"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"Payer"|"Plan"|"Inpatient Gross Charges"|"Inpatient Expected Reimbursement"|"Inpatient Max Reimbursement"|"Inpatient Minimal Reimbursement"|"Outpatient Gross Charges"|"Outpatient Expected Reimbursement"|"Outpatient Max Reimbursement"|"Outpatient Minimal Reimbursement" 0296T|EAP|0730|EXT ECG RECORDING|Blue Cross PPO|BLUE CROSS PPO|||||1.65||| 0296T|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 0296T|EAP|0271||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 0296T|EAP|0730|EXT ECG RECORDING|ChampVA|CHAMPVA OF CO DENVER|||||1.65||| 0296T|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 0296T|EAP|0730|EXT ECG RECORDING|Blue Cross PPO|BCBS TRANE PPO|||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.65||| 0296T|EAP|0343||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.08||| 0296T|EAP|0730|EXT ECG RECORDING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.65||| 0296T|EAP|0762||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.75||| 0296T|EAP|0730|EXT ECG RECORDING|Medicaid|MEDICAID|||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|United Healthcare|GOLDEN RULE INSURANCE|||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.65||| 0296T|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.28||| 0296T|EAP|0730|EXT ECG RECORDING|Cigna|CIGNA OPEN ACCESS PLUS|||||1.65||| 0296T|EAP|0257||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 0296T|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 0296T|EAP|0730|EXT ECG RECORDING|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.65||| 0296T|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 0296T|EAP|0483||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.21||| 0296T|EAP|0341||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||58.13||| 0296T|EAP|0730|EXT ECG RECORDING|NON CONTRACTED|COMMERCIAL OTHER|||||1.65||| 0296T|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.93||| 0296T|EAP|0730|EXT ECG RECORDING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.65||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.65||| 0296T|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.86||| 0296T|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.14||| 0296T|EAP|0730|EXT ECG RECORDING|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.65||| 0296T|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 0296T|EAP|0730|EXT ECG RECORDING|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.65||| 0296T|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 0296T|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.36||| 0296T|EAP|0730|EXT ECG RECORDING|Aetna|AETNA EXXON MOBIL|||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|Blue Cross PPO|BLUE CROSS POS|||||1.65||| 0296T|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 0296T|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 0296T|EAP|0730|EXT ECG RECORDING|Blue Cross PPO Select|BCBS UTHCT|||||1.65||| 0296T|EAP|0482||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.03||| 0296T|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.14||| 0296T|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 0296T|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 0296T|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.07||| 0296T|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.51||| 0296T|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.19||| 0296T|EAP|0762||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.00||| 0296T|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 0296T|EAP|0730|EXT ECG RECORDING|Medicare|MEDICARE A & B|1.65||||1.65||| 0296T|EAP|0730|EXT ECG RECORDING|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.65||| 0296T|EAP|0250||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Blue Cross PPO|BLUE CROSS PPO|||||15.55||| 10005|EAP|0510|FNA BX W/US GDN 1ST LES|Medicare|MEDICARE A & B|||||15.55||| 10005|EAP|0999||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 10005|EAP|0360|FINE NEEDLE ASP|Blue Cross PPO Select|BCBS UTHCT|||||1,554.90||| 10005|EAP|0360|FINE NEEDLE ASP|Blue Cross PPO|BLUE CROSS POS|||||1,554.95||| 10005|EAP|0360|FINE NEEDLE ASP|Medicare|MEDICARE A & B|||||1,554.90||| 10005|EAP|0360|FINE NEEDLE ASP|Aetna|AETNA|||||15.55||| 10005|EAP|0312||Medicare|MEDICARE A & B|||||5.94||| 10005|EAP|0510|FNA BX W/US GDN 1ST LES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||15.55||| 10005|EAP|0999||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 10005|EAP|0360|FINE NEEDLE ASP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||15.55||| 10005|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.59||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.55||| 10005|EAP|0360|FINE NEEDLE ASP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||15.55||| 10005|EAP|0360|FINE NEEDLE ASP|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||15.55||| 10005|EAP|0402||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.62||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Blue Cross PPO|BLUE CROSS POS|||||15.55||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|NON CONTRACTED|COMMERCIAL OTHER|||||15.55||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||15.55||| 10005|EAP|0510|FNA BX W/US GDN 1ST LES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||15.55||| 10005|EAP|0360|FINE NEEDLE ASP|Aetna|TRS COORDINATED CARE|||||1,554.90||| 10005|EAP|0360|FINE NEEDLE ASP|Blue Cross PPO|BLUE CROSS PPO|||||15.55||| 10005|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.62||| 10005|EAP|0360|FINE NEEDLE ASP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1,554.90||| 10005|EAP|0401||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.38||| 10005|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.59||| 10005|EAP|0360|FINE NEEDLE ASP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.55||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Blue Cross PPO Select|BCBS UTHCT|||||15.55||| 10005|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Medicare|MEDICARE A & B|||||15.55||| 10005|EAP|0361||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.97||| 10005|EAP|0311||Medicare|MEDICARE A & B|||||5.72||| 10005|EAP|0361||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.97||| 10005|EAP|0360||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||150.18||| 10006|EAP|0360|FNA W/ US GUIDANCE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||150.18||| 10006|EAP|0510|FNA BX W/US GDN EA ADDL|Medicare|MEDICARE A & B|||||1.50||| 10006|EAP|0360|FNA W/ US GUIDANCE|Medicare|MEDICARE A & B|||||150.18||| 10006|EAP|0360|FNA W/ US GUIDANCE|Blue Cross PPO|BLUE CROSS PPO|||||150.18||| 10006|EAP|0360|FNA W/ US GUIDANCE|Blue Cross PPO|BLUE CROSS POS|||||150.18||| 10006|EAP|0360|FNA W/ US GUIDANCE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||150.18||| 10006|EAP|0360|FNA W/ US GUIDANCE|NON CONTRACTED|COMMERCIAL OTHER|||||150.18||| 10006|EAP|0360|FNA W/ US GUIDANCE|Blue Cross PPO Select|BCBS UTHCT|||||150.18||| 10022|EAP|0320||Blue Cross PPO|BLUE CROSS POS|||||6.68||| 10022|EAP|0320||Medicare|MEDICARE A & B|||||6.68||| 10022|EAP|0320||Aetna|TRS COORDINATED CARE|||||6.68||| 10022|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.68||| 10022|EAP|0320|FINE NEEDLE APIRATION W/IMAGIN|Medicare|MEDICARE A & B|||||6.68||| 10022|EAP|0320||Aetna|AETNA EL PASO CLAIMS OFFICE|||||6.68||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|NON CONTRACTED|COMMERCIAL OTHER|||||5.18||| 10060|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 10060|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.19||| 10060|EAP|0510|I&D ABSC; SMPL OR SGL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Managed Medicaid|MOLINA MEDICAID|||||5.18||| 10060|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 10060|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.56||| 10060|EAP|0510|I&D ABSC; SMPL OR SGL|Blue Cross PPO Select|BCBS UTHCT|||||4.14||| 10060|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.55||| 10060|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.08||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.18||| 10060|EAP|0510|I&D ABSC; SMPL OR SGL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Blue Cross PPO|BLUE CROSS PPO|||||5.18||| 10060|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 10060|EAP|0510|I&D ABSC; SMPL OR SGL|Medicare|MEDICARE A & B|||||4.14||| 10060|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.90||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Cigna|CIGNA OF TN CHATTANOOGA|||||5.18||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.18||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Blue Cross PPO Select|BCBS UTHCT|||||5.18||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.18||| 10060|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 10060|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 10060|EAP|0949||Medicare|MEDICARE A & B|||||181.41||| 10060|EAP|0450|I&D ABSC; SMPL OR SGL|Medicaid|MEDICAID|||||5.18||| 10060|EAP|0761|I&D ABSC, SIMPL OR SGL|Medicare|MEDICARE A & B|||||4.14||| 10060|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.36||| 10061|EAP|0450|I & D OF ABSCESS; COMPLICATED|United Healthcare|UMR|||||5.51||| 10061|EAP|0510|I & D OF ABSCESS; COMPLICATED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.41||| 10061|EAP|0450||United Healthcare|UMR|||||5.69||| 10061|EAP|0981||United Healthcare|UMR|||||0.00||| 10120|EAP|0510|INC & REM FB, SQ; SMPL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.35||| 10140|EAP|0510|I&D HEMATOMA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||13.13||| 10140|EAP|0270||Medicare|MEDICARE A & B|||||0.36||| 10140|EAP|0510|I&D HEMATOMA|Medicare|MEDICARE A & B|||||13.13||| 10160|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 10160|EAP|0450|PUNCT ASP - ABSC,HEMAT,CYST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.56||| 10160|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.18||| 103|DRG||HEADACHES W/O MCC|Medicare|MEDICARE A & B|24,607.20|7969.92|7969.92|7969.92|||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||24.36||| 11042|EAP|0270|SHOE POST-OP M XLG|Medicare|MEDICARE A & B|||||66.15||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Medicare|MEDICARE A & B|||||24.36||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Blue Cross PPO|BCBS WALMART|||||24.36||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||24.36||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Blue Cross PPO|BLUE CROSS POS|||||24.36||| 11042|EAP|0306||Medicare|MEDICARE A & B|||||1.07||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||24.36||| 11042|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.25||| 11042|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 11042|EAP|0272|4.0 VICRYL PLUS-A/B PS-2|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.20||| 11042|EAP|0510|DEBRIDE; SKIN TO SQ TISSUE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||24.36||| 11042|EAP|0306||Blue Cross PPO|BCBS WALMART|||||1.07||| 11042|EAP|0306||Medicare|MEDICARE A & B|||||0.49||| 11044|EAP|0306||Medicare|MEDICARE A & B|||||1.32||| 11044|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 11044|EAP|0510|DEB BONE 20 SQ CM/<|Medicare|MEDICARE A & B|||||12.00||| 11044|EAP|0306||Medicare|MEDICARE A & B|||||1.07||| 11044|EAP|0510|DEB BONE 20 SQ CM/<|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||12.00||| 11044|EAP|0312||Medicare|MEDICARE A & B|||||0.98||| 11044|EAP|0312||Medicare|MEDICARE A & B|||||5.97||| 11044|EAP|0306||Medicare|MEDICARE A & B|||||0.49||| 11044|EAP|0510|DEBRIDEMENT,BONE,1ST 20 SQ\LES|NON CONTRACTED|COMMERCIAL OTHER|||||12.00||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Medicare|MEDICARE RAILROAD|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SGL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Medicare|MEDICARE A & B|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Blue Cross PPO|BLUE CROSS PPO|||||1.29||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Blue Cross PPO|BLUE CROSS POS|||||1.29||| 11055|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 11055|EAP|0510|PARE BENIGN LES; SINGLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.29||| 11055|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.65||| 11056|EAP|0510|PARE BENIGN LES; 2 TO 4 LESION|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.29||| 11056|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 11056|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 11056|EAP|0510|PARE BENIGN LES; 2 TO 4 LESION|Medicare|MEDICARE A & B|||||1.29||| 11056|EAP|0510|PARE BENIGN LES; 2 TO 4 LESION|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.29||| 11056|EAP|0510|PARE BENIGN LES; 2 TO 4 LESION|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.29||| 11056|EAP|0510|PARE BENIGN LES; 2 TO 4 LESION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.29||| 11056|EAP|0510|PARE BENIGN LES; 2 TO 4 LESION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.29||| 11057|EAP|0510|PARING/CUTTING BENIGN LES 4+|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||646.92||| 11102|EAP|0510|BX-SKIN,SQ/MM; SGL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||129.63||| 11102|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.17||| 11102|EAP|0510|BX-SKIN,SQ/MM; SGL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||129.63||| 11102|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| 11102|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.37||| 11102|EAP|0510|BX-SKIN,SQ/MM; SGL|Medicare|MEDICARE A & B|||||129.63||| 11102|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.15||| 11103|EAP|0510|TANGENTIAL BIOPSY OF SKIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.37||| 11103|EAP|0510|TANGENTIAL BIOPSY OF SKIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.37||| 11104|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 11104|EAP|0510|PUNCH BX|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.68||| 11104|EAP|0510|PUNCH BIOPSY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.24||| 11104|EAP|0272|5.0 NYLON NON ABS REV CUTTING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.24||| 11104|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.08||| 11104|EAP|0510|PUNCH BX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.24||| 11104|EAP|0510|PUNCH BX|United Healthcare|UMR|||||6.68||| 11104|EAP|0510|PUNCH BX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.24||| 11104|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 11104|EAP|0310|IMMUNIHISTOCHEMISTRY (GENOPTIX|Medicare|MEDICARE A & B|||||2.76||| 11104|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 11104|EAP|0272|4.0 MONOCRYL PS-2 REV CUTTING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.21||| 11104|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.94||| 11104|EAP|0272|3.0 NYLON P-12|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.51||| 11104|EAP|0510|PUNCH BX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.68||| 11104|EAP|0510|PUNCH BIOPSY|Medicare|MEDICARE A & B|||||6.68||| 11104|EAP|0310|IMMUNIHISTO 2ND (GENOPTIX|Medicare|MEDICARE A & B|||||2.61||| 11104|EAP|0510|PUNCH BX|Medicare|MEDICARE A & B|||||5.24||| 11104|EAP|0510|EXC, BEN LES,T/A/L;3.1-4.0CM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.68||| 11104|EAP|0510|PUNCH BIOPSY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.68||| 11104|EAP|0310|SURG PATH; CONS & RPT PREP|Medicare|MEDICARE A & B|||||2.52||| 11104|EAP|0510|PUNCH BX|Blue Cross PPO Select|BCBS UTHCT|||||6.68||| 11104|EAP|0312|SPECIAL STAINS - GROUP 1|Medicare|MEDICARE A & B|||||3.00||| 11104|EAP|0510|INT REP S/A/T/EX; 2.6-7.5 CM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.39||| 11104|EAP|0510|PUNCH BX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.68||| 11105|EAP|0510|PUNCH BIOPSY|Medicare|MEDICARE A & B|||||2.94||| 11105|EAP|0510|PUNCH BX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.94||| 11106|EAP|0510|INCISIONAL BIOPSY OF SKIN, SNG|Medicare|MEDICARE A & B|||||8.43||| 11200|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 11200|EAP|0510|REM SKIN TAGS; TO 15 (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||1.19||| 11200|EAP|0510|REM SKIN TAGS; TO 15 (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.19||| 11301|EAP|0510|SHAVING,EPIDERMAL/DERMAL LESIO|Blue Cross PPO|BLUE CROSS PPO|||||2.34||| 11402|EAP|0510|REM SKIN TAGS; TO 15 (SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.78||| 11402|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.74||| 11402|EAP|0510|EXC,B9 LES+MAR TR-EXT 1.1-2CM|Medicare|MEDICARE A & B|||||13.78||| 11402|EAP|0510|REM SKIN TAGS; TO 15 (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||13.78||| 11403|EAP|0510|EXC BENIGN LESION,T,A,L;2.1-3C|Blue Cross PPO|BLUE CROSS PPO|||||26.75||| 11403|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 11403|EAP|0510|EXC, BEN LES,T/A/L; >4.0CM|Blue Cross PPO|BLUE CROSS PPO|||||40.89||| 11403|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||9.74||| 11404|EAP|0510|EXC, BEN LES,T/A/L;3.1-4.0CM|Medicare|MEDICARE A & B|||||36.44||| 11404|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 11406|EAP|0510||Medicare|MEDICARE A & B|||||40.89||| 11406|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||40.89||| 11406|EAP|0510|EXC, BEN LES,T/A/L; >4.0CM|Blue Cross PPO|BLUE CROSS PPO|||||13.83||| 11406|EAP|0510|EXC, BEN LES,T/A/L; >4.0CM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||41.18||| 11406|EAP|0510|EXC, BEN LES,T/A/L; >4.0CM|Medicare|MEDICARE A & B|||||41.18||| 11406|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||5.39||| 11422|EAP|0510|EXC,BEN LES,SCLP,NECK,HND,FT,G|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||26.35||| 11422|EAP|0510|LAYER CLOSURE WOUND,F,E,E,N,L;|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.55||| 11422|EAP|0510|EXC BENIGN LESION,S,N,H;1.1-2C|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||26.35||| 11422|EAP|0510|LAYER CLOSURE OF S,A,T,E - 2.5|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.74||| 11422|EAP|0510|EXC,BEN LES,SCLP,NECK,HND,FT,G|Medicare|MEDICARE A & B|||||26.35||| 11423|EAP|0510|EXC, BLES,S/N/EX,G;2.1-3.0CM|Medicare|MEDICARE A & B|||||44.60||| 11423|EAP|0510|LAYER CLOSURE WOUND,N,H,F,G;2.|Medicare|MEDICARE A & B|||||3.76||| 11426|EAP|0510|EXC H-F-NK-SP B9+MARG >4CM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||63.83||| 11606|EAP|0510|EXC MLES,T/A/L;>4.0CM|Medicare|MEDICARE A & B|||||25.62||| 11622|EAP|0510|EXC MLES,S/N/EXT/G; 1.1-2.0 CM|Medicare|MEDICARE A & B|||||15.40||| 11622|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 11719|EAP|0510|TRIM ND NAILS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|Medicare|MEDICARE A & B|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|Blue Cross PPO|BLUE CROSS PPO|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|Medicare|MEDICARE RAILROAD|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.58||| 11719|EAP|0510|TRIM ND NAILS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.58||| 11720|EAP|0510|DEBRIDEMENT NAIL METHOD 1TO 5|Medicare|MEDICARE RAILROAD|||||1.88||| 11720|EAP|0510|DEBRIDEMENT NAIL METHOD 1TO 5|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.88||| 11720|EAP|0510|DEBRIDEMENT NAIL METHOD 1TO 5|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.88||| 11720|EAP|0510|DEBRIDEMENT NAIL METHOD 1TO 5|Medicare|MEDICARE A & B|||||1.88||| 11720|EAP|0510|DEBRIDEMENT NAIL METHOD 1TO 5|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.88||| 11720|EAP|0510|DEBRIDEMENT NAIL METHOD 1TO 5|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.88||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.65||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.54||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||109.50||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.65||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.54||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|United Healthcare|UMR|||||0.54||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.54||| 11721|EAP|0510||Medicare|MEDICARE A & B|||||1.29||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Medicare|MEDICARE A & B|||||0.54||| 11721|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Medicare|MEDICARE A & B|||||0.48||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Blue Cross PPO Select|BCBS UTHCT|||||0.54||| 11721|EAP|0510|DEBRIDEMENT NAILS SIX OR MORE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||109.50||| 11730|EAP|0450|AVUL NAIL, PART/COMP SIMP;SNGL|Medicare|MEDICARE A & B|4.12||||||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||9.59||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.59||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.55||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Blue Cross PPO Select|BCBS UTHCT|||||9.57||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Medicaid|MEDICAID|||||9.55||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Medicare|MEDICARE A & B|||||9.59||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.55||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.55||| 11750|EAP|0270||Medicare|MEDICARE A & B|||||66.15||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Medicare|MEDICARE A & B|||||9.55||| 11750|EAP|0510|EXC NAIL & MATRIX, REMOVAL|Blue Cross PPO|BLUE CROSS PPO|||||9.55||| 11900|EAP|0510|INJ,INTRALESIONAL UP TO & INCL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.12||| 11900|EAP|0510|INJ,INTRALESIONAL UP TO & INCL|Medicare|MEDICARE A & B|||||4.12||| 11981|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.82||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.44||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.44||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.44||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|NON CONTRACTED|COMMERCIAL OTHER|||||2.44||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.44||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Cigna|CIGNA OF TN CHATTANOOGA|||||2.44||| 11981|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Blue Cross PPO|BLUE CROSS POS|||||2.44||| 11981|EAP|0510|INSERTION,NON-BIOD DRUG DEL IM|Blue Cross PPO|BLUE CROSS PPO|||||2.44||| 11982|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 11982|EAP|0510|REMOVAL, NON-BIODEGRADABLE DRU|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||9.83||| 11982|EAP|0510|REMOVAL NONBIODE DRUG DELI IMP|Blue Cross PPO|BLUE CROSS PPO|||||0.91||| 11982|EAP|0510|REMOVAL NONBIODE DRUG DELI IMP|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||9.83||| 11982|EAP|0510|REMOVAL NONBIODE DRUG DELI IMP|Managed Medicaid|FAMILY PLANNING GRANT|||||0.91||| 11982|EAP|0510|REMOVAL, NON-BIODEGRADABLE DRU|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||958.50||| 11982|EAP|0510|REMOVAL, NON-BIODEGRADABLE DRU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.34||| 11982|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.99||| 11982|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 11982|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 11982|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.79||| 11982|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.10||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Aetna|AETNA|||||1.81||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Multiplan|TML GRP INS|||||1.81||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.81||| 11983|EAP|0510||Multiplan|TML GRP INS|||||2.82||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Blue Cross PPO|BLUE CROSS POS|||||1.81||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Blue Cross PPO|BCBS WALMART|||||1.81||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.81||| 11983|EAP|0510||PHCS|TML GRP INS|||||2.82||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Blue Cross PPO|BLUE CROSS PPO|||||1.81||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|Managed Medicaid|FAMILY PLANNING GRANT|||||1.81||| 11983|EAP|0510|REMOVAL WITH REINST, DRUG IMPL|PHCS|TML GRP INS|||||1.81||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Blue