NON-EPITHELIAL CANCER OF | OFFICE/CLINIC | $141.60 | $58.81 | $4,013.19 | $330.00 | $355.61 | $308.81 | $5,208.02 | |||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER NON-EPITHELIAL CANCER OF | INDEPENDENT LABORATORY | $11.08 | $3,500.00 | $3,500.00 | $221.87 | $7,232.95 | |||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER NON-EPITHELIAL CANCER OF | ACUTE-CARE OUTPATIENT FACILITY | $1,263.48 | $1,007.70 | $2,271.18 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE OUTPATIENT FACILITY | $1,327.50 | $1,327.50 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | OTHER THERAPEUTIC CLASS | RETAIL | $12.28 | $12.28 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | SKIN AND SUBCUTANEOUS TISSUE I | OFFICE/CLINIC | $1,283.02 | $1,283.02 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | SPONDYLOSIS; INTERVERTEBRAL DI | ACUTE-CARE OUTPATIENT FACILITY | $783.09 | $1,816.15 | $5,831.74 | $8,430.98 | ||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | SPONDYLOSIS; INTERVERTEBRAL DI | OFFICE/CLINIC | $205.06 | $205.06 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | SPRAINS AND STRAINS | ACUTE-CARE OUTPATIENT FACILITY | $517.05 | $517.05 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | UNKNOWN DIAGNOSIS | OFFICE/CLINIC | $312.27 | $297.20 | $78.50 | $687.97 | ||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | UNKNOWN DIAGNOSIS | ACUTE-CARE OUTPATIENT FACILITY | $652.48 | $615.00 | $1,267.48 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | UNKNOWN DIAGNOSIS | OTHER OUTPATIENT PLACE OF SERVICE | $50.64 | $101.28 | $151.92 | |||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | URINARY ANTIBACTERIALS | RETAIL | $7.69 | $7.69 | ||||||||||||||||||||
| 327538160 | 60 - 64 | MALE | ACTIVE | Z51.11 | MAINTENANCE CHEMOTHERAPY; RADI | $367,441.73 | $687.05 | $368,128.78 | OPEN | URINARY TRACT INFECTIONS | OFFICE/CLINIC | $72.37 | $72.37 | ||||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ABDOMINAL HERNIA | ACUTE-CARE INPATIENT FACILITY | $31.28 | $31.28 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ABDOMINAL PAIN | OFFICE/CLINIC | $121.31 | $125.86 | $247.17 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ABDOMINAL PAIN | ACUTE-CARE OUTPATIENT FACILITY | $450.21 | $1,124.80 | -$3,880.34 | $474.37 | $5,810.63 | $11,606.42 | $165.92 | $690.73 | $3,025.16 | $140.82 | $1,931.65 | $21,540.37 | |||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ABDOMINAL PAIN | ACUTE-CARE INPATIENT FACILITY | -$198.50 | $2,479.57 | $102.82 | $130.64 | $2,284.00 | $4,798.53 | |||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ABDOMINAL PAIN | OTHER OUTPATIENT PLACE OF SERVICE | -$133.82 | $0.00 | $876.26 | $742.44 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ADMINISTRATIVE/SOCIAL ADMISSIO | ACUTE-CARE INPATIENT FACILITY | $12.52 | $12.52 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ANESTHETIC LOCAL TOPICAL | RETAIL | $15.42 | $15.42 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ANTI-ULCER PREPS/GASTROINTESTINAL PREPS | RETAIL | $7.88 | $27.96 | $72.00 | $107.84 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ANTIHISTAMINES | RETAIL | $3.22 | $3.52 | $6.74 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ANTINAUSEANTS | RETAIL | $0.00 | $52.05 | $104.51 | $68.13 | $160.72 | $172.78 | $35.25 | $593.44 | |||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ANTIPARASITICS | RETAIL | $9.91 | $9.91 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ANTISPASMODIC AND ANTICHOLINERGIC AGENTS | RETAIL | $12.89 | $27.81 | $43.75 | $84.45 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ASTHMA | ACUTE-CARE OUTPATIENT FACILITY | $565.26 | $565.26 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ASTHMA | ACUTE-CARE INPATIENT FACILITY | $937.02 | $937.02 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ASTHMA | OFFICE/CLINIC | $150.38 | $150.38 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ASTHMA | OTHER OUTPATIENT PLACE OF SERVICE | $4.60 | $4.60 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | BACTERIAL INFECTION; UNSPECIFI | ACUTE-CARE INPATIENT FACILITY | $211.18 | $211.18 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | BRONCHIAL DILATORS | RETAIL | $0.00 | $10.42 | $687.16 | $744.56 | $50.45 | $650.81 | $689.46 | $2,832.86 | |||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | BURNS | ACUTE-CARE OUTPATIENT FACILITY | $1,761.85 | $1,761.85 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | CARDIAC DYSRHYTHMIAS | ACUTE-CARE INPATIENT FACILITY | $102.82 | $102.82 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | CARDIAC DYSRHYTHMIAS | ACUTE-CARE OUTPATIENT FACILITY | $15.51 | $15.51 | $15.51 | $46.53 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | CEPHALOSPORINS | RETAIL | $0.26 | $30.57 | $95.13 | $125.96 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | CHOLESTEROL REDUCERS | RETAIL | $299.94 | $299.94 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | COLD AND COUGH PREPARATIONS | RETAIL | $9.38 | $9.38 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | COMPLICATION OF DEVICE; IMPLAN | ACUTE-CARE OUTPATIENT FACILITY | $474.37 | $474.37 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | COMPLICATIONS OF SURGICAL PROC | ACUTE-CARE OUTPATIENT FACILITY | $8,039.01 | $5,586.96 | $13,625.97 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | COMPLICATIONS OF SURGICAL PROC | ACUTE-CARE INPATIENT FACILITY | $12,660.33 | $12,660.33 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | COUGH PREPARATIONS/EXPECTORANTS | RETAIL | $9.30 | $9.30 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | DEFICIENCY AND OTHER ANEMIA | ACUTE-CARE OUTPATIENT FACILITY | $374.97 | $374.97 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | DIABETES MELLITUS WITH COMPLIC | ACUTE-CARE OUTPATIENT FACILITY | $201.11 | $529.65 | $730.76 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | DIABETES MELLITUS WITH COMPLIC | ACUTE-CARE INPATIENT FACILITY | $2,099.19 | $2,099.19 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | DIABETES MELLITUS WITHOUT COMP | ACUTE-CARE INPATIENT FACILITY | $225.08 | $450.16 | $84.96 | $760.20 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | DIABETIC THERAPY | RETAIL | $1,037.08 | $1,037.08 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | DISEASES OF WHITE BLOOD CELLS | ACUTE-CARE OUTPATIENT FACILITY | $3,311.00 | $3,311.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ERYTHROMYCINS | RETAIL | $11.01 | $11.01 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ESOPHAGEAL DISORDERS | ACUTE-CARE OUTPATIENT FACILITY | $2,632.04 | $1,580.00 | $3,033.24 | $715.75 | $7,961.03 | ||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ESOPHAGEAL DISORDERS | OTHER OUTPATIENT PLACE OF SERVICE | -$1.00 | $0.00 | -$1.00 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | ESTROGENS | RETAIL | $442.92 | $442.92 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | FEVER OF UNKNOWN ORIGIN | ACUTE-CARE OUTPATIENT FACILITY | $82.26 | $82.26 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | FOLIC ACID PREPARATIONS | RETAIL | $1.10 | $1.10 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GASTRITIS AND DUODENITIS | INDEPENDENT LABORATORY | $336.21 | $336.21 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GASTRITIS AND DUODENITIS | ACUTE-CARE OUTPATIENT FACILITY | -$1,200.00 | $450.21 | -$749.79 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GASTRITIS AND DUODENITIS | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | $0.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GASTROINTESTINAL HEMORRHAGE | ACUTE-CARE INPATIENT FACILITY | $617.48 | $617.48 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GENITOURINARY SYMPTOMS AND ILL | INDEPENDENT LABORATORY | $5.49 | $5.49 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GENITOURINARY SYMPTOMS AND ILL | OFFICE/CLINIC | $427.74 | $3.00 | $430.74 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GENITOURINARY SYMPTOMS AND ILL | ACUTE-CARE OUTPATIENT FACILITY | $2,307.36 | $827.47 | $3,134.83 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | GLUCOCORTICOIDS | RETAIL | $0.00 | $0.00 | $196.33 | $196.33 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | HEADACHE; INCLUDING MIGRAINE | OTHER OUTPATIENT PLACE OF SERVICE | $54.00 | $54.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | IMMUNIZATIONS AND SCREENING FO | ACUTE-CARE OUTPATIENT FACILITY | -$65.00 | -$65.