Cross PPO|BCBS WALMART|||||4.36||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Medicaid|MEDICAID|||||4.36||| 12001|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 12001|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|NON CONTRACTED|COMMERCIAL OTHER|||||4.36||| 12001|EAP|0450||Medicaid|MEDICAID|||||5.28||| 12001|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.21||| 12001|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||14.70||| 12001|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 12001|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 12001|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 12001|EAP|0272||Medicare|MEDICARE A & B|||||8.40||| 12001|EAP|0270||Medicare|MEDICARE A & B|||||0.64||| 12001|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 12001|EAP|0981||Medicaid|MEDICAID|||||0.00||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Workers Compensation|DO NOT USE----ENABLE COMP|||||4.36||| 12001|EAP|0450||Blue Cross PPO|BCBS WALMART|||||5.51||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Medicare|MEDICARE A & B|||||4.36||| 12001|EAP|0272||Medicare|MEDICARE A & B|||||0.19||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|NON CONTRACTED|MRAMVA|||||4.36||| 12001|EAP|0771||Workers Compensation|WC OTHER|||||160.36||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.36||| 12001|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.19||| 12001|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 12001|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.07||| 12001|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.20||| 12001|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.20||| 12001|EAP|0270||Managed Medicaid|SUPERIOR STAR MCD|||||0.07||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Managed Medicaid|SUPERIOR STAR MCD|||||4.36||| 12001|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.36||| 12001|EAP|0450||Medicaid|MEDICAID|||||2.15||| 12001|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 12001|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 12001|EAP|0450||Medicare|MEDICARE A & B|||||5.28||| 12001|EAP|0450|DRAIN/INJ MAJOR JNT/BUR (ER)|NON CONTRACTED|MRAMVA|||||10.22||| 12001|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 12001|EAP|0272||Medicare|MEDICARE A & B|||||0.21||| 12002|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.70||| 12002|EAP|0270||United Healthcare|UMR|||||0.07||| 12002|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 12002|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 12002|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 12002|EAP|0450|SIMPLE REPAIR 2.6CM TO 7.5CM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.12||| 12002|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 12002|EAP|0450|SIMPLE REPAIR 2.6CM TO 7.5CM|Medicare|MEDICARE A & B|4.12||||4.12||| 12002|EAP|0272||Medicare|MEDICARE A & B|||||0.21||| 12002|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 12002|EAP|0450|SIMPLE REPAIR 2.6CM TO 7.5CM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.12||| 12002|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 12002|EAP|0272||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.21||| 12002|EAP|0450||Medicare|MEDICARE A & B|4.12||||10.22||| 12002|EAP|0272||Medicare|MEDICARE A & B|||||0.09||| 12002|EAP|0450|SIMPLE REPAIR 2.6CM TO 7.5CM|Workers Compensation|WC TX MUTUAL INS|||||4.12||| 12002|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 12002|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.21||| 12002|EAP|0450|SIMPLE REPAIR 2.6CM TO 7.5CM|Managed Medicaid|SUPERIOR STAR MCD|||||4.12||| 12004|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 12004|EAP|0450|SIMPLE REPAIR 7.6 - 12.5 CM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.19||| 12004|EAP|0450|SIMPLE REPAIR 7.6 - 12.5 CM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.19||| 12004|EAP|0450|SIMPLE REPAIR 7.6 - 12.5 CM|Medicare|MEDICARE A & B|||||4.19||| 12004|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 12011|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 12011|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 12011|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 12011|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 12011|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.19||| 12011|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 12011|EAP|0450|SIMP REP F/E/N/L/MM;2.5CM OR <|Cigna|CIGNA OPEN ACCESS PLUS|||||4.20||| 12011|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.36||| 12011|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 12011|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||14.70||| 12011|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 12011|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 12011|EAP|0450|SIMP REP F/E/N/L/MM;2.5CM OR <|Managed Medicaid|SUPERIOR STAR MCD|||||4.20||| 12011|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.07||| 12011|EAP|0450|SIMP REP F/E/N/L/MM;2.5CM OR <|Medicare|MEDICARE A & B|||||4.20||| 12011|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.21||| 12011|EAP|0450|SIMP REP F/E/N/L/MM;2.5CM OR <|Blue Cross PPO|BLUE CROSS PPO|||||4.20||| 12011|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 12011|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||14.70||| 12013|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 12014|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||0.19||| 12014|EAP|0450|SREP F/E/N/L/MM; 5.1-7.5CM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.96||| 12031|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.74||| 12031|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||9.74||| 12031|EAP|0510|LAYER CLOSURE OF S,A,T,E - 2.5|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.74||| 12031|EAP|0510|LAYER CLOSURE OF S,A,T,E - 2.5|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.74||| 12031|EAP|0510|LAYER CLOSURE OF S,A,T,E - 2.5|Blue Cross PPO|BLUE CROSS PPO|||||9.74||| 12032|EAP|0450|INT REP S/A/T/EX; 2.6-7.5 CM|Managed Medicaid|SUPERIOR STAR MCD|||||6.74||| 12032|EAP|0510|INT REP S/A/T/EX; 2.6-7.5 CM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.39||| 12032|EAP|0510|INT REP S/A/T/EX; 2.6-7.5 CM|Blue Cross PPO|BLUE CROSS PPO|||||5.39||| 12032|EAP|0510|INT REP S/A/T/EX; 2.6-7.5 CM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.39||| 12032|EAP|0510|INT REP S/A/T/EX; 2.6-7.5 CM|Medicare|MEDICARE A & B|||||5.39||| 12041|EAP|0510|LAYER CLOSURE WOUND,N,H,F,G;2.|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.76||| 12041|EAP|0510|LAYER CLOSURE WOUND,N,H,F,G;2.|Medicare|MEDICARE A & B|||||3.76||| 12051|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.55||| 13132|EAP|0761|COMPLEX REPAIR 2.6-7.5CM|Blue Cross PPO|BLUE CROSS PPO|||||1,343.52||| 13132|EAP|0450|COMPLEX REP F/G/H/F; 2.6-7.5CM|Medicare|MEDICARE A & B|||||7.55||| 13152|EAP|0510|CMPLX RPR E/N/E/L 2.6-7.5 CM|Medicare|MEDICARE A & B|||||12.96||| 15130|EAP|0510|DERMAL AUTOGRAFT TRUNK/ARM/LEG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||43.86||| 153|DRG||OTITIS MEDIA & URI W/O MCC|United Healthcare|UMR|31,405.04|72|72|72|||| 15600|EAP|0510|DELAY FLAP TRUNK|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||53.64||| 15839|EAP|0510|EXCISE EXCESS SKIN & TISSUE|Medicare|MEDICARE A & B|||||63.83||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.15||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.15||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Blue Cross PPO|BLUE CROSS PPO|||||7.15||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.15||| 17000|EAP|0510|DESTRUCT PREMALG LES, 2-14|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.17||| 17000|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.17||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.15||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Medicare|MEDICARE A & B|||||5.24||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.24||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Medicare|MEDICARE A & B|||||619.50||| 17000|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 17000|EAP|0510|DESTR BENIGN/PM LES; 1ST|Blue Cross PPO Select|BCBS UTHCT|||||7.15||| 17000|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 17003|EAP|0510|DESTRUCT PREMALG LES, 2-14|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||570.50||| 17003|EAP|0510|DESTRUCT PREMALG LES, 2-14|Medicare|MEDICARE A & B|||||570.50||| 17003|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.17||| 17003|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.17||| 17003|EAP|0510|DESTRUCT PREMALG LES, 2-14|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.24||| 17003|EAP|0510|DESTRUCT PREMALG LES, 2-14|Medicare|MEDICARE A & B|||||5.24||| 17110|EAP|0510|DESTRUCT FLAT WARTS; UP TO 14|Medicare|MEDICARE A & B|||||10.03||| 17110|EAP|0510|DESTRUCT FLAT WARTS; UP TO 14|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.03||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Medicare|MEDICARE A & B|39,580.69|11871.975|18271.66|8967.79|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Aetna|AETNA EL PASO CLAIMS OFFICE|22,628.99|18271.66|18271.66|8967.79|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|18,724.80|11464.48|18271.66|8967.79|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|24,731.92|8967.79|18271.66|8967.79|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Humana Medicare Advantage|HUMANA MEDICARE PPO|27,165.15|11227.43|18271.66|8967.79|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Medicare|MEDICARE A & B|17,964.93|8213.295|8213.295|4112.15|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|30,600.78|7782.96|8213.295|4112.15|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Blue Cross PPO|BLUE CROSS PPO|4,112.15|4112.15|8213.295|4112.15|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Veterans Affairs|VETERANS CHOICE - TRI WEST|45,986.07|14126.17|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|NON CONTRACTED|COMMERCIAL OTHER 2|16,539.75|14951.8|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|SUPERIOR STAR MCD|7,790.36|2824.78|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|31,178.80|15850.29|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE A & B|34,180.37|17146.46|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicaid|MEDICAID|124,001.77|44963.04|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|NON CONTRACTED|COMMERCIAL OTHER|24,315.26|24315.26|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Healthcare|UMR|18,865.42|54|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|36,712.07|16160.67|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|38,845.08|16160.67|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|PHCS|TML GRP INS|39,306.11|32150.4|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Aetna|AETNA EL PASO CLAIMS OFFICE|35,287.70|21106.58|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|36,829.56|6820.16|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross PPO|BLUE CROSS PPO|24,403.86|9365.575|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross PPO|BCBS WALMART|50,717.11|11439.76|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE PART A|188,583.93|58765.52|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Multiplan|TML GRP INS|39,306.11|32150.4|58765.52|54|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|7,166.59|2125.02|58765.52|54|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|34,241.73|10087.14|27827.21|10087.14|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Aetna|AETNA EL PASO CLAIMS OFFICE|36,804.10|13676.3|27827.21|10087.14|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|32,998.14|11399.93|27827.21|10087.14|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|112,759.89|27827.21|27827.21|10087.14|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|38,072.62|13805.13|27827.21|10087.14|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Medicare|MEDICARE A & B|33,609.37|12028.51|27827.21|10087.14|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Blue Cross PPO|BLUE CROSS PPO|24,529.04|15453.3|15453.3|3414.16|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11,410.44|3414.16|15453.3|3414.16|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|53,785.65|7877.26|15453.3|3414.16|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Medicare|MEDICARE A & B|15,585.60|9402.57|15453.3|3414.16|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|43,720.14|8951.11|15453.3|3414.16|||| 186|DRG||PLEURAL EFFUSION W MCC|Medicare|MEDICARE A & B|30,244.85|11825.04|11825.04|11825.04|||| 187|DRG||PLEURAL EFFUSION W CC|Medicare|MEDICARE PART A|56,270.28|9241.18|9241.18|9241.18|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Humana Medicare Advantage|HUMANA MEDICARE PPO|33,796.20|9728.1|12011.95|7929.48|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE PART A|72,384.75|12011.95|12011.95|7929.48|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Veterans Affairs|VETERANS CHOICE - TRI WEST|56,234.40|9928.19|12011.95|7929.48|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross PPO|BLUE CROSS PPO|32,789.25|7929.48|12011.95|7929.48|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|36,997.50|9722.68|12011.95|7929.48|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE A & B|27,874.10|10445.7|12011.95|7929.48|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|51,531.21|9315.43|9996.13|4411.54|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|34,109.87|4411.54|9996.13|4411.54|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|NON CONTRACTED|COMMERCIAL OTHER|7,856.25|7856.25|9996.13|4411.54|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|20,123.93|7296.94|9996.13|4411.54|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Veterans Affairs|VETERANS CHOICE - TRI WEST|49,307.80|9508.7|9996.13|4411.54|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Blue Cross PPO|BLUE CROSS PPO|46,821.60|5725.19|9996.13|4411.54|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE A & B|30,092.33|9996.13|9996.13|4411.54|||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Cigna|CIGNA OF TN CHATTANOOGA|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Blue Cross PPO|BLUE CROSS PPO|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Medicare|MEDICARE A & B|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Managed Medicaid|FAMILY PLANNING GRANT|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Blue Cross PPO Select|BCBS UTHCT|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Aetna|TRS COORDINATED CARE|||||5.44||| 19000|EAP|0320|ASPIRATION OF BREAST CYST|Blue Cross PPO|BLUE CROSS POS|||||5.44||| 19001|EAP|0761|PUNCT ASP BRST CYST - EA ADDTL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.84||| 19020|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 19020|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||10.56||| 19030|EAP|0320|INJECTION DUCTOGRAM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.28||| 19030|EAP|0320|INJECTION DUCTOGRAM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.28||| 19030|EAP|0320|INJECTION DUCTOGRAM|Blue Cross PPO|BLUE CROSS PPO|||||6.28||| 19030|EAP|0320|INJECTION DUCTOGRAM|Medicare|MEDICARE A & B|||||6.28||| 19081|EAP|0320|BX BREAST W/PLMT DEV 1ST L SG|Blue Cross PPO Select|BCBS UTHCT|||||19.39||| 19081|EAP|0320|BX BREAST W/PLMT DEV 1ST L SG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||19.39||| 19081|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 19081|EAP|0320|BX BREAST W/PLMT DEV 1ST L SG|Blue Cross PPO|BLUE CROSS PPO|||||19.39||| 19081|EAP|0320|BX BREAST W/PLMT DEV 1ST L SG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.39||| 19081|EAP|0320|BX BREAST W/PLMT DEV 1ST L SG|Medicare|MEDICARE A & B|||||19.39||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.39||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.39||| 19083|EAP|0310|MORPHOMETRIC ANALYSIS EA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.48||| 19083|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.25||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Blue Cross PPO Select|BCBS UTHCT|||||19.39||| 19083|EAP|0312|MORPHOMTRIC ANALY;TUMOR (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 19083|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 19083|EAP|0312|MORPHOMTRIC ANALY;TUMOR (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 19083|EAP|0312|MORPH ISH QUANT/SEMIQ (CLARIEN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.66||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Blue Cross PPO|BLUE CROSS POS|||||19.39||| 19083|EAP|0272||Medicare|MEDICARE A & B|||||0.59||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.39||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Aetna|TRS COORDINATED CARE|||||19.39||| 19083|EAP|0312|MORPHOMTRIC ANALY;TUMOR (REF)|Medicare|MEDICARE A & B|||||1.68||| 19083|EAP|0310|MORPHOMETRIC ANALYSIS EA (REF)|Medicare|MEDICARE A & B|||||8.48||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||19.39||| 19083|EAP|0272||Medicare|MEDICARE A & B|||||2.24||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Medicare|MEDICARE A & B|||||19.39||| 19083|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.99||| 19083|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.25||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.39||| 19083|EAP|0312|MORPH ANALYS (FISH) MULT (GEN)|Medicare|MEDICARE A & B|||||4.99||| 19083|EAP|0312||Medicare|MEDICARE A & B|||||1.25||| 19083|EAP|0312|MORPH ISH QUANT/SEMIQ (CLARIEN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.66||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.39||| 19083|EAP|0272||Medicare|MEDICARE A & B|||||0.56||| 19083|EAP|0272||Medicare|MEDICARE A & B|||||3.36||| 19083|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.39||| 19083|EAP|0312|MORPH ISH QUANT/SEMIQ (CLARIEN|Medicare|MEDICARE A & B|||||9.66||| 19083|EAP|0312||Medicare|MEDICARE A & B|||||4.99||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Blue Cross PPO|BLUE CROSS PPO|||||19.39||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Managed Medicaid|FAMILY PLANNING GRANT|||||19.39||| 19083|EAP|0312|MORPH ANALYS (FISH) MULT (GEN)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.99||| 19083|EAP|0401|BX BREAST W/PLMT DEVICE US 1ST|Cigna|CIGNA OF TN CHATTANOOGA|||||19.39||| 19084|EAP|0320|BX BREAST W/PLMT DEVICE US EA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.82||| 19084|EAP|0320|BX BREAST W/PLMT DEVICE US EA|Blue Cross PPO|BLUE CROSS POS|||||1.82||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Medicare|MEDICARE A & B|26,665.09|8423.09|8423.09|103.86|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|26,535.80|8043.04|8423.09|103.86|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|28,357.93|7871.29|8423.09|103.86|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|39,360.84|8043.04|8423.09|103.86|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Cigna|NALC HLTH BENEFIT|45,184.18|103.86|8423.09|103.86|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Blue Cross PPO Select|BCBS UTHCT|16,717.20|4362.98|8423.09|103.86|||| 19100|EAP|0360|BX BREAST,PERCUT,NEEDLE CORE|Blue Cross PPO|BLUE CROSS POS|||||37.10||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Blue Cross PPO|BLUE CROSS PPO|27,169.97|3150.31|11926.02|3150.31|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|32,890.28|11926.02|11926.02|3150.31|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|16,177.20|6968.32|11926.02|3150.31|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Aetna|AETNA EL PASO CLAIMS OFFICE|23,084.75|7801.2|11926.02|3150.31|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Medicare|MEDICARE A & B|23,520.89|7273.07|11926.02|3150.31|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|26,085.73|9458.69|13787.065|3653.85|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross PPO|BLUE CROSS PPO|352.51|3653.85|13787.065|3653.85|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicaid|MEDICAID|38,022.80|13787.065|13787.065|3653.85|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|100,105.77|4878.37|13787.065|3653.85|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE A & B|38,850.65|11183.57|13787.065|3653.85|||| 19350|EAP|0360|NIPPLE RECONSTRUCTION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||7,557.96||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|27,166.16|9850.445|9850.445|69.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Medicare|MEDICARE A & B|27,120.46|8396.8|9850.445|69.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|48,277.65|7852.46|9850.445|69.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|22,377.50|7847.46|9850.445|69.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Cigna|NALC HLTH BENEFIT|36,572.15|69.24|9850.445|69.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Blue Cross PPO|BLUE CROSS PPO|45,061.43|4058.89|9850.445|69.24|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Medicare|MEDICARE A & B|18,191.68|7103.33|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|35,103.83|6923.27|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross PPO Select|BCBS UTHCT|19,471.10|2623.84|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|ChampVA|CHAMPVA OF CO DENVER|27,359.68|3767.72|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|19,868.32|6811.33|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross PPO|BCBS TRANE PPO|20,923.04|2623.84|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|15,521.15|2544.59|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross PPO|BLUE CROSS PPO|14,801.13|2623.84|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross PPO|BLUE CROSS POS|16,140.22|4787.97|7219.56|2544.59|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Medicare|MEDICARE PART A|12,497.31|7219.56|7219.56|2544.59|||| 197|DRG||INTERSTITIAL LUNG DISEASE W CC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11,730.69|8794.43|8794.43|8084.875|||| 197|DRG||INTERSTITIAL LUNG DISEASE W CC|Medicare|MEDICARE A & B|21,038.76|8084.875|8794.43|8084.875|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|38,486.78|8184.69|8767.99|8184.69|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Medicare|MEDICARE PART A|12,501.73|8767.99|8767.99|8184.69|||| 20206|EAP|0510|BIOPSY MUSCLE|Medicare|MEDICARE A & B|||||37.10||| 20206|EAP|0350|NEEDLE BIOPSY MUSCLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.45||| 20206|EAP|0312|MORPHOMTRIC ANALY;TUMOR (REF)|Medicare|MEDICARE A & B|||||1.68||| 20220|EAP|0320|BIOPSY BONE SUPERFICIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.84||| 20225|EAP|0360|FNA BX; CT, BONE, DEEP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.83||| 20550|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 20550|EAP|0510|TRIGGER POINT INJECTION|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.00||| 20550|EAP|0402||Blue Cross PPO|BLUE CROSS POS|||||3.74||| 20550|EAP|0320||Blue Cross PPO|BLUE CROSS POS|||||2.97||| 20550|EAP|0510|TRIGGER POINT INJECTION|Blue Cross PPO|BLUE CROSS PPO|||||6.00||| 20550|EAP|0510|INJ;TENDON SHEATH,LIGAMENT,GAN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.00||| 20550|EAP|0510|TRIGGER POINT INJECTION|Blue Cross PPO|BLUE CROSS POS|||||6.00||| 20550|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.11||| 20550|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.22||| 20550|EAP|0510|TRIGGER POINT INJECTION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.00||| 20550|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 20550|EAP|0510|TRIGGER POINT INJECTION|Blue Cross PPO Select|BCBS UTHCT|||||6.00||| 20550|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.82||| 20550|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.09||| 20550|EAP|0510|INJ;TENDON SHEATH,LIGAMENT,GAN|Blue Cross PPO Select|BCBS UTHCT|||||6.00||| 20550|EAP|0510|TRIGGER POINT INJECTION|Medicare|MEDICARE A & B|||||6.00||| 20550|EAP|0510|TRIGGER POINT INJECTION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.00||| 20550|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 20550|EAP|0510|TRIGGER POINT INJ; INITAL, EAC|Medicare|MEDICARE A & B|||||6.00||| 20550|EAP|0510|TRIGGER POINT INJECTION|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.00||| 20552|EAP|0636||Medicare|MEDICARE A & B|||||30.90||| 20552|EAP|0510|TRIGGER POINT INJ; 1 OR 2 MUSC|Medicare|MEDICARE A & B|||||543.50||| 20552|EAP|0510|TRIGGER POINT INJ; 1 OR 2 MUSC|Medicare|MEDICARE A & B|||||7.85||| 20552|EAP|0510|INJECTN(S) SING OR MULT TRIG P|Medicare|MEDICARE A & B|||||7.85||| 20552|EAP|0510||Medicare|MEDICARE A & B|||||4.12||| 20552|EAP|0251||Medicare|MEDICARE A & B|||||20.10||| 20552|EAP|0510|INJECTN(S) SING OR MULT TRIG P|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.85||| 20552|EAP|0510|INJECTN(S) SING OR MULT TRIG P|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.63||| 20552|EAP|0510|TRIGGER POINT INJ; 1 OR 2 MUSC|Medicare|MEDICARE A & B|||||3.02||| 20600|EAP|0450||Medicare|MEDICARE A & B|||||3.87||| 20600|EAP|0510|DRAIN/INJECT SM JNT/BURSA|Medicare|MEDICARE A & B|||||3.30||| 20600|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||5.28||| 20600|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 20600|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 20600|EAP|0450||Medicare|MEDICARE A & B|||||4.36||| 20600|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 20600|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 20600|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 20600|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||4.12||| 20600|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 20600|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.36||| 20600|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 20600|EAP|0510|DRAIN/INJECT SM JNT/BURSA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.30||||3.30||| 20600|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.28||| 20600|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||5.28||| 20600|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||4.36||| 20600|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||5.28||| 20600|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.28||| 20600|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||6.74||| 20600|EAP|0450||Medicaid|MEDICAID|||||5.28||| 20600|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 20600|EAP|0302|C-REACTIVE PROTEIN|Medicare|MEDICARE A & B|||||1.11||| 20600|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 20600|EAP|0450||Medicare|MEDICARE A & B|||||5.28||| 20600|EAP|0450||Medicare|MEDICARE A & B|||||3.45||| 20600|EAP|0450||Workers Compensation|DO NOT USE----ENABLE COMP|||||5.28||| 20600|EAP|0450|EXC NAIL & MATRIX, REMOVAL|Cigna|CIGNA OF TN CHATTANOOGA|||||9.59||| 20605|EAP|0274||Cigna|CIGNA OF TN CHATTANOOGA|||||0.09||| 20605|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 20605|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.51||| 20605|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 20605|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||5.01||| 20605|EAP|0450||Workers Compensation|WC OTHER|||||3.37||| 20605|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.18||| 20605|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||669.83||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.85||| 20605|EAP|0270||Cigna|CIGNA OF TN CHATTANOOGA|||||0.07||| 20605|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||7.85||| 20605|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.85||| 20605|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 20605|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|Medicare|MEDICARE RAILROAD|||||2.22||| 20605|EAP|0450||Medicare|MEDICARE A & B|||||6.43||| 20605|EAP|0450||Medicare|MEDICARE A & B|||||4.36||| 20605|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||1.77||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.30||| 20605|EAP|0450||Workers Compensation|WC OTHER|||||181.41||| 20605|EAP|0272||Medicare|MEDICARE A & B|||||0.21||| 20605|EAP|0450|DRAIN/INJ INTERM JNT/BURSA|Cigna|CIGNA OF TN CHATTANOOGA|||||7.85||| 20605|EAP|0272||Medicare|MEDICARE A & B|||||0.17||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.85||| 20605|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 20605|EAP|0450||Workers Compensation|WC OTHER|||||7.85||| 20605|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||669.83||| 20605|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||2.10||| 20605|EAP|0981||United Healthcare|GOLDEN RULE INSURANCE|||||0.00||| 20605|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||213.82||| 20605|EAP|0450||Medicare|MEDICARE A & B|||||5.51||| 20605|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|Medicare|MEDICARE A & B|||||3.30||| 20605|EAP|0450||Medicare|MEDICARE A & B|||||4.20||| 20605|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 20605|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||7.85||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|Blue Cross PPO|BLUE CROSS PPO|||||2.22||| 20605|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 20605|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.45||| 20605|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 20605|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 20605|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.58||| 20605|EAP|0510|DRAIN/INJ INTERM JNT/BURSA|Blue Cross PPO Select|BCBS UTHCT|||||3.30||| 20605|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||3.45||| 20605|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.85||| 20605|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 20605|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||2.10||| 20605|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||5.01||| 20605|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||3.75||| 20610|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 20610|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 20610|EAP|0302||Medicare|MEDICARE A & B|||||2.23||| 20610|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||10.22||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.11||| 20610|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.06||| 20610|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 20610|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.11||| 20610|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||6.11||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|Blue Cross PPO|BLUE CROSS PPO|||||6.11||| 20610|EAP|0450||Medicare|MEDICARE A & B|||||10.22||| 20610|EAP|0450|DRAIN/INJ MAJOR JNT/BUR (ER)|Workers Compensation|WC TX MUTUAL INS|||||10.22||| 20610|EAP|0612||Medicare|MEDICARE A & B|||||48.14||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|Medicare|MEDICARE A & B|||||6.11||| 20610|EAP|0301||Medicare|MEDICARE A & B|||||0.92||| 20610|EAP|0771||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||160.36||| 20610|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.11||| 20610|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.50||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||6.11||| 20610|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.11||| 20610|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 20610|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||10.22||| 20610|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.12||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|Blue Cross PPO Select|BCBS UTHCT|||||6.11||| 20610|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||36.25||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.11||| 20610|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||50.80||| 20610|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.08||| 20610|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||10.22||| 20610|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.10||| 20610|EAP|0252||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| 20610|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.63||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||6.11||| 20610|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 20610|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||6.11||| 20610|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.12||| 20610|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 20610|EAP|0255||Medicare|MEDICARE A & B|||||2.40||| 20610|EAP|0255||Medicare|MEDICARE A & B|||||5.25||| 20610|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 20610|EAP|0450||Medicare|MEDICARE A & B|||||5.51||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|Medicare|MEDICARE A & B|||||6.11||| 20610|EAP|0450||NON CONTRACTED|MRAMVA|||||10.22||| 20610|EAP|0352||Medicare|MEDICARE A & B|||||27.12||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.11||| 20610|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.11||| 20610|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 20610|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||10.22||| 20612|EAP|0510|ASP AND/OR INJ GANGLION CYST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.70||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Humana Medicare Advantage|HUMANA MEDICARE PPO|319,229.65|114904.495|114904.495|46188.05|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Medicare|MEDICARE A & B|177,143.54|61546.38|114904.495|46188.05|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Medicare|MEDICARE PART A|106,348.55|46188.05|114904.495|46188.05|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Aetna|AETNA EL PASO CLAIMS OFFICE|103,871.52|72555.34|114904.495|46188.05|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Blue Cross PPO|BLUE CROSS PPO|102,357.46|64485.2|114904.495|46188.05|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Medicare|MEDICARE A & B|49,473.50|21625.38|21625.38|15055.88|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Humana Medicare Advantage|HUMANA MEDICARE PPO|57,746.32|15055.88|21625.38|15055.88|||| 21011|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||36.92||| 24650|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||3.75||| 24650|EAP|0450|TREATMENT OF RADIUS FRACTURE|Managed Medicaid|SUPERIOR STAR MCD|||||3.28||| 24650|EAP|0450|CL TX RADIAL & ULNA FX W MANIP|Managed Medicaid|SUPERIOR STAR MCD|||||8.80||| 24650|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 24670|EAP|0450|CLSD TX ULNAR FX;WO MANIP|Managed Medicaid|MOLINA MEDICAID|||||4.54||| 24670|EAP|0450|CLSD TX ULNAR FX;WO MANIP|Managed Medicaid|SUPERIOR STAR MCD|||||4.54||| 24670|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||1,571.10||| 24670|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 24670|EAP|0450||Medicare|MEDICARE A & B|||||2.15||| 24670|EAP|0450||Medicare|MEDICARE A & B|||||3.45||| 24670|EAP|0450|CLSD TX ULNAR FX;WO MANIP|Blue Cross PPO|BLUE CROSS PPO|||||4.54||| 24670|EAP|0450|CLSD TX ULNAR FX;WO MANIP|Medicare|MEDICARE A & B|||||4.54||| 24670|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 24670|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 24670|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 24670|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 26010|EAP|0510|DRAINAGE FINGER ABSCESS, SIMPL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.40||| 26111|EAP|0510|EXC HAND LES SC 1.5 CM/>|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||36.92||| 26645|EAP|0450|Treat thumb fracture|Blue Cross PPO|BLUE CROSS PPO|||||35.23||| 26700|EAP|0450|CL TX MCP DISLOC, SGL, W MANIP|Managed Medicaid|SUPERIOR STAR MCD|||||3.51||| 26700|EAP|0450|CL TX MCP DISLOC, SGL, W MANIP|Blue Cross PPO|BLUE CROSS PPO|||||3.51||| 26700|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 26700|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||2.15||| 26700|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 26770|EAP|0450|CL TX IP JNT D,W MANIP;WO ANES|Medicare|MEDICARE A & B|||||3.87||| 27762|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 27762|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 27762|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.42||| 27762|EAP|0271||Blue Cross PPO Select|BCBS UTHCT|||||4.90||| 27762|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||5.25||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|13,756.21|49.88|8471.63|49.88|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|31,627.70|8471.63|8471.63|49.88|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|Medicare|MEDICARE A & B|18,488.60|7576.22|7576.22|7134.59|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|8,043.93|7137.86|7576.22|7134.59|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|33,570.35|7134.59|7576.22|7134.59|||| 28515|EAP|0450|CL TX FX,PHLX/PHLG W/MANIP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.85||| 288|DRG||ACUTE & SUBACUTE ENDOCARDITIS W MCC|Blue Cross PPO|BLUE CROSS PPO|41,590.20|21946.47|21946.47|21946.47|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE PART A|14,129.45|9153.81|11360.705|4984.71|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|36,797.32|4984.71|11360.705|4984.71|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE A & B|25,886.38|11360.705|11360.705|4984.71|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|16,936.85|6141.3|11360.705|4984.71|||| 29105|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 29105|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Managed Medicaid|SUPERIOR STAR MCD|||||3.75||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.75||| 29105|EAP|0450||Medicaid|MEDICAID|||||4.19||| 29105|EAP|0981||Medicaid|MEDICAID|||||0.00||| 29105|EAP|0450|APPLY LONG ARM SPLINT|NON CONTRACTED|COMMERCIAL OTHER|||||3.75||| 29105|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||5.51||| 29105|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 29105|EAP|0270||NON CONTRACTED|COMMERCIAL OTHER|||||0.07||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Medicaid|MEDICAID|||||3.75||| 29105|EAP|0450||Medicaid|MEDICAID|||||3.45||| 29105|EAP|0450||Medicaid|MEDICAID|||||2.10||| 29105|EAP|0450||Medicaid|MEDICAID|||||669.83||| 29105|EAP|0450||Medicare|MEDICARE A & B|||||0.00||| 29105|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||1.77||| 29105|EAP|0271||Managed Medicaid|MOLINA MEDICAID|||||4.90||| 29105|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 29105|EAP|0272||Managed Medicaid|MOLINA MEDICAID|||||0.17||| 29105|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.07||| 29125|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 29125|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 29125|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||2.15||| 29125|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.75||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.45||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|Medicare|MEDICARE A & B|||||3.45||| 29125|EAP|0981||Medicaid|MEDICAID|||||0.00||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|Managed Medicaid|SUPERIOR STAR MCD|||||3.45||| 29125|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 29125|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||3.45||| 29125|EAP|0320||Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 29125|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 29125|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 29125|EAP|0981||Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.00||| 29125|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|NON CONTRACTED|COMMERCIAL OTHER|||||3.45||| 29125|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 29125|EAP|0450|APPLY SHORT ARM SPLINT|Medicaid|MEDICAID|||||3.45||| 292|DRG||HEART FAILURE & SHOCK W CC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|44,779.74|16237.13|16237.13|3407.86|||| 292|DRG||HEART FAILURE & SHOCK W CC|Veterans Affairs|VETERANS CHOICE - TRI WEST|31,300.93|8117.2|16237.13|3407.86|||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE A & B|30,154.07|8502.22|16237.13|3407.86|||| 292|DRG||HEART FAILURE & SHOCK W CC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|51,044.89|3407.86|16237.13|3407.86|||| 292|DRG||HEART FAILURE & SHOCK W CC|NON CONTRACTED|COMMERCIAL OTHER|16,033.53|8117.2|16237.13|3407.86|||| 292|DRG||HEART FAILURE & SHOCK W CC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|24,057.20|8254.12|16237.13|3407.86|||| 292|DRG||HEART FAILURE & SHOCK W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|18,667.89|7777.66|16237.13|3407.86|||| 29240|EAP|0420|STRAPPING; SHOULDER|Multiplan|WEB TPA|||||2.96||| 29240|EAP|0420|STRAPPING; SHOULDER|Medicare|MEDICARE A & B|||||2.96||| 29240|EAP|0420|STRAPPING; SHOULDER|PHCS|WEB TPA|||||2.96||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Medicare|MEDICARE A & B|21,802.12|7048.27|7048.27|6656.51|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|52,495.55|6656.51|7048.27|6656.51|||| 29515|EAP|0450||Medicare|MEDICARE A & B|||||5.51||| 29515|EAP|0450|APPLICATION OF SHORT LEG SPLIN|Medicare|MEDICARE A & B|||||3.37||| 29515|EAP|0450|APPLICATION OF SHORT LEG SPLIN|Workers Compensation|WC OTHER|||||3.37||| 29515|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 29515|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 29515|EAP|0450||Medicare|MEDICARE A & B|||||1.77||| 29580|EAP|0510|UNNA BOOT|Medicare|MEDICARE A & B|||||2.10||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Blue Cross PPO|BLUE CROSS PPO|23,250.39|5122.13|5122.13|5122.13|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Blue Cross PPO|BCBS WALMART|29,374.85|3155.96|17959.03|3155.96|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|21,066.55|3155.96|17959.03|3155.96|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Veterans Affairs|VETERANS CHOICE - TRI WEST|36,275.93|6774.71|17959.03|3155.96|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|49,528.50|17959.03|17959.03|3155.96|||| 305|DRG||HYPERTENSION W/O MCC|Medicare|MEDICARE A & B|13,594.78|7412.75|7412.75|7412.75|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Medicare|MEDICARE A & B|23,524.90|10451.15|10451.15|10451.15|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Veterans Affairs|VETERANS CHOICE - TRI WEST|20,597.99|7365.3|7693.82|7365.3|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Medicare|MEDICARE A & B|39,269.71|7693.82|7693.82|7365.3|||| 30901|EAP|0450|CONTROL NASAL HEMORRHAGE, ANT,|Blue Cross PPO|BLUE CROSS PPO|||||4.32||| 30901|EAP|0450|CONTROL NASAL HEMORRHAGE, ANT,|Blue Cross PPO Select|BCBS UTHCT|||||4.32||| 30901|EAP|0272|RR NASAL PACK 5.5CM ANTERIOR|Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Medicare|MEDICARE A & B|26,512.76|6434.67|6434.67|2563.89|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|33,498.20|6099.93|6434.67|2563.89|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Blue Cross PPO|BLUE CROSS PPO|17,841.55|2563.89|6434.67|2563.89|||| 311|DRG||ANGINA PECTORIS|NON CONTRACTED|COMMERCIAL OTHER|35,232.30|64|64|64|||| 312|DRG||SYNCOPE & COLLAPSE|Humana Medicare Advantage|HUMANA MEDICARE PPO|23,655.01|7590.5|8079.23|7590.5|||| 312|DRG||SYNCOPE & COLLAPSE|Medicare|MEDICARE A & B|13,875.90|8079.23|8079.23|7590.5|||| 313|DRG||CHEST PAIN|NON CONTRACTED|COMMERCIAL OTHER|17,748.80|17748.8|17748.8|17748.8|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Medicare|MEDICARE A & B|30,931.10|8908.3|8908.3|3541.61|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|31,518.08|3541.61|8908.3|3541.61|||| 31500|EAP|0410||Managed Medicaid|MOLINA MEDICAID|||||21.68||| 31500|EAP|0360|INSERTION ENDOTRACH TUBE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.69||| 31500|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.45||| 31500|EAP|0450|INSERTION ENDOTRACH TUBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.69||| 31500|EAP|0410||Managed Medicaid|MOLINA MEDICAID|||||16.64||| 31500|EAP|0450|INSERTION ENDOTRACH TUBE|Managed Medicaid|MOLINA MEDICAID|||||7.69||| 31500|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 31500|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 31500|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 31500|EAP|0309||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.39||| 316|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC|Medicare|MEDICARE A & B|21,611.20|7603.69|7603.69|7603.69|||| 31624|EAP|0361|BRONCHOSCOPY INCLUDING FLUERO|Blue Cross PPO|BLUE CROSS POS|3,463.59||||||| 31624|EAP|0361|BRONCHOSCOPY INCLUDING FLUERO|Medicare|MEDICARE A & B|3,463.59||||3,463.59||| 31624|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE A & B|||||2.11||| 31624|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Blue Cross PPO|BLUE CROSS PPO|||||2.11||| 31624|EAP|0306|NT MAC MIC RWL (REF)|Medicare|MEDICARE A & B|||||3.00||| 31624|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Medicare|MEDICARE A & B|||||3.54||| 31624|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Medicare|MEDICARE A & B|||||0.49||| 31624|EAP|0361|BRONCHOSCOPY INCLUDING FLUERO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3,463.59||| 31624|EAP|0309|SEQ DNAP (RWL)|Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 31624|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 31624|EAP|0306|DEFINITIVE ID, MOL (REF)|Medicare|MEDICARE A & B|||||2.04||| 31624|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicare|MEDICARE A & B|||||1.66||| 31624|EAP|0309|SEQ DNAP (RWL)|Medicare|MEDICARE A & B|||||2.25||| 31624|EAP|0306|KINYOUN STAIN|Medicare|MEDICARE A & B|||||1.38||| 31624|EAP|0306||Medicare|MEDICARE A & B|||||1.32||| 31624|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Medicare|MEDICARE A & B|||||1.07||| 31624|EAP|0361|BRONCHOSCOPY INCLUDING FLUERO|Cigna|CIGNA OF TN CHATTANOOGA|||||3,463.59||| 31624|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||21.30||| 31624|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.00||| 31624|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BLUE CROSS PPO|||||1.38||| 31624|EAP|0361|BRONCHOSCOPY INCLUDING FLUERO|Blue Cross PPO|BLUE CROSS PPO|||||3,463.59||| 31624|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross PPO|BLUE CROSS PPO|||||3.54||| 32405|EAP|0360|BIOPSY OF LUNG OR MEDIASTINUM|Medicare|MEDICARE A & B|||||33.29||| 32405|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| 32554|EAP|0361|THORACENTESIS FOR ASPIRATION|Blue Cross PPO|BLUE CROSS PPO|13.40||||||| 32554|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 32554|EAP|0250|NEBIVOLOL 5 MG TAB PO|Medicare|MEDICARE A & B|||||17.80||| 32554|EAP|0251||Medicare|MEDICARE A & B|||||3.15||| 32554|EAP|0252||Medicare|MEDICARE A & B|||||7.35||| 32554|EAP|0311||Medicare|MEDICARE A & B|||||2.56||| 32554|EAP|0361|THORACENTESIS FOR ASPIRATION|Medicare|MEDICARE A & B|13.40||||||| 32555|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.57||| 32555|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||26.57||| 32555|EAP|0301||Medicare|MEDICARE A & B|||||1.19||| 32555|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 32555|EAP|0360|THORACENTESIS WITH IMAGING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||18.42||| 32555|EAP|0306||Medicare|MEDICARE A & B|||||0.40||| 32555|EAP|0311|CYTO, NON-GYN LIQUID BASED|Medicare|MEDICARE A & B|||||2.56||| 32555|EAP|0301||Medicare|MEDICARE A & B|||||1.58||| 32555|EAP|0306||Medicare|MEDICARE A & B|||||0.83||| 32555|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.08||| 32555|EAP|0306||Medicare|MEDICARE A & B|||||3.47||| 32555|EAP|0360|THORACENTESIS WITH IMAGING|Medicare|MEDICARE A & B|||||18.42||| 32555|EAP|0402||Medicare|MEDICARE A & B|||||8.25||| 32555|EAP|0360|THORACENTESIS WITH IMAGING|Aetna|AETNA EL PASO CLAIMS OFFICE|||||18.42||| 32555|EAP|0333|SPECIAL TREATMENT PROCEDURE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||13.80||| 32555|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.22||| 32555|EAP|0301||Medicare|MEDICARE A & B|||||1.28||| 32555|EAP|0306||Medicare|MEDICARE A & B|||||1.54||| 32555|EAP|0311|CYTO, NON-GYN LIQUID BASED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.56||| 32555|EAP|0311||Medicare|MEDICARE A & B|||||5.72||| 32555|EAP|0301||Medicare|MEDICARE A & B|||||1.75||| 32555|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicare|MEDICARE