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | IMMUNIZATIONS AND SCREENING FO | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | $0.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | INTESTINAL INFECTION | ACUTE-CARE OUTPATIENT FACILITY | $8,150.20 | $19,099.33 | $1,763.06 | $2,895.08 | $31,907.67 | ||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | INTESTINAL INFECTION | ACUTE-CARE INPATIENT FACILITY | $25,123.21 | $8,335.55 | $2,286.04 | $35,744.80 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | INTESTINAL INFECTION | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | $140.00 | $140.00 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | INTESTINAL OBSTRUCTION WITHOUT | ACUTE-CARE OUTPATIENT FACILITY | $2,135.99 | $2,135.99 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NAUSEA AND VOMITING | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | -$474.37 | $1,026.83 | $552.46 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NAUSEA AND VOMITING | OFFICE/CLINIC | $249.48 | $249.48 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NAUSEA AND VOMITING | ACUTE-CARE INPATIENT FACILITY | $89.17 | -$508.03 | $794.88 | $376.02 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NAUSEA AND VOMITING | ACUTE-CARE OUTPATIENT FACILITY | -$303.87 | $3,311.00 | $608.19 | $3,079.20 | $6,694.52 | ||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NON-OPIOID ANALGESICS | RETAIL | $22.56 | $446.90 | $469.46 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NONINFECTIOUS GASTROENTERITIS | ACUTE-CARE INPATIENT FACILITY | $772.23 | $772.23 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NONINFECTIOUS GASTROENTERITIS | ACUTE-CARE OUTPATIENT FACILITY | $3,733.60 | $3,787.26 | $1,200.00 | $2,453.33 | $8,257.20 | $19,431.39 | |||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NONSPECIFIC CHEST PAIN | ACUTE-CARE OUTPATIENT FACILITY | $3,210.33 | $15.51 | $15.51 | $3,241.35 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | NONSPECIFIC CHEST PAIN | OTHER OUTPATIENT PLACE OF SERVICE | $1,068.01 | $1,068.01 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER AFTERCARE | ACUTE-CARE INPATIENT FACILITY | $561.90 | $561.90 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER AND ILL-DEFINED HEART DI | ACUTE-CARE INPATIENT FACILITY | $16.52 | $16.52 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER AND UNSPECIFIED BENIGN N | ACUTE-CARE OUTPATIENT FACILITY | $3,833.50 | $6,485.42 | $10,318.92 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER AND UNSPECIFIED BENIGN N | OFFICE/CLINIC | $79.96 | $146.52 | $226.48 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER ANTIBIOTICS | RETAIL | $4,997.30 | $13.49 | $5,010.79 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER CONNECTIVE TISSUE DISEAS | ACUTE-CARE INPATIENT FACILITY | $30.08 | $30.08 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DIAGNOSIS | ACUTE-CARE INPATIENT FACILITY | $182.51 | $182.51 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DIAGNOSIS | OTHER OUTPATIENT PLACE OF SERVICE | $88.01 | $88.01 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DIAGNOSIS | ACUTE-CARE OUTPATIENT FACILITY | $3,289.25 | $3,311.00 | $622.60 | $2,917.90 | $10,140.75 | ||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DIAGNOSIS | OFFICE/CLINIC | $628.65 | $628.65 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISEASES OF BLADDER AND | ACUTE-CARE OUTPATIENT FACILITY | $42,678.78 | $42,678.78 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISEASES OF BLADDER AND | OFFICE/CLINIC | $426.59 | $426.59 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISEASES OF KIDNEY AND U | ACUTE-CARE INPATIENT FACILITY | $139.14 | $139.14 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISORDERS OF STOMACH AND | OFFICE/CLINIC | $99.25 | $99.25 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISORDERS OF STOMACH AND | ACUTE-CARE INPATIENT FACILITY | $68,000.84 | $68,000.84 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISORDERS OF STOMACH AND | OTHER OUTPATIENT PLACE OF SERVICE | -$33,366.95 | -$33,366.95 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER DISORDERS OF STOMACH AND | ACUTE-CARE