A & B|||||5.94||| 32555|EAP|0301||Medicare|MEDICARE A & B|||||0.76||| 32555|EAP|0301||Medicare|MEDICARE A & B|||||1.21||| 32555|EAP|0309||Medicare|MEDICARE A & B|||||1.16||| 32555|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 32555|EAP|0306||Medicare|MEDICARE A & B|||||1.58||| 32555|EAP|0320||Medicare|MEDICARE A & B|||||2.35||| 32555|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 32555|EAP|0510|THORACENTESIS WITH IMAGING|Medicare|MEDICARE A & B|||||17.04||| 32555|EAP|0311|CYTO, NON-GYN LIQUID BASED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.56||| 32555|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 32555|EAP|0360|THORACENTESIS WITH IMAGING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||18.42||| 36410|EAP|0450|VENIPUNCTURE PHY SKILL|Medicare|MEDICARE A & B|1.06||||||| 36415|EAP|0251||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.15||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0510||PHCS|TML GRP INS|||||3.79||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||39.05||| 36415|EAP|0343||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||16.41||| 36415|EAP|0761||Medicare|MEDICARE A & B|||||0.83||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.55||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.05||| 36415|EAP|0352||Medicare|MEDICARE A & B|||||23.22||| 36415|EAP|0257||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.06||| 36415|EAP|0335||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||10.47||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Optum Behavioral Health|OPTUM|0.19||||||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.19||||0.19||| 36415|EAP|0390||Medicare|MEDICARE A & B|||||0.36||| 36415|EAP|0403||United Healthcare|UMR|||||0.82||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.55||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 36415|EAP|0459||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.00||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 36415|EAP|0271||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.90||| 36415|EAP|0301||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.19||||1.29||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| 36415|EAP|0271||PHCS|WEB TPA|||||4.90||| 36415|EAP|0305||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.25||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||7.69||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||669.83||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||266.25||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||669.83||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|Medicare|MEDICARE A & B|||||3.26||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||14.20||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.06||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.15||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Multiplan|PHCS OF AZ PHEONIX|||||0.19||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.03||| 36415|EAP|0510|CLINIC VISIT; HIGH MODERATE, C|Medicare|MEDICARE A & B|||||6.83||| 36415|EAP|0335||NON CONTRACTED|COMMERCIAL OTHER|||||10.47||| 36415|EAP|0771||United Healthcare|UMR|||||160.36||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.34||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||34.25||| 36415|EAP|0302|ANA TITER|United Healthcare|UMR|||||2.23||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.19||| 36415|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|United Healthcare|UMR|||||10.47||| 36415|EAP|0300||NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 36415|EAP|0250||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||408.85||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|PHCS|WEB TPA|||||1.77||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.38||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.10||| 36415|EAP|0513||United Healthcare|UMR|||||3.79||| 36415|EAP|0460||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.35||| 36415|EAP|0301|VENIPUNCTURE|Multiplan|TML GRP INS|0.19||||0.00||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||17.85||| 36415|EAP|0510||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| 36415|EAP|0412||Medicare|MEDICARE A & B|||||2.20||| 36415|EAP|0272||PHCS|WEB TPA|||||0.07||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||0.11||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.50||| 36415|EAP|0459||United Healthcare|UMR|||||13.15||| 36415|EAP|0921||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||27.00||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0251||United Healthcare|UMR|||||3.15||| 36415|EAP|0410||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.20||| 36415|EAP|0750||Medicare|MEDICARE A & B|||||20.18||| 36415|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||0.30||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||2.99||| 36415|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 36415|EAP|0510||Multiplan|TML GRP INS|||||3.79||| 36415|EAP|0450||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.45||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||121.85||| 36415|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.10||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||35.50||| 36415|EAP|0750|DIAGNOSTIC COLONOSCOPY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| 36415|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.15||| 36415|EAP|0360|SPINAL PUNCTURE, LUMBAR|Medicare|MEDICARE A & B|||||6.90||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.55||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.19||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||25.35||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.25||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.07||| 36415|EAP|0513||United Healthcare|UMR|||||4.38||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|PHCS|TML GRP INS|0.19||||0.19||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||3.44||| 36415|EAP|0260|HYDRATION IV INF,31MIN-1HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 36415|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.32||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||34.30||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| 36415|EAP|0510||United Healthcare|UMR|||||2.99||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||0.19||| 36415|EAP|0271||NON CONTRACTED|COMMERCIAL OTHER|||||4.90||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||2.59||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|United Healthcare|UMR|||||2.10||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||71.40||| 36415|EAP|0301||United Healthcare|UMR|0.19||||2.13||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||0.70||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.72||| 36415|EAP|0450||United Healthcare|UMR|||||3.85||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||107.70||| 36415|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||0.47||| 36415|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.82||| 36415|EAP|0306|HEPATITIS C GENOTYPING BY PCR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.07||| 36415|EAP|0251|THYROID, 30MG TAB|United Healthcare|UMR|||||3.15||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.77||| 36415|EAP|0307||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.25||| 36415|EAP|0771|ADM OF INFLUENZA VACC(5 EAST)|Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0301||United Healthcare|UMR|0.19||||2.66||| 36415|EAP|0302||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.23||| 36415|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.35||| 36415|EAP|0302||United Healthcare|UMR|||||2.31||| 36415|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|United Healthcare|UMR|||||4.38||| 36415|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.18||| 36415|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.78||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|United Healthcare|UMR|0.19||||4.14||| 36415|EAP|0251|GLIPIZIDE TAB 5MG U/D|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.15||| 36415|EAP|0730||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.86||| 36415|EAP|0272||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||5.25||| 36415|EAP|0771||PHCS|TML GRP INS|||||160.36||| 36415|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.54||| 36415|EAP|0403||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.82||| 36415|EAP|0460||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.82||| 36415|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||1.80||| 36415|EAP|0335||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.52||| 36415|EAP|0301|VENIPUNCTURE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.00||| 36415|EAP|0306||United Healthcare|UMR|||||0.06||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|PHCS|WEB TPA OF GRAND PRAIRIE|||||0.19||| 36415|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.19||| 36415|EAP|0949||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 36415|EAP|0300||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.31||| 36415|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 36415|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.80||| 36415|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 36415|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.02||| 36415|EAP|0306||United Healthcare|UMR|||||0.97||| 36415|EAP|0419||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.37||| 36415|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||197.62||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.45||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||18.68||| 36415|EAP|0301|PROTEIN, 24-HR URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.94||| 36415|EAP|0459||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.42||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||2.34||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.19||||1.47||| 36415|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 36415|EAP|0343||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||9.08||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||0.00||| 36415|EAP|0257||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 36415|EAP|0272||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||5.25||| 36415|EAP|0271||Multiplan|WEB TPA|||||4.90||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.07||| 36415|EAP|0255||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.80||| 36415|EAP|0302||United Healthcare|UMR|||||7.35||| 36415|EAP|0942||Medicare|MEDICARE A & B|||||0.56||| 36415|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||181.41||| 36415|EAP|0272||PHCS|WEB TPA|||||4.90||| 36415|EAP|0981|ER VISIT; LEVEL IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.00||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.63||| 36415|EAP|0350||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||29.32||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|PHCS|PHCS OF AZ PHEONIX|||||0.19||| 36415|EAP|0306|HPV HIGH RISK PCR THIN P(ARUP)|United Healthcare|UMR|||||0.77||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.42||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||2.33||| 36415|EAP|0309||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.54||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||610.42||| 36415|EAP|0771||Medicare|MEDICARE PART B|||||160.36||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.77||| 36415|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||0.38||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.69||| 36415|EAP|0302||Blue Cross PPO|BCBS WALMART|||||1.20||| 36415|EAP|0341||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||58.13||| 36415|EAP|0402||Blue Cross PPO|BLUE CROSS PPO|||||11.22||| 36415|EAP|0255||Blue Cross PPO Select|BCBS UTHCT|||||5.25||| 36415|EAP|0730||Blue Cross PPO|BLUE CROSS POS|||||3.86||| 36415|EAP|0301||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.14||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.34||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 36415|EAP|0252|GLIMEPIRIDE 2 MG *AMARYL* UD|Medicare|MEDICARE A & B|||||4.40||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Blue Cross PPO Select|BCBS UTHCT|0.19||||1.10||| 36415|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross PPO|BLUE CROSS PPO|||||18.68||| 36415|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||3.40||| 36415|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 36415|EAP|0459||Blue Cross PPO|BLUE CROSS PPO|||||13.15||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.38||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS PPO|||||197.62||| 36415|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||92.70||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.08||| 36415|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||0.38||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||0.78||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS POS|||||3.10||| 36415|EAP|0302||Blue Cross PPO|BCBS WALMART|||||2.23||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||3.03||| 36415|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.09||| 36415|EAP|0302||Blue Cross PPO|BCBS WALMART|||||1.11||| 36415|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BCBS WALMART|||||669.83||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||1.74||| 36415|EAP|0302|V.ZOSTER AB, IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.39||| 36415|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||5.25||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 36415|EAP|0257||Medicare|MEDICARE RAILROAD|||||0.65||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.70||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||0.08||| 36415|EAP|0311|FLOW CYTOMETRY EA ADL MARKER|Medicare|MEDICARE A & B|||||1.20||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.54||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS POS|||||0.50||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Blue Cross PPO|BLUE CROSS PPO|||||1.77||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||213.82||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||3.54||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS POS|||||6,252.60||| 36415|EAP|0636|ERTAPENEM 1 GRAM IV/IM|Blue Cross PPO|BLUE CROSS PPO|||||345.40||| 36415|EAP|0251|NIACIN CONTROLLED REL 500MG,PO|Medicare|MEDICARE A & B|6.90||||18.55||| 36415|EAP|0513||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||27.30||| 36415|EAP|0459||Blue Cross PPO|BCBS WALMART|||||3.00||| 36415|EAP|0258||Medicare|MEDICARE RAILROAD|||||41.10||| 36415|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 36415|EAP|0402||Blue Cross PPO|BLUE CROSS PPO|||||9.78||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||19.60||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.12||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||1.07||| 36415|EAP|0301|CHOLINESTERASE, RBC (REF)|Blue Cross PPO Select|BCBS UTHCT|0.19||||0.55||| 36415|EAP|0306|SUSCEPTIBILITY AFB ;PROPORTION|Blue Cross PPO|BLUE CROSS PPO|||||3.07||| 36415|EAP|0258||Medicare|MEDICARE A & B|||||0.42||| 36415|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 36415|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.52||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Blue Cross PPO|BCBS WALMART|||||3.79||| 36415|EAP|0999||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0260|THER/DIAG CONCURRENT INF|Medicare|MEDICARE A & B|1.03||||0.70||| 36415|EAP|0302||Blue Cross PPO|BCBS WALMART|||||1.89||| 36415|EAP|0309||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.38||| 36415|EAP|0305||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.68||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||69.31||| 36415|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|||||1.89||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||181.41||| 36415|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||3.14||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||11.19||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||3.26||| 36415|EAP|0252|WARFARIN NA TAB 1 MG U/D|Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.99||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||369.80||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||4.36||| 36415|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||34.25||| 36415|EAP|0459||Blue Cross PPO|BLUE CROSS PPO|||||1.65||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||610.42||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO Select|BCBS UTHCT|0.19||||0.86||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.11||| 36415|EAP|0302||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.52||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BLUE CROSS POS|||||2.10||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.27||| 36415|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 36415|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO Select|BCBS UTHCT|0.19||||2.28||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||30.20||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||1.16||| 36415|EAP|0981|ER VISIT; LEVEL IV|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0258|SODIUM CHLORIDE 0.9%-KCL 20MEQ|Medicare|MEDICARE A & B|||||46.15||| 36415|EAP|0900||Blue Cross PPO|BLUE CROSS PPO|||||3.39||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||2.07||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.32||| 36415|EAP|0272|SUCTION;YANKAUER W/CONTROL|Medicare|MEDICARE A & B|||||4.90||| 36415|EAP|0900||Blue Cross PPO|BLUE CROSS PPO|||||2.01||| 36415|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||3.69||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||50.40||| 36415|EAP|0341||Blue Cross PPO|BLUE CROSS PPO|||||58.13||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS POS|||||0.78||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||1.14||| 36415|EAP|0403||Blue Cross PPO|BLUE CROSS POS|||||0.82||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 36415|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BCBS TRANE PPO|||||5.51||| 36415|EAP|0270|GRIPPER, 20 GA, 1 INCH|Medicare|MEDICARE A & B|||||17.85||| 36415|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.43||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||43.50||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.34||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BLUE CROSS PPO|||||610.42||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||7.35||| 36415|EAP|0311||Medicare|MEDICARE A & B|||||0.99||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||0.76||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Blue Cross PPO|BCBS WALMART|||||160.36||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.05||| 36415|EAP|0419||Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||3.00||| 36415|EAP|0730||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.82||| 36415|EAP|0410||Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 36415|EAP|0350|CTA, LOWER EXTREMITY W/CONT NC|Blue Cross PPO|BLUE CROSS PPO|||||28.27||| 36415|EAP|0301|VENIPUNCTURE|Medicare|MEDICARE A & B|0.19||||0.00||| 36415|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||2.35||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||0.25||| 36415|EAP|0343||Blue Cross PPO|BLUE CROSS PPO|||||9.08||| 36415|EAP|0730||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.65||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 36415|EAP|0391||Blue Cross PPO|BLUE CROSS PPO|||||1,370.23||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||11.40||| 36415|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.94||| 36415|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.64||| 36415|EAP|0513||Blue Cross PPO|BCBS WALMART|||||2.64||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||206.30||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||3.45||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||42.85||| 36415|EAP|0403||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.83||| 36415|EAP|0309|IRL A IGG BILL (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.60||| 36415|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||9.75||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.66||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||4.44||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.11||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|Medicare|MEDICARE A & B|0.19||||0.34||| 36415|EAP|0260||Aetna|AETNA EL PASO CLAIMS OFFICE|||||619.42||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 36415|EAP|0251|AMITRIPTYLINE 50MG PO|Medicare|MEDICARE A & B|6.90||||3.80||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||0.86||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| 36415|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Medicaid|MEDICAID|||||669.83||| 36415|EAP|0250|RANOLAZINE 500MG PO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.95||| 36415|EAP|0306|HPV HIGH RISK PCR (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.82||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||0.65||| 36415|EAP|0270|SUBCLAVIAN DRESSING KIT|Blue Cross PPO|BCBS WALMART|||||11.55||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.14||| 36415|EAP|0981||Aetna|AETNA|||||0.00||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.19||| 36415|EAP|0311||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.57||| 36415|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.50||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.77||| 36415|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.97||| 36415|EAP|0300|Allergen, Insect, rApi m 1 REF|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||479.05||| 36415|EAP|0300|POC GLUCOSE BLOOD TEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.20||| 36415|EAP|0255||Blue Cross PPO|BLUE CROSS PPO|||||1.80||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||3.85||| 36415|EAP|0252||Blue Cross PPO|BLUE CROSS PPO|||||96.05||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.28||| 36415|EAP|0301|NEPHELOMETRY EA NOS (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.65||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.83||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.18||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.69||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||4.90||| 36415|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 36415|EAP|0730||Aetna|AETNA US HEALTHCARE PA|||||3.86||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.16||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||517.50||| 36415|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||1.63||| 36415|EAP|0252||Blue Cross PPO|BLUE CROSS PPO|||||3.15||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||0.06||| 36415|EAP|0301|APOLIPOPROTEIN, EA (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.65||| 36415|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.38||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||0.00||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Aetna|AETNA EXXON MOBIL|||||0.19||| 36415|EAP|0300||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.09||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||2.07||| 36415|EAP|0301|BILIRUBIN TOTAL (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.65||| 36415|EAP|0251|CHOLESTYRAMINE POWDER 4GM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.12||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||14.70||| 36415|EAP|0251||Blue Cross PPO|BLUE CROSS POS|||||11.50||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||0.86||| 36415|EAP|0301|VENIPUNCTURE|Aetna|AETNA EXXON MOBIL|||||0.00||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||0.86||| 36415|EAP|0250|PREDNISONE 2.5MG TAB PO|Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||0.19||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||0.92||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.39||| 36415|EAP|0410||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.20||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.39||| 36415|EAP|0771||Aetna|AETNA|||||160.36||| 36415|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Medicare|MEDICARE A & B|||||5.43||| 36415|EAP|0300|INFLUENZA VIRUS MULT TYPES|Blue Cross PPO|BCBS WALMART|||||2.10||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||0.97||| 36415|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Medicare|MEDICARE A & B|0.19||||6.28||| 36415|EAP|0460||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.93||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.40||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.70||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.26||| 36415|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 36415|EAP|0307||Medicare|MEDICARE A & B|||||0.69||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.08||| 36415|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 36415|EAP|0301|CHLORIDE, SERUM|Medicare|MEDICARE A & B|0.19||||0.75||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||5.81||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross PPO|BCBS TRANE PPO|0.19||||0.00||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.19||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||35.35||| 36415|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| 36415|EAP|0272|ADMIN SET BLOOD (ER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.28||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||5.04||| 36415|EAP|0300||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.31||| 36415|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.10||| 36415|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.47||| 36415|EAP|0761||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.83||| 36415|EAP|0301|HAPTOGLOBIN QUANT (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.65||| 36415|EAP|0301|ALT SGPT (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.65||| 36415|EAP|0311||Medicare|MEDICARE A & B|||||2.56||| 36415|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 36415|EAP|0258||Aetna|AETNA EL PASO CLAIMS OFFICE|||||41.10||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||1.63||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||3.51||| 36415|EAP|0270|GRIPPER, 20 GA, 1 INCH|Blue Cross PPO|BCBS WALMART|||||17.85||| 36415|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||17.75||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||8.40||| 36415|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||30.20||| 36415|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||24.40||| 36415|EAP|0272||Blue Cross PPO|BCBS WALMART|||||0.07||| 36415|EAP|0731||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.15||| 36415|EAP|0301|IGA (REF)|Blue Cross PPO|BLUE CROSS PPO|0.19||||1.53||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.59||| 36415|EAP|0251||Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.60||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Aetna|AETNA|||||0.19||| 36415|EAP|0730||Managed Medicaid|SUPERIOR STAR MCD|||||3.86||| 36415|EAP|0301|PSA, TOTAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||2.10||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.97||| 36415|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||0.08||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||31.75||| 36415|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 36415|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.82||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.10||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.59||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 36415|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.60||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||17.30||| 36415|EAP|0260||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||213.82||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.44||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||9.75||| 36415|EAP|0271||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.90||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||110.50||| 36415|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.32||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||0.73||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Blue Cross PPO|BLUE CROSS PPO|0.19||||1.10||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Blue Cross PPO|BLUE CROSS POS|0.19||||1.10||| 36415|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.56||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.45||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross PPO|BCBS WALMART|0.19||||0.00||| 36415|EAP|0450||Medicaid|MEDICAID|||||18.68||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.73||| 36415|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||188.63||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.08||| 36415|EAP|0301|FINGER, HEEL STICK|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.08||| 36415|EAP|0309|SEQ DNAP (RWL)|Medicare|MEDICARE A & B|||||2.25||| 36415|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.36||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.45||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.63||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||9.55||| 36415|EAP|0301|FOLATE, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.41||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.21||| 36415|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||14.97||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Aetna|AETNA US HEALTHCARE PA|||||0.19||| 36415|EAP|0255||Blue Cross PPO|BLUE CROSS PPO|||||7.50||| 36415|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.14||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.61||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.51||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.32||| 36415|EAP|0251|CARBAMAZEPINE TAB 200 MG U/D|Medicare|MEDICARE A & B|6.90||||5.70||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.07||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.86||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||1.77||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.99||| 36415|EAP|0306|HPV HIGH RISK PCR THIN P(ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.77||| 36415|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Medicare|MEDICARE A & B|||||0.31||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.53||| 36415|EAP|0302||Aetna|TRS COORDINATED CARE|||||1.41||| 36415|EAP|0305||Medicare|MEDICARE RAILROAD|||||1.22||| 36415|EAP|0309|IRL B IGM BILL (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.57||| 36415|EAP|0271||Blue Cross PPO|BCBS WALMART|||||4.90||| 36415|EAP|0302|BORDETELLA PERT AB IGA (IGG,M)|Medicare|MEDICARE A & B|||||0.67||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.12||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 36415|EAP|0260||Medicaid|MEDICAID|||||213.82||| 36415|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 36415|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS PPO|||||669.83||| 36415|EAP|0460||Medicaid|MEDICAID|||||1.93||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 36415|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||21.30||| 36415|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||0.86||| 36415|EAP|0730||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.74||| 36415|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 36415|EAP|0301|FINGER, HEEL STICK|Medicare|MEDICARE A & B|0.19||||0.08||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.26||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||2.66||| 36415|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 36415|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.25||| 36415|EAP|0450|INJECTION ANTIBIOTIC|Medicaid|MEDICAID|||||181.41||| 36415|EAP|0301|B-12|Blue Cross PPO|BCBS WALMART|0.19||||0.42||| 36415|EAP|0306|HEPATITIS C GENOTYPING BY PCR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.18||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.63||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.73||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||129.20||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||2.28||| 36415|EAP|0412||Medicaid|MEDICAID|||||2.20||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.77||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.38||| 36415|EAP|0762||Medicaid|MEDICAID|||||0.75||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.77||| 36415|EAP|0251||Blue Cross PPO|BCBS WALMART|||||11.50||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.55||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||0.25||| 36415|EAP|0762||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.34||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.17||| 36415|EAP|0260|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 36415|EAP|0260|IV INFUSION THER,EA ADD'L HR|Medicaid|MEDICAID|||||1.03||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.86||| 36415|EAP|0258||Blue Cross PPO|BLUE CROSS PPO|||||42.85||| 36415|EAP|0272||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.07||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.86||| 36415|EAP|0301|B-12|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.42||| 36415|EAP|0510||Aetna|AETNA|||||2.50||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.80||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.02||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.86||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| 36415|EAP|0271||Medicaid|MEDICAID|||||4.90||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.45||| 36415|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||2.28||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||1.80||| 36415|EAP|0251|LAMOTRIGINE 100MG, ORAL|Medicare|MEDICARE A & B|6.90||||3.15||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.35||| 36415|EAP|0250|HYDROXOCOBALAM 5 GM (CYANOKIT)|Blue Cross PPO|BLUE CROSS POS|||||1,478.40||| 36415|EAP|0459||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.42||| 36415|EAP|0310|BCR-ABL1 MINOR QUANT (INT ARUP|Medicare|MEDICARE A & B|||||5.92||| 36415|EAP|0771||Aetna|AETNA EXXON MOBIL|||||160.36||| 36415|EAP|0307||Medicare|MEDICARE A & B|||||1.18||| 36415|EAP|0305||Aetna|AETNA EL PASO CLAIMS OFFICE|||||96.50||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||1.03||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||3.14||| 36415|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.77||| 36415|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.67||| 36415|EAP|0301|T4, TOTAL|Medicare|MEDICARE A & B|0.19||||1.80||| 36415|EAP|0341||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||58.13||| 36415|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 36415|EAP|0301||Medicaid|MEDICAID|0.19||||2.33||| 36415|EAP|0301|GGT (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.65||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||2.28||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||110.50||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Medicare|MEDICARE A & B|1.03||||3.45||| 36415|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 36415|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.16||| 36415|EAP|0312||Medicare|MEDICARE A & B|||||4.99||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||3.14||| 36415|EAP|0251|ARIPIPRAZOLE 20MG, PO|Blue Cross PPO|BLUE CROSS PPO|||||159.75||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||47.25||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.98||| 36415|EAP|0320||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.00||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||55.05||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||74.50||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.52||| 36415|EAP|0272||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.17||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.69||| 36415|EAP|0251|MIRTAZAPINE 7.5MG HALF TAB PO|Medicare|MEDICARE A & B|6.90||||9.35||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Access Direct Platinum|ACCESS DIRECT|||||0.19||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS POS|||||11.55||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||2.77||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||224.50||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||11.55||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.50||| 36415|EAP|0301|SODIUM, SERUM|Medicare|MEDICARE A & B|0.19||||0.96||| 36415|EAP|0391||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,370.23||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||13.20||| 36415|EAP|0482||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.03||| 36415|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.99||| 36415|EAP|0301|LYTE PANEL (ELECTROLYTES)|Medicare|MEDICARE A & B|0.19||||2.31||| 36415|EAP|0981||Aetna|AETNA US HEALTHCARE PA|||||0.00||| 36415|EAP|0730||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.09||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.32||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.65||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||17.85||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.51||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.88||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.10||| 36415|EAP|0309|AER ORG SUSCEPT (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.48||| 36415|EAP|0252|DILTIAZEM SR CAP 120MG U/D|Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 36415|EAP|0301|FOLATE, SERUM|Medicare|MEDICARE A & B|0.19||||0.41||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.58||| 36415|EAP|0450||Aetna|AETNA US HEALTHCARE PA|||||669.83||| 36415|EAP|0309|IRL B IGG BILL (ARUP)|Medicare|MEDICARE A & B|||||1.60||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 36415|EAP|0252|OLANZAPINE (ZYPREXA) 10 MG TAB|Medicare|MEDICARE A & B|||||63.80||| 36415|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 36415|EAP|0762||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.75||| 36415|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.41||| 36415|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Medicare|MEDICARE A & B|0.19||||2.66||| 36415|EAP|0390||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.34||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||80.85||| 36415|EAP|0251|ESTRADIOL TAB 1 MG 100'S|Medicare|MEDICARE A & B|6.90||||3.15||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.27||| 36415|EAP|0271||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.18||| 36415|EAP|0771||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| 36415|EAP|0300|Allergen, Insect, rVes v1(REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 36415|EAP|0771||Managed Medicaid|FAMILY PLANNING GRANT|||||0.86||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.20||| 36415|EAP|0301|IGA (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||109.80||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||1.37||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.50||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.11||| 36415|EAP|0300||Blue Cross PPO|BLUE CROSS PPO|||||0.09||| 36415|EAP|0410||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.20||| 36415|EAP|0306|HEPATITIS C GENOTYPING BY PCR|Medicare|MEDICARE A & B|||||7.07||| 36415|EAP|0301|VENIPUNCTURE|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.00||| 36415|EAP|0309|IRL A IGM BILL (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.57||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BCBS WALMART|0.19||||0.86||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||1.68||| 36415|EAP|0250||Blue Cross PPO|BLUE CROSS PPO|||||38.70||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.19||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||3.14||| 36415|EAP|0250||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.98||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||18.68||| 36415|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||3.14||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.23||| 36415|EAP|0981||Aetna|TRS COORDINATED CARE|||||0.00||| 36415|EAP|0949||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||197.62||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.25||| 36415|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.77||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO|BCBS TRANE PPO|0.19||||0.19||| 36415|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross PPO|BCBS WALMART|||||213.83||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.76||| 36415|EAP|0272||Medicaid|MEDICAID|||||0.07||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 36415|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Medicare|MEDICARE A & B|||||1.44||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.19||| 36415|EAP|0403||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.82||| 36415|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.47||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||15.50||| 36415|EAP|0252||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.15||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.58||| 36415|EAP|0301|B-12|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.42||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.92||| 36415|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|0.19||||3.14||| 36415|EAP|0302|ANA TITER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 36415|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| 36415|EAP|0272||Medicaid|MEDICAID|||||0.17||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.97||| 36415|EAP|0252|ZONISAMIDE 100MG CAPSULES *ZON|Blue Cross PPO|BLUE CROSS PPO|||||3.20||| 36415|EAP|0450||Medicaid|MEDICAID|||||1.14||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.86||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Aetna|TRS COORDINATED CARE|||||0.19||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||36.75||| 36415|EAP|0307||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.18||| 36415|EAP|0252||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||49.75||| 36415|EAP|0343||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.08||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||17.58||| 36415|EAP|0302||Aetna|TRS COORDINATED CARE|||||0.94||| 36415|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.15||| 36415|EAP|0981||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 36415|EAP|0301|VENIPUNCTURE|Aetna|AETNA|||||0.00||| 36415|EAP|0761||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.83||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.68||| 36415|EAP|0311||Medicare|MEDICARE A & B|||||0.93||| 36415|EAP|0260||Blue Cross PPO|BLUE CROSS POS|||||1.14||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||3.00||| 36415|EAP|0307||Medicare|MEDICARE RAILROAD|||||0.69||| 36415|EAP|0250||Aetna|AETNA EL PASO CLAIMS OFFICE|||||15.40||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.44||| 36415|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||174.30||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.53||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||2.46||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.34||| 36415|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.98||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||6.65||| 36415|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|0.19||||0.86||| 36415|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.63||| 36415|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.49||| 36415|EAP|0301|VITAMIN D, 25 HYDROXY|Medicare|MEDICARE A & B|0.19||||2.15||| 36415|EAP|0351||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.61||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.63||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||1.14||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.17||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS POS|||||37.80||| 36415|EAP|0305|DRVVT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.38||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.73||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.81||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||7.35||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||2.28||| 36415|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 36415|EAP|0949||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||0.25||| 36415|EAP|0302||Aetna|TRS COORDINATED CARE|||||2.67||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.14||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.45||| 36415|EAP|0309|AER ORG SUSCEPT (ARUP)|Medicare|MEDICARE A & B|||||0.93||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.36||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||25.60||| 36415|EAP|0272||Medicaid|MEDICAID|||||5.25||| 36415|EAP|0510||Aetna|AETNA EXXON MOBIL|||||2.50||| 36415|EAP|0272||Blue Cross PPO|BCBS WALMART|||||45.15||| 36415|EAP|0307||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.69||| 36415|EAP|0306|HEP C RNA, QNT NAAT (REF)|Medicare|MEDICARE A & B|||||1.17||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Aetna|TRS COORDINATED CARE|||||5.51||| 36415|EAP|0320|PELVIS AP VIEW ONLY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||17.85||| 36415|EAP|0300||Blue Cross PPO|BLUE CROSS PPO|||||1.40||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 36415|EAP|0270|IV ADMINISTRATION NITRO|Blue Cross PPO|BCBS WALMART|||||37.80||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||1.81||| 36415|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.00||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.28||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||0.76||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.50||| 36415|EAP|0301||Aetna|TRS COORDINATED CARE|||||2.33||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.46||| 36415|EAP|0305|D-DIMER (QUANTITATIVE)|Medicare|MEDICARE A & B|||||2.77||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||17.85||| 36415|EAP|0252||Blue Cross PPO|BLUE CROSS PPO|||||13.60||| 36415|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Medicaid|MEDICAID|||||1.14||| 36415|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.83||| 36415|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Blue Cross PPO|BLUE CROSS PPO|0.19||||174.30||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.13||| 36415|EAP|0300|LDL Cholesterol, Direct|Medicare|MEDICARE A & B|||||0.20||| 36415|EAP|0403||Blue Cross PPO|BLUE CROSS POS|||||4.83||| 36415|EAP|0305|PARTIAL THROMBP TIME (REF)|Medicare|MEDICARE A & B|||||0.49||| 36415|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||20.10||| 36415|EAP|0255||Medicare|MEDICARE A & B|||||2.40||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||438.80||| 36415|EAP|0459||Blue Cross PPO|BLUE CROSS PPO|||||8.95||| 36415|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|||||0.99||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||1.61||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||3.14||| 36415|EAP|0251||Blue Cross PPO Select|BCBS UTHCT|||||31.75||| 36415|EAP|0510||Blue Cross PPO|BCBS WALMART|||||3.26||| 36415|EAP|0272|CATH SUCTION 8 FR|Medicare|MEDICARE A & B|||||4.90||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.75||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.50||| 36415|EAP|0771||Blue Cross PPO|BLUE CROSS POS|||||160.36||| 36415|EAP|0612||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||44.00||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO Select|BCBS UTHCT|0.19||||0.19||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.66||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Medicaid|MEDICAID|||||669.83||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.66||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.90||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||7.27||| 36415|EAP|0305||Blue Cross PPO|BCBS