OUTPATIENT FACILITY | $1,689.45 | $6,505.85 | $7,201.08 | $2,292.32 | $17,688.70 | ||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER GASTROINTESTINAL DISORDE | ACUTE-CARE INPATIENT FACILITY | $469.42 | $253.15 | $119.89 | $288.02 | $1,130.48 | ||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER GASTROINTESTINAL DISORDE | ACUTE-CARE OUTPATIENT FACILITY | -$7,648.41 | $12,462.89 | $450.21 | $2,455.40 | $529.65 | $8,249.74 | |||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER GASTROINTESTINAL DISORDE | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | -$248.14 | -$248.14 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER INFECTIONS; INCLUDING PA | OTHER OUTPATIENT PLACE OF SERVICE | $3,016.96 | $3,016.96 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER INJURIES AND CONDITIONS | OTHER OUTPATIENT PLACE OF SERVICE | $895.59 | $895.59 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER LIVER DISEASES | ACUTE-CARE INPATIENT FACILITY | $98.06 | $98.06 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER LIVER DISEASES | ACUTE-CARE OUTPATIENT FACILITY | $98.06 | $98.06 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER LOWER RESPIRATORY DISEAS | ACUTE-CARE OUTPATIENT FACILITY | $200.12 | $200.12 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER NERVOUS SYSTEM DISORDERS | ACUTE-CARE OUTPATIENT FACILITY | $552.30 | $3,287.00 | $80.24 | $3,919.54 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER NERVOUS SYSTEM DISORDERS | ACUTE-CARE INPATIENT FACILITY | $202.10 | $202.10 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER NON-TRAUMATIC JOINT DISO | ACUTE-CARE OUTPATIENT FACILITY | $30.59 | $30.59 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE OUTPATIENT FACILITY | $374.97 | $0.00 | $374.97 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER SCREENING FOR SUSPECTED | ACUTE-CARE INPATIENT FACILITY | $45.16 | $45.16 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER SKIN DISORDERS | OFFICE/CLINIC | $133.95 | $133.95 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER SKIN DISORDERS | ACUTE-CARE OUTPATIENT FACILITY | $830.00 | $830.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER THERAPEUTIC CLASS | RETAIL | $91.35 | $53.13 | $70.64 | $356.53 | $159.06 | $126.59 | $174.87 | $145.68 | $1,177.85 | ||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER UPPER RESPIRATORY INFECT | ACUTE-CARE OUTPATIENT FACILITY | $115.00 | $115.00 | $230.00 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | OTHER UPPER RESPIRATORY INFECT | OTHER OUTPATIENT PLACE OF SERVICE | $0.00 | $0.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PANCREATIC DISORDERS (NOT DIAB | OFFICE/CLINIC | $121.31 | $162.54 | $283.85 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PENICILLINS | RETAIL | $53.21 | $12.87 | $27.88 | $93.96 | |||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PERITONITIS AND INTESTINAL ABS | ACUTE-CARE INPATIENT FACILITY | $19,056.92 | $19,056.92 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PLEURISY; PNEUMOTHORAX; PULMON | ACUTE-CARE INPATIENT FACILITY | $10.32 | $10.32 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PNEUMONIA (EXCEPT THAT CAUSED | ACUTE-CARE OUTPATIENT FACILITY | $701.74 | $701.74 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PNEUMONIA (EXCEPT THAT CAUSED | OTHER OUTPATIENT PLACE OF SERVICE | $201.50 | $201.50 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | PNEUMONIA (EXCEPT THAT CAUSED | ACUTE-CARE INPATIENT FACILITY | $1,972.00 | $1,972.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | SKIN AND SUBCUTANEOUS TISSUE I | ACUTE-CARE INPATIENT FACILITY | $169.92 | $423.07 | $592.99 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | SPONDYLOSIS; INTERVERTEBRAL DI | ACUTE-CARE OUTPATIENT FACILITY | $1,200.00 | $1,200.00 | |||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | SPRAINS AND STRAINS | ACUTE-CARE OUTPATIENT FACILITY | $1,313.37 | $2,291.41 | $3,604.78 | ||||||||||||||||||
| 424855690 | 45 - 49 | FEMALE | ACTIVE | A09 | INTESTINAL INFECTION | $355,314.80 | $12,562.28 | $367,877.08 | OPEN | Y | SYNCOPE | ACUTE-CARE INPATIENT FACILITY | $135.43 | $135.43 |
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