WALMART|||||1.68||| 36415|EAP|0981||Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||0.00||| 36415|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||4.74||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.33||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||0.84||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 36415|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||2.11||| 36415|EAP|0300|PTT 2 HOUR 1:1 MIX REFLEX|Medicare|MEDICARE A & B|||||0.32||| 36415|EAP|0942||Blue Cross PPO|BCBS WALMART|||||1.05||| 36415|EAP|0210||Medicare|MEDICARE A & B|37.43||||||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.27||| 36415|EAP|0390||Blue Cross PPO|BLUE CROSS PPO|||||19.94||| 36415|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.32||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.55||| 36415|EAP|0450||Medicaid|MEDICAID|||||669.83||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||18.68||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.45||| 36415|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||1.93||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||1.62||| 36415|EAP|0390|CARTER: Z1005|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 36415|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.64||| 36415|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Medicare|MEDICARE A & B|1.03||||610.42||| 36415|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 36415|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Medicaid|MEDICAID|0.19||||82.60||| 36415|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.69||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||197.62||| 36415|EAP|0274||Medicare|MEDICARE A & B|||||56.70||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 36415|EAP|0762||Blue Cross PPO|BLUE CROSS PPO|||||3.00||| 36415|EAP|0305|SICKLING OF RBC,REDUCTION(REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.84||| 36415|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicare|MEDICARE A & B|||||3.96||| 36415|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.50||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.10||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.43||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.47||| 36415|EAP|0272||Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.25||| 36415|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 36415|EAP|0250||Aetna|AETNA EL PASO CLAIMS OFFICE|||||21.30||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||2.17||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||3.55||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS POS|||||2,650.25||| 36415|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Medicare|MEDICARE A & B|||||2.34||| 36415|EAP|0306|HPV THINPREP|Blue Cross PPO|BLUE CROSS PPO|||||0.77||| 36415|EAP|0301|BUN|Medicare|MEDICARE A & B|0.19||||0.84||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||9.75||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||181.41||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||0.48||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.44||| 36415|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross PPO|BLUE CROSS PPO|||||13.15||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.03||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.70||| 36415|EAP|0771||Blue Cross PPO|BCBS WALMART|||||160.36||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||1.38||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||3.06||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||82.50||| 36415|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||8.25||| 36415|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 36415|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Medicaid|MEDICAID|||||5.69||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||1,047.25||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||6.40||| 36415|EAP|0762||Blue Cross PPO|BLUE CROSS PPO|||||0.75||| 36415|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.99||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||63.90||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||5.39||| 36415|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.68||| 36415|EAP|0251||Medicare|MEDICARE RAILROAD|||||11.50||| 36415|EAP|0513||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 36415|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||3.65||| 36415|EAP|0390||Blue Cross PPO|BLUE CROSS PPO|||||9.34||| 36415|EAP|0257||Medicare|MEDICARE A & B|3.15||||0.65||| 36415|EAP|0302|V.ZOSTER AB, IGM (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.39||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 36415|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Blue Cross PPO|BCBS WALMART|||||213.82||| 36415|EAP|0301|BILIRUBIN; DIRECT|Medicare|MEDICARE A & B|0.19||||1.35||| 36415|EAP|0300||Blue Cross PPO Select|BCBS UTHCT|||||2.00||| 36415|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.09||| 36415|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|Blue Cross PPO|BCBS WALMART|||||10.47||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||0.09||| 36415|EAP|0302||Blue Cross PPO|BCBS WALMART|||||3.43||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||2.59||| 36415|EAP|0459||Aetna|AETNA EL PASO CLAIMS OFFICE|||||13.15||| 36415|EAP|0302|ANA TITER|Blue Cross PPO|BLUE CROSS POS|||||0.34||| 36415|EAP|0301|VASOACTIVE INTESTINAL PEPTIDE|Medicare|MEDICARE A & B|0.19||||3.72||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross PPO Select|BCBS UTHCT|0.19||||0.00||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.13||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||0.86||| 36415|EAP|0251|VENLAFAXINE HCL 37.5MG TABLET|Medicare|MEDICARE A & B|6.90||||7.10||| 36415|EAP|0305||Blue Cross PPO|BCBS TRANE PPO|||||1.68||| 36415|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 36415|EAP|0255|LOCM 300-399MG/ML IODINE,300MG|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 36415|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||3.54||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||15.25||| 36415|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO|BLUE CROSS POS|0.19||||0.19||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||7.07||| 36415|EAP|0270||Medicaid|MEDICAID|||||0.07||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||104.20||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.89||| 36415|EAP|0730||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.86||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||669.83||| 36415|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO|BLUE CROSS PPO|||||1.36||| 36415|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.75||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.03||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||0.97||| 36415|EAP|0272||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.07||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.18||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.18||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||669.83||| 36415|EAP|0450||PHCS|WEB TPA|||||3.45||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 36415|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 36415|EAP|0771||United Healthcare|UMR|||||0.86||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS POS|||||45.15||| 36415|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.38||| 36415|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.14||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||2.21||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.30||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.19||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||17.75||| 36415|EAP|0762||Medicare|MEDICARE A & B|3.00||||3.00||| 36415|EAP|0301||United Healthcare|UMR|0.19||||1.46||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.19||| 36415|EAP|0510||PHCS|TML GRP INS|||||2.50||| 36415|EAP|0483||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||14.21||| 36415|EAP|0306|HPV HIGH RISK PCR (ARUP)|United Healthcare|UMR|||||1.82||| 36415|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.15||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.46||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| 36415|EAP|0949||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 36415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|United Healthcare|UMR|||||4.52||| 36415|EAP|0510|IV PUSH NEW SUBS/DRUG EA|United Healthcare|UMR|||||1.14||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.90||| 36415|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||47.65||| 36415|EAP|0510||PHCS|WEB TPA|||||2.50||| 36415|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Medicare|MEDICARE A & B|||||5.15||| 36415|EAP|0302||United Healthcare|UMR|||||2.23||| 36415|EAP|0450||United Healthcare|UMR|||||391.92||| 36415|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||0.45||| 36415|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.33||| 36415|EAP|0510||United Healthcare|UMR|||||2.50||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 36415|EAP|0305|THROMBIN TIME 1:1 MIX (REF)|Medicare|MEDICARE A & B|||||0.20||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||1.75||| 36415|EAP|0412||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.20||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||24,338.40||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.25||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|PHCS|WEB TPA|||||5.51||| 36415|EAP|0762||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.00||| 36415|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.25||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||0.65||| 36415|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.54||| 36415|EAP|0250|MEDROXYPROGESTERONE 10MG TAB|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.06||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.20||| 36415|EAP|0252||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||10.50||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.77||| 36415|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.96||| 36415|EAP|0320||Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 36415|EAP|0301|VENIPUNCTURE|Medicare|MEDICARE PART B|||||0.00||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.92||| 36415|EAP|0301|B-12|Medicare|MEDICARE A & B|0.19||||1.15||| 36415|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 36415|EAP|0403||Cigna|CIGNA OF TN CHATTANOOGA|||||4.83||| 36415|EAP|0311||Medicaid|MEDICAID|||||0.60||| 36415|EAP|0300||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 36415|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.55||| 36415|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 36415|EAP|0459||Medicaid|MEDICAID|||||13.15||| 36415|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.27||| 36415|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||2.64||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||1.74||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||120.30||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.73||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||8.35||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 36415|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.25||| 36415|EAP|0300||Cigna|CIGNA OF TN CHATTANOOGA|||||0.30||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.96||| 36415|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||3.45||| 36415|EAP|0352||Blue Cross PPO Select|BCBS UTHCT|||||28.51||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.07||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.79||| 36415|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.86||| 36415|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.25||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||2.10||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||0.04||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.44||| 36415|EAP|0252|DONEPEZIL *ARICEPT* 5MG TAB 30|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.15||| 36415|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||2.50||| 36415|EAP|0981||Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.00||| 36415|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.91||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.69||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.31||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.71||| 36415|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.99||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.67||| 36415|EAP|0302|COMPLEMENT;AG EACH (REF)|Medicare|MEDICARE A & B|||||2.34||| 36415|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| 36415|EAP|0301|VENIPUNCTURE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.00||| 36415|EAP|0302||Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.58||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.75||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.81||| 36415|EAP|0301|GLYCOHEMOGLOBIN, POC|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.63||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.94||| 36415|EAP|0311||Cigna|CIGNA OF TN CHATTANOOGA|||||0.99||| 36415|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.53||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||17.25||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.00||| 36415|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.68||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||1.63||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||8.85||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||4.14||| 36415|EAP|0305||NON CONTRACTED|COMMERCIAL OTHER|||||96.50||| 36415|EAP|0301||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.19||||3.14||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||37.63||| 36415|EAP|0460||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.93||| 36415|EAP|0914||NON CONTRACTED|COMMERCIAL OTHER|||||0.25||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 36415|EAP|0419||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.20||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.10||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|PHCS|WEB TPA|||||0.19||| 36415|EAP|0301|VENIPUNCTURE|United Healthcare|GOLDEN RULE INSURANCE|||||0.00||| 36415|EAP|0307||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.18||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|ChampVA|CHAMPVA OF CO DENVER|0.19||||0.19||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.25||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0307||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.18||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||48.65||| 36415|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||89.25||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||0.15||| 36415|EAP|0513||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.81||| 36415|EAP|0981||United Healthcare|GOLDEN RULE INSURANCE|||||0.00||| 36415|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||0.86||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.19||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||11.55||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.74||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||20.10||| 36415|EAP|0301||ChampVA|CHAMPVA OF CO DENVER|0.19||||2.17||| 36415|EAP|0302||ChampVA|CHAMPVA OF CO DENVER|||||34.25||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.44||| 36415|EAP|0311|FLOW CYTO TC 1ST (PATH ASSOC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 36415|EAP|0320||United Healthcare|UMR|||||2.04||| 36415|EAP|0301|TPMT, ERYTHROCYTES (REF)|NON CONTRACTED|COMMERCIAL OTHER|0.19||||3.00||| 36415|EAP|0301||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.19||||2.59||| 36415|EAP|0301||United Healthcare|UMR|0.19||||0.45||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.45||| 36415|EAP|0981||PHCS|TML GRP INS|||||0.00||| 36415|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.40||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||3.45||| 36415|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||18.68||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||6.90||| 36415|EAP|0250|HALOPERIDOL 0.5 MG TAB|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 36415|EAP|0459||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||8.95||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|United Healthcare|GOLDEN RULE INSURANCE|||||1.14||| 36415|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||45.15||| 36415|EAP|0260|IV INFUSION THER,EA ADD'L HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.03||| 36415|EAP|0981||Multiplan|WEB TPA|||||0.00||| 36415|EAP|0370||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.02||| 36415|EAP|0510||United Healthcare|GOLDEN RULE INSURANCE|||||2.25||| 36415|EAP|0302|MHA-TP (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.19||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||2.09||| 36415|EAP|0510||United Healthcare|GOLDEN RULE INSURANCE|||||2.64||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Cigna|CIGNA OF TN CHATTANOOGA|||||5.51||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.90||| 36415|EAP|0301|BUN|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.84||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.56||| 36415|EAP|0301|FINGER, HEEL STICK|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.08||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.35||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||1.47||| 36415|EAP|0272||Cigna|CIGNA OPEN ACCESS PLUS|||||5.25||| 36415|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.54||| 36415|EAP|0311|FLOW CYTO TC 1ST (PATH ASSOC)|Medicare|MEDICARE A & B|||||1.68||| 36415|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||0.96||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||70.60||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|NON CONTRACTED|COMMERCIAL OTHER|0.19||||4.14||| 36415|EAP|0250|CYCLOSPORIN EYE DROPS 0.4 ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||33.05||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.70||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.73||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.30||| 36415|EAP|0762||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.75||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Medicare|MEDICARE PART B|||||0.19||| 36415|EAP|0981|ER VISIT; LEVEL IV|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 36415|EAP|0949||Medicare|MEDICARE A & B|181.41||||197.62||| 36415|EAP|0301||United Healthcare|UMR|0.19||||2.28||| 36415|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| 36415|EAP|0301|VENIPUNCTURE|United Healthcare|AARP OF GA ATLANTA|||||0.00||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.07||| 36415|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 36415|EAP|0301|LIPID PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.36||| 36415|EAP|0255||Medicare|MEDICARE A & B|||||5.25||| 36415|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||1.77||| 36415|EAP|0302||PHCS|TML GRP INS|||||1.13||| 36415|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.50||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||4.50||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.30||| 36415|EAP|0311||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.56||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||1.22||| 36415|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||0.94||| 36415|EAP|0920||Blue Cross PPO Select|BCBS UTHCT|||||6.89||| 36415|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.89||| 36415|EAP|0513||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 36415|EAP|0301||Cigna|CIGNA OTHER|||||2.10||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||36.50||| 36415|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 36415|EAP|0301||Cigna|CIGNA OTHER|||||3.14||| 36415|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||3.44||| 36415|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 36415|EAP|0301|VENIPUNCTURE|Cigna|CIGNA OTHER|||||0.00||| 36415|EAP|0258||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||46.15||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||38.70||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.11||| 36415|EAP|0403||Cigna|CIGNA OPEN ACCESS PLUS|||||0.82||| 36415|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|||||1.68||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Medicare|MEDICARE RAILROAD|0.19||||0.19||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA OF TN CHATTANOOGA|||||9.50||| 36415|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 36415|EAP|0302|REFLEX RPR TITER (ARUP)|Medicare|MEDICARE A & B|||||0.45||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.68||| 36415|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.10||| 36415|EAP|0270||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| 36415|EAP|0450||Medicaid|MEDICAID|||||4.12||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.09||| 36415|EAP|0311|FLOW CYTO CELL 1 MARKER - REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.52||| 36415|EAP|0311|FLOW CYTO CELL 1 MARKER - REF|Medicare|MEDICARE A & B|||||1.68||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||3.45||| 36415|EAP|0305|PLATELET NEUTRALIZATION - REF|Medicare|MEDICARE A & B|||||0.86||| 36415|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||0.38||| 36415|EAP|0305|DRVVT (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.49||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.34||| 36415|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.66||| 36415|EAP|0513||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 36415|EAP|0771||Managed Medicaid|FAMILY PLANNING GRANT|||||160.36||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||76.90||| 36415|EAP|0510||Cigna|NALC HLTH BENEFIT|||||2.64||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||1.55||| 36415|EAP|0252||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.94||| 36415|EAP|0301|IMMUNO G SUBCLASSES 2,3,4(REF)|Medicare|MEDICARE A & B|0.19||||29.95||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||3.51||| 36415|EAP|0771||Cigna|NALC HLTH BENEFIT|||||160.36||| 36415|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||0.45||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||3.82||| 36415|EAP|0301|VENIPUNCTURE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.00||| 36415|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||3.26||| 36415|EAP|0301|VENIPUNCTURE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 36415|EAP|0271||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.09||| 36415|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Medicaid|MEDICAID|0.19||||0.19||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.38||| 36415|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 36415|EAP|0250|LIPASE/AMYLASE/PRO(ZENP-40)CAP|Medicaid|MEDICAID|||||48.40||| 36415|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||18.68||| 36415|EAP|0305||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 36415|EAP|0251|NITROGLYCERIN PATCH 0.2MG/HR|Medicare|MEDICARE A & B|6.90||||6.75||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||11.19||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||2.63||| 36415|EAP|0251|BUPROPRION SR 200MG, PO|Medicare|MEDICARE A & B|6.90||||12.75||| 36415|EAP|0301|METANEPHRINES, TOT 24 HR UR (R|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||6.71||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.07||| 36415|EAP|0250|EMTRICITABINE/TENOGOVIR ALAFER|Medicare|MEDICARE A & B|||||218.05||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||2.31||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.08||| 36415|EAP|0301|ESTRONE, SERUM (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.05||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.33||| 36415|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||0.43||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||9.75||| 36415|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||3.45||| 36415|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.25||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO Select|BCBS UTHCT|||||5.51||| 36415|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||2.07||| 36415|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||14.95||| 36415|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.36||| 36415|EAP|0301|SODIUM, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.96||| 36415|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.94||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||6.30||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|ChampVA|CHAMPVA OF CO DENVER|||||5.51||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Cigna|CIGNA OPEN ACCESS PLUS|||||2.10||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||3.55||| 36415|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||3.56||| 36415|EAP|0301|VENIPUNCTURE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 36415|EAP|0459||Cigna|CIGNA OF TN CHATTANOOGA|||||13.15||| 36415|EAP|0272||Medicare|MEDICARE RAILROAD|||||0.07||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||1.37||| 36415|EAP|0301|VENIPUNCTURE|Cigna|CIGNA BEHAVIORAL HEALTH|0.19||||0.00||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.02||| 36415|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.25||| 36415|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||0.30||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||14.80||| 36415|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.07||| 36415|EAP|0301|VENIPUNCTURE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||0.00||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.94||| 36415|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.33||| 36415|EAP|0403||Cigna|CIGNA OPEN ACCESS PLUS|||||4.83||| 36415|EAP|0301|IMMUNOGLOBULIN SUBCLASSES(REF)|Medicare|MEDICARE A & B|0.19||||29.95||| 36415|EAP|0252|GALANTAMINE 4MG PO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.15||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.50||| 36415|EAP|0305||Medicare|MEDICARE RAILROAD|||||2.77||| 36415|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.09||| 36415|EAP|0307||Cigna|CIGNA OF TN CHATTANOOGA|||||1.18||| 36415|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||669.83||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||27.90||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.82||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.28||| 36415|EAP|0981|ER VISIT; LEVEL IV|Medicaid|MEDICAID|||||0.00||| 36415|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||0.70||| 36415|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.54||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Cigna|CIGNA OPEN ACCESS PLUS|||||3.79||| 36415|EAP|0301|VITAMIN D, 25 HYDROXY|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.48||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||0.04||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.90||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.86||| 36415|EAP|0419||Medicare|MEDICARE A & B|||||2.20||| 36415|EAP|0257||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.46||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.02||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||1.14||| 36415|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 36415|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||4.50||| 36415|EAP|0460||Medicare|MEDICARE A & B|||||8.25||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.47||| 36415|EAP|0311||Cigna|CIGNA OF TN CHATTANOOGA|||||1.89||| 36415|EAP|0310||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.93||| 36415|EAP|0320|DX LMBR SPI PNXR W/FLUOR/CT|Medicare|MEDICARE A & B|||||16.89||| 36415|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 36415|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.69||| 36415|EAP|0403||Medicare|MEDICARE A & B|||||0.82||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.45||| 36415|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.03||| 36415|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.17||| 36415|EAP|0981|ER VISIT; LEVEL IV|Medicare|MEDICARE A & B|0.00||||0.00||| 36415|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||3.69||| 36415|EAP|0301|VENIPUNCTURE|Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.00||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||7.27||| 36415|EAP|0301|POTASSIUM, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.14||| 36415|EAP|0351||Medicare|MEDICARE A & B|||||20.61||| 36415|EAP|0301|CO 2 OR 3 (BICARBONATE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.90||| 36415|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Blue Cross PPO Select|BCBS UTHCT|||||21.30||| 36415|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||0.97||| 36415|EAP|0257||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 36415|EAP|0307||Blue Cross PPO Select|BCBS UTHCT|||||0.47||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Medicare|MEDICARE A & B|5.69||||5.51||| 36415|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|||||181.41||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||3.14||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.32||| 36415|EAP|0260||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||213.82||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||2.16||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Cigna|CIGNA OPEN ACCESS PLUS|||||3.45||| 36415|EAP|0403||Cigna|CIGNA OF TN CHATTANOOGA|||||0.82||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.48||| 36415|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.37||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.37||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||3.37||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.44||| 36415|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.39||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 36415|EAP|0730||Medicare|MEDICARE A & B|3.86||||1.82||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||0.86||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.36||| 36415|EAP|0459||Medicare|MEDICARE A & B|||||8.95||| 36415|EAP|0301|VENIPUNCTURE|ChampVA|CHAMPVA OF CO DENVER|0.19||||0.00||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.34||| 36415|EAP|0513||Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0302||ChampVA|CHAMPVA OF CO DENVER|||||0.43||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||3.03||| 36415|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Medicare|MEDICARE A & B|||||3,005.20||| 36415|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.17||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.34||| 36415|EAP|0636|FUROSEMIDE 20MG VIAL IV|Medicare|MEDICARE A & B|||||11.50||| 36415|EAP|0270||Cigna|NALC HLTH BENEFIT|||||0.05||| 36415|EAP|0320|**KNEE; 2 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.50||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|COMMERCIAL OTHER 2|0.19||||0.19||| 36415|EAP|0301|VENIPUNCTURE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.19||||0.00||| 36415|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.69||| 36415|EAP|0942||Medicare|MEDICARE A & B|||||1.05||| 36415|EAP|0301||ChampVA|CHAMPVA OF CO DENVER|0.19||||2.28||| 36415|EAP|0459||Blue Cross PPO Select|BCBS UTHCT|||||8.95||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.19||||0.19||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Multiplan|WEB TPA|||||0.19||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Cigna|CIGNA OF TN CHATTANOOGA|||||1.14||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA BEHAVIORAL HEALTH|0.19||||0.19||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||5.51||| 36415|EAP|0311||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.57||| 36415|EAP|0257||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.95||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||206.30||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||0.19||| 36415|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| 36415|EAP|0730||Medicare|MEDICARE RAILROAD|||||1.82||| 36415|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||11.50||| 36415|EAP|0981||Multiplan|TML GRP INS|||||0.00||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||0.19||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.50||| 36415|EAP|0460||Medicare|MEDICARE A & B|||||2.35||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||182.99||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.26||| 36415|EAP|0302|HEPATITIS B CORE ATB IgM (811)|NON CONTRACTED|COMMERCIAL OTHER|||||0.48||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||121.35||| 36415|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.55||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.14||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||3.12||| 36415|EAP|0302|RAST; MOLDMIX1 (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||58.55||| 36415|EAP|0272||Managed Medicaid|MEDICAID CSHCN|||||5.25||| 36415|EAP|0302||Multiplan|TML GRP INS|||||1.13||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.46||| 36415|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.27||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Multiplan|WEB TPA|||||5.51||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 36415|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||17.75||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.52||| 36415|EAP|0306||Managed Medicaid|FAMILY PLANNING GRANT|||||0.97||| 36415|EAP|0450|INJECTION ANTIBIOTIC|Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 36415|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.70||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|NON CONTRACTED|COMMERCIAL OTHER|||||5.51||| 36415|EAP|0450|INJECTION ANTIBIOTIC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 36415|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| 36415|EAP|0510||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.64||| 36415|EAP|0730||Multiplan|WEB TPA|||||3.86||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.45||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.69||| 36415|EAP|0300|Allergen, Insect, rPol d 5|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||3.14||| 36415|EAP|0311||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.57||| 36415|EAP|0924||Medicare|MEDICARE A & B|||||0.81||| 36415|EAP|0258||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||42.85||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||669.83||| 36415|EAP|0320||Medicare|MEDICARE RAILROAD|||||3.69||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.18||| 36415|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.31||| 36415|EAP|0272||Managed Medicaid|MEDICAID CSHCN|||||0.17||| 36415|EAP|0391||NON CONTRACTED|COMMERCIAL OTHER|||||1,370.23||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.76||| 36415|EAP|0762||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.75||| 36415|EAP|0731||Medicare|MEDICARE A & B|||||9.15||| 36415|EAP|0333||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.25||| 36415|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.25||| 36415|EAP|0410||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.20||| 36415|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.14||| 36415|EAP|0402||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.59||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||2.33||| 36415|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.93||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|SUPERIOR STAR MCD|||||1.14||| 36415|EAP|0918||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 36415|EAP|0341||Medicare|MEDICARE A & B|||||58.13||| 36415|EAP|0391||Managed Medicaid|SUPERIOR STAR MCD|||||1,370.23||| 36415|EAP|0260||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.77||| 36415|EAP|0921||Medicare|MEDICARE A & B|||||1.91||| 36415|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 36415|EAP|0420||Medicare|MEDICARE A & B|||||4.37||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.19||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||42.60||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.15||| 36415|EAP|0391||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1,370.23||| 36415|EAP|0510|CLINIC VISIT; MID, EST (POD)|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.40||| 36415|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.77||| 36415|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.86||| 36415|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicare|MEDICARE A & B|3.86||||154.50||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.73||| 36415|EAP|0636||Medicare|MEDICARE RAILROAD|||||11.50||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|OTHER MEDICAID|||||669.83||| 36415|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||11.19||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.41||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||1,047.25||| 36415|EAP|0510||Managed Medicaid|FAMILY PLANNING GRANT|||||2.64||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.19||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|FAMILY PLANNING GRANT|||||1.14||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 36415|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 36415|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.07||| 36415|EAP|0309||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.73||| 36415|EAP|0250|TRANEXAMIC ACID 650 MG TAB PO|NON CONTRACTED|COMMERCIAL OTHER|||||26.35||| 36415|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.34||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0300||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.17||| 36415|EAP|0335||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.47||| 36415|EAP|0483||Medicare|MEDICARE A & B|||||14.21||| 36415|EAP|0510||Managed Medicaid|MEDICAID CSHCN|||||2.64||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.10||| 36415|EAP|0981||Medicare|MEDICARE A & B|0.00||||0.00||| 36415|EAP|0300||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.18||| 36415|EAP|0301||Managed Medicaid|FAMILY PLANNING GRANT|||||0.38||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.89||| 36415|EAP|0482||Medicare|MEDICARE A & B|||||13.03||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.77||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.45||| 36415|EAP|0981||Medicare|MEDICARE RAILROAD|||||0.00||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||5.69||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||3.45||| 36415|EAP|0459||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.95||| 36415|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|NON CONTRACTED|COMMERCIAL OTHER|||||5.51||| 36415|EAP|0306|HEP C RNA, QNT NAAT (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.66||| 36415|EAP|0320|FLUORO GUIDE LOCAL - SPINE DIA|Medicare|MEDICARE A & B|||||4.49||| 36415|EAP|0301|GENERAL HEALTH PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.86||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||45.15||| 36415|EAP|0257||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Multiplan|WEB TPA|||||1.77||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||50.15||| 36415|EAP|0391||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1,370.23||| 36415|EAP|0301||Multiplan|TML GRP INS|0.19||||2.35||| 36415|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.35||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||92.70||| 36415|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.59||| 36415|EAP|0949||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||213.82||| 36415|EAP|0450|PERIPHERAL NERVE INJECTION|NON CONTRACTED|COMMERCIAL OTHER|||||7.52||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.11||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|FAMILY PLANNING GRANT|||||5.51||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|MRAMVA|||||0.19||| 36415|EAP|0459||Managed Medicaid|SUPERIOR STAR MCD|||||5.42||| 36415|EAP|0914||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||5.63||| 36415|EAP|0459||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.42||| 36415|EAP|0510||NON CONTRACTED|PPO OTHER|||||3.26||| 36415|EAP|0730|ECG, ROUTINE, 12-LEAD|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.86||| 36415|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||7.27||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.17||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.33||| 36415|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.25||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||45.15||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.02||| 36415|EAP|0257||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.15||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||181.41||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.32||| 36415|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||12.62||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||5.51||| 36415|EAP|0480|STRESS ECHO; EXERCISE|Medicare|MEDICARE A & B|||||17.30||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.65||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.45||| 36415|EAP|0272||Multiplan|WEB TPA|||||5.25||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|0.19||||0.19||| 36415|EAP|0301||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||13.65||| 36415|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.99||| 36415|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||213.82||| 36415|EAP|0459||Medicare|MEDICARE A & B|||||13.15||| 36415|EAP|0302|HEP B SURF ANTIGEN(811)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 36415|EAP|0305|PT W/INR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.22||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||28.25||| 36415|EAP|0403||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.15||| 36415|EAP|0391||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1,370.23||| 36415|EAP|0260||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 36415|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Medicare|MEDICARE A & B|||||2.99||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.14||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||11.19||| 36415|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER 2|||||3.26||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.18||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.79||| 36415|EAP|0460||Medicare|MEDICARE A & B|||||1.93||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| 36415|EAP|0450|INJECTION ANTIBIOTIC|NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 36415|EAP|0301|VENIPUNCTURE|Managed Medicaid|MOLINA MEDICAID|0.19||||0.00||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.10||| 36415|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.38||| 36415|EAP|0390||Medicare|MEDICARE A & B|||||9.34||| 36415|EAP|0260|HYDRATION IV INF,31MIN-1HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.14||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.18||| 36415|EAP|0301||Managed Medicaid|FAMILY PLANNING GRANT|||||0.47||| 36415|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||50.40||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||32.78||| 36415|EAP|0940||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||381.05||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.92||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||3.75||| 36415|EAP|0257||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||100.70||| 36415|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.97||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.66||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.66||| 36415|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Medicare|MEDICARE A & B|||||2.09||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Managed Medicaid|SUPERIOR STAR MCD|||||1.77||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||3.69||| 36415|EAP|0510||Managed Medicaid|FAMILY PLANNING GRANT|||||2.50||| 36415|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.22||| 36415|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0301|VENIPUNCTURE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||0.00||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.77||| 36415|EAP|0410|VENT SUPPORT INITATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||21.68||| 36415|EAP|0270||NON CONTRACTED|MRAMVA|||||0.07||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 36415|EAP|0302||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||34.25||| 36415|EAP|0750||Medicare|MEDICARE A & B|||||19.98||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.19||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|COMMUNITY CARE|||||0.00||| 36415|EAP|0300||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.09||| 36415|EAP|0459||Managed Medicaid|SUPERIOR STAR MCD|||||13.15||| 36415|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||1.32||| 36415|EAP|0301|ALT SGPT (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.73||| 36415|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.26||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE A & B|5.69||||1.14||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.40||| 36415|EAP|0271||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 36415|EAP|0513||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.50||| 36415|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.79||| 36415|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Medicare|MEDICARE A & B|||||21.30||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.79||| 36415|EAP|0410|VENTILATION PER DAY|Medicare|MEDICARE A & B|||||16.64||| 36415|EAP|0250||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||15.40||| 36415|EAP|0459||Medicare|MEDICARE A & B|||||5.42||| 36415|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 36415|EAP|0250|MEDROXYPROGESTERONE 10MG TAB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.06||| 36415|EAP|0260||NON CONTRACTED|COMMERCIAL OTHER|||||1.77||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.62||| 36415|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.17||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||4.20||| 36415|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.17||| 36415|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER 2|||||0.00||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|MEDICAID CSHCN|||||0.19||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||0.19||| 36415|EAP|0352||Medicare|MEDICARE A & B|||||28.51||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.94||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.09||| 36415|EAP|0636||Medicare|MEDICARE RAILROAD|||||47.45||| 36415|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 36415|EAP|0251|OLANZAPINE ZYDIS 20MG TAB PO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||145.20||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||2,194.35||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.77||| 36415|EAP|0270||NON CONTRACTED|COMMERCIAL OTHER|||||4.90||| 36415|EAP|0305||Managed Medicaid|FAMILY PLANNING GRANT|||||0.25||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 36415|EAP|0306||NON CONTRACTED|BOONE CHAPMAN|||||4.50||| 36415|EAP|0302|HEPATITIS B SURF ANTIBODY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.44||| 36415|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||30.90||| 36415|EAP|0510||Multiplan|WEB TPA|||||2.50||| 36415|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.94||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 36415|EAP|0450|I&D HEMATOMA|Medicare|MEDICARE A & B|5.69||||25.89||| 36415|EAP|0306|NT MYCO RADID MIC RWL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.40||| 36415|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.82||| 36415|EAP|0391||NON CONTRACTED|COMMERCIAL OTHER|||||1,370.23||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|SUPERIOR STAR MCD|0.19||||0.19||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||4.96||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.14||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||10,022.15||| 36415|EAP|0351||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.61||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.60||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||5.18||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.27||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||11.50||| 36415|EAP|0258||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||55.50||| 36415|EAP|0352||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.22||| 36415|EAP|0981||Multiplan|WEB TPA OF GRAND PRAIRIE|||||0.00||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.07||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||6.11||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.46||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.36||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.59||| 36415|EAP|0301||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.14||| 36415|EAP|0419||Medicare|MEDICARE A & B|||||6.37||| 36415|EAP|0251|HALOPERIDOL LAC 2MG/ML CONC 5M|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||14.90||| 36415|EAP|0459||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.42||| 36415|EAP|0306||NON CONTRACTED|BOONE CHAPMAN|||||2.11||| 36415|EAP|0410||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||16.64||| 36415|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.93||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||669.83||| 36415|EAP|0949||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.68||| 36415|EAP|0611||Medicare|MEDICARE A & B|||||29.47||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.15||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||3.45||| 36415|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.55||| 36415|EAP|0410||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.37||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 36415|EAP|0302|OH RUBELLA IGGANTIBODY|NON CONTRACTED|COMMERCIAL OTHER|||||0.55||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 36415|EAP|0940||Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0309||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.98||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.10||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|NON CONTRACTED|COMMERCIAL OTHER|||||1.77||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.53||| 36415|EAP|0309|SEQ DNAP (RWL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.38||| 36415|EAP|0310|MPL 515 MUTATION QUANT (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||7.90||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.19||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||7.55||| 36415|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.93||| 36415|EAP|0419||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.09||| 36415|EAP|0949||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||18.68||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.20||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Medicare|MEDICARE A & B|5.69||||1.77||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|OTHER MEDICAID|||||0.19||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||4.15||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||7.27||| 36415|EAP|0762||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.00||| 36415|EAP|0335||Medicare|MEDICARE A & B|||||4.52||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.99||| 36415|EAP|0310|CALR EXON 9 MUTATION PCR (ARUP|NON CONTRACTED|COMMERCIAL OTHER|||||5.80||| 36415|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.86||| 36415|EAP|0255||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.40||| 36415|EAP|0999||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 36415|EAP|0410|VENT SUPPORT INITATION|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||21.68||| 36415|EAP|0390||Medicare|MEDICARE A & B|||||3.14||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.68||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||669.83||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|SIERRA HEALTH & LIFE|||||0.19||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 36415|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Medicare|MEDICARE A & B|||||20.61||| 36415|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.66||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.45||| 36415|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.84||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.41||| 36415|EAP|0302|HEPATITIS A AB TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.79||| 36415|EAP|0942||Medicare|MEDICARE A & B|||||1.50||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||3.13||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.51||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 36415|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||0.77||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||7.69||| 36415|EAP|0981|ER VISIT; LEVEL IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 36415|EAP|0350||Medicare|MEDICARE A & B|||||29.32||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 36415|EAP|0301|ALCOHOL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.27||| 36415|EAP|0301|VENIPUNCTURE|NON CONTRACTED|COMMERCIAL OTHER 2|0.19||||0.00||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||4.14||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||3.51||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.86||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.51||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.40||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.19||||1.63||| 36415|EAP|0981|ER VISIT; LEVEL IV|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||1.14||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Multiplan|TML GRP INS|0.19||||0.19||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.25||| 36415|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 36415|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||137.20||| 36415|EAP|0636||Cigna|CIGNA OF TN CHATTANOOGA|||||45.15||| 36415|EAP|0257||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.50||| 36415|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Medicare|MEDICARE A & B|||||2.99||| 36415|EAP|0307||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.69||| 36415|EAP|0410|MINI NEB TX OR SPUTUM IND(IMC)|Medicare|MEDICARE A & B|||||2.20||| 36415|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.69||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||104.20||| 36415|EAP|0771||Multiplan|TML GRP INS|||||160.36||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.45||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.38||| 36415|EAP|0762||Medicare|MEDICARE A & B|0.75||||0.75||| 36415|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||0.40||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||24.30||| 36415|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.20||| 36415|EAP|0260|HYDRATION IV INF,31MIN-1HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.14||| 36415|EAP|0272||Multiplan|WEB TPA|||||0.07||| 36415|EAP|0306|HPV THINPREP|Cigna|CIGNA OPEN ACCESS PLUS|||||96.50||| 36415|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.07||| 36415|EAP|0981||Medicare|MEDICARE PART A|||||0.00||| 36415|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||5.25||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.19||| 36415|EAP|0459||Medicare|MEDICARE RAILROAD|||||13.15||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.38||| 36415|EAP|0771||ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.99||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||82.60||| 36415|EAP|0331||Medicare|MEDICARE A & B|||||2.48||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA OTHER|||||0.19||| 36415|EAP|0760||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||200.04||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.42||| 36415|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||5.69||| 36415|EAP|0460||Medicare|MEDICARE A & B|||||4.74||| 36415|EAP|0450||Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||3.45||| 36415|EAP|0260||NON CONTRACTED|COMMERCIAL OTHER|||||669.83||| 36415|EAP|0730||Blue Cross PPO Select|BCBS UTHCT|||||3.86||| 36415|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 36415|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.12||| 36415|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||213.82||| 36415|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0260||Cigna|NALC HLTH BENEFIT|||||213.82||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|NON CONTRACTED|COMMERCIAL OTHER 2|||||669.83||| 36415|EAP|0320|HEEL/CALCANEUS, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||0.88||| 36415|EAP|0391||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.69||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.08||| 36415|EAP|0510||NON CONTRACTED|BOONE CHAPMAN|||||2.64||| 36415|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 36415|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.55||| 36415|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.39||| 36415|EAP|0301|H. PYLORI BREATH ADULT (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.67||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO Select|BCBS UTHCT|||||2.10||| 36415|EAP|0460||NON CONTRACTED|COMMERCIAL OTHER|||||1.93||| 36415|EAP|0306|NT MYCO RADID MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.60||| 36415|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.74||| 36415|EAP|0350|3D RENDER W/O POSTPROCESS|Medicare|MEDICARE A & B|||||7.87||| 36415|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Cigna|CIGNA OPEN ACCESS PLUS|||||4.84||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Multiplan|GILSBAR INC|||||0.19||| 36415|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||669.83||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||4.38||| 36415|EAP|0305||Cigna|CIGNA OPEN ACCESS PLUS|||||0.25||| 36415|EAP|0352||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.06||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||5.69||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||18.68||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||2.04||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Blue Cross PPO Select|BCBS UTHCT|||||1.77||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.99||| 36415|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 36415|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||1.03||| 36415|EAP|0301||Managed Medicaid|FAMILY PLANNING GRANT|||||0.45||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||10.56||| 36415|EAP|0301|FOLATE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.41||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.50||| 36415|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||1.66||| 36415|EAP|0305||Cigna|CIGNA OTHER|||||1.68||| 36415|EAP|0403||Medicare|MEDICARE A & B|||||4.83||| 36415|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 36415|EAP|0352||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||21.84||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Medicare|MEDICARE A & B|||||3.26||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.08||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.36||| 36415|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.03||| 36415|EAP|0450||Medicaid|MEDICAID|||||213.82||| 36415|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.09||| 36415|EAP|0450||Multiplan|TML GRP INS|||||3.37||| 36415|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.35||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||6.75||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||0.38||| 36415|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 36415|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0251|ESCITALOPRAM 5MG TAB PO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||14.70||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.95||| 36415|EAP|0981||Medicaid|MEDICAID|||||0.00||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.26||| 36415|EAP|0250||Medicare|MEDICARE RAILROAD|||||34.65||| 36415|EAP|0272||Cigna|CIGNA OPEN ACCESS PLUS|||||0.07||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 36415|EAP|0335||Medicare|MEDICARE A & B|||||10.47||| 36415|EAP|0419||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.37||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||14.82||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.19||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||110.50||| 36415|EAP|0251|FLUDROCORTISONE TAB .1MG (FLOR|Medicare|MEDICARE A & B|6.90||||3.75||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (GIC)|Blue Cross PPO Select|BCBS UTHCT|||||3.26||| 36415|EAP|0306|NT MYCO RADID MIC RWL (REF)|Medicare|MEDICARE A & B|||||3.60||| 36415|EAP|0301|CHLORIDE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.75||| 36415|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||3.51||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||0.47||| 36415|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.75||| 36415|EAP|0272|CATH TRAY IC 16FR (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||89.25||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||1.03||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.28||| 36415|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.04||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|NALC HLTH BENEFIT|0.19||||0.19||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.91||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||4.36||| 36415|EAP|0352||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.51||| 36415|EAP|0636|POTASSIUM CHLORIDE 40 MEQ/20ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||4.36||| 36415|EAP|0251|HALOPERIDOL TAB 1MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.31||| 36415|EAP|0301||ChampVA|CHAMPVA OF CO DENVER|0.19||||1.65||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||0.19||| 36415|EAP|0257||Medicare|MEDICARE A & B|3.15||||11.50||| 36415|EAP|0272||Cigna|CIGNA OPEN ACCESS PLUS|||||0.17||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||36.45||| 36415|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.35||| 36415|EAP|0771||Cigna|CIGNA OPEN ACCESS PLUS|||||160.36||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||18.50||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.48||| 36415|EAP|0410||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.33||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||4.08||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.17||| 36415|EAP|0762||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.75||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.00||| 36415|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.18||| 36415|EAP|0271|VILAZODONE 20MG TAB PO|Medicare|MEDICARE A & B|||||33.85||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.07||| 36415|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.45||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||1.77||| 36415|EAP|0352||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||24.37||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|SUPERIOR STAR MCD|||||669.83||| 36415|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| 36415|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.32||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||0.30||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.73||| 36415|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 36415|EAP|0301|LIPID PANEL|Medicare|MEDICARE A & B|0.19||||2.36||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 36415|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.27||| 36415|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.31||| 36415|EAP|0312|MORPH ISH QUANT/SEMIQ (CLARIEN|Medicare|MEDICARE A & B|||||14.49||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.19||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (INFD)|Medicare|MEDICARE A & B|||||3.26||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||4.50||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.34||| 36415|EAP|0636|GLUCAGON INJ 1MG SDV|Medicare|MEDICARE A & B|||||673.95||| 36415|EAP|0352|CT STONE STUDY ABDOMEN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.51||| 36415|EAP|0258||Medicare|MEDICARE A & B|||||41.10||| 36415|EAP|0311||Blue Cross PPO Select|BCBS UTHCT|||||0.57||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.88||| 36415|EAP|0272|LIMB HOLDER|Medicare|MEDICARE A & B|||||37.80||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.30||| 36415|EAP|0301|CATHECHOLAMINES,24-HR URINE-RF|Medicare|MEDICARE A & B|0.19||||2.23||| 36415|EAP|0305||Cigna|CIGNA OPEN ACCESS PLUS|||||0.78||| 36415|EAP|0305||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 36415|EAP|0301|HIAA, 24 HR URINE (REF) (V)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.64||| 36415|EAP|0301|ESTRONE, SERUM (REF)|Medicare|MEDICARE A & B|0.19||||1.05||| 36415|EAP|0260|HYDRATION IV INF,31MIN-1HR|Cigna|CIGNA OPEN ACCESS PLUS|||||1.14||| 36415|EAP|0333||Medicare|MEDICARE A & B|||||12.42||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.80||| 36415|EAP|0459||Managed Medicaid|SUPERIOR STAR MCD|||||8.95||| 36415|EAP|0390||Medicare|MEDICARE A & B|||||0.25||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 36415|EAP|0301|B-12|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.42||| 36415|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||0.47||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||11.50||| 36415|EAP|0510||Cigna|CIGNA OTHER|||||2.64||| 36415|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.59||| 36415|EAP|0510||Cigna|CIGNA OTHER|||||3.79||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||3.45||| 36415|EAP|0761||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.82||| 36415|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Blue Cross PPO Select|BCBS UTHCT|||||4.84||| 36415|EAP|0301|VENIPUNCTURE|Medicaid|MEDICAID|0.19||||0.00||| 36415|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 36415|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||1.38||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 36415|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE A & B|||||2.11||| 36415|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.11||| 36415|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.35||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.97||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.19||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||2.21||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||3.95||| 36415|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.94||| 36415|EAP|0450||Multiplan|WEB TPA|||||3.45||| 36415|EAP|0403||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.83||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.76||| 36415|EAP|0306|KINYOUN STAIN|Medicare|MEDICARE A & B|||||1.38||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.19||| 36415|EAP|0271||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| 36415|EAP|0730||Medicare|MEDICARE A & B|3.86||||3.86||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||18.68||| 36415|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.12||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||11.19||| 36415|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.59||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|FAMILY PLANNING GRANT|||||0.19||| 36415|EAP|0459||Medicare|MEDICARE A & B|||||3.00||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.37||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.61||| 36415|EAP|0274|SLING,ARM, MEDIUM|Medicare|MEDICARE A & B|||||8.40||| 36415|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 36415|EAP|0252|PAROXETINE TAB 20 MG|Medicare|MEDICARE A & B|||||9.95||| 36415|EAP|0311|FLOW CYTO TC ADD (PATH aSSOC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.99||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.60||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.76||| 36415|EAP|0255||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||6.35||| 36415|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||1.14||| 36415|EAP|0301|VMA URINE, QUANT (REF) (V)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.83||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||35.95||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.41||| 36415|EAP|0510||Multiplan|TML GRP INS|||||2.50||| 36415|EAP|0301||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 36415|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicare|MEDICARE A & B|||||0.25||| 36415|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 36415|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 36415|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Medicare|MEDICARE A & B|||||2.09||| 36415|EAP|0333||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.00||| 36415|EAP|0301|VENIPUNCTURE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 36415|EAP|0305||Medicare|MEDICARE RAILROAD|||||1.68||| 36415|EAP|0771||Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.13||| 36415|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 36415|EAP|0771|ADM OF PNEUMOCOCCAL VACC (5E)|Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0350||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||29.32||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.63||| 36415|EAP|0306||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||7.07||| 36415|EAP|0459||NON CONTRACTED|COMMERCIAL OTHER 2|||||1.65||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.19||| 36415|EAP|0252|DIVALPROEX NA EC TAB 250 MG U/|Medicare|MEDICARE A & B|||||6.25||| 36415|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||0.34||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.59||| 36415|EAP|0312|SURG PATH - LEVEL I|Medicare|MEDICARE A & B|||||0.72||| 36415|EAP|0301|URINE DIP AUTOM W/O MICRO|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.60||| 36415|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.44||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.19||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.66||| 36415|EAP|0402||Medicare|MEDICARE A & B|||||11.18||| 36415|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 36415|EAP|0311|FLOW CYTOMETRY EA ADL MARKER|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.80||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicare|RESERVE NAT INS|||||0.19||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.19||||0.45||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.25||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||117.95||| 36415|EAP|0403||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.82||| 36415|EAP|0302|MHA-TP (REF)|Medicare|MEDICARE A & B|||||0.19||| 36415|EAP|0301|CORTISOL, FREE 24-HR URINE (RE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||1.28||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||2.21||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Medicaid|MEDICAID|||||2.10||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.19||||0.19||| 36415|EAP|0306|HEPATITIS C GENOTYPING BY PCR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.07||| 36415|EAP|0450|INJECTION ANTIBIOTIC|Medicare|MEDICARE A & B|5.69||||213.82||| 36415|EAP|0260||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.45||| 36415|EAP|0307||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.69||| 36415|EAP|0460||Medicare|MEDICARE A & B|||||2.82||| 36415|EAP|0410||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.37||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 36415|EAP|0302|BORD PERTUSSIS AB IGG BY IMMUB|Medicare|MEDICARE A & B|||||0.67||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 36415|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Medicare|MEDICARE A & B|||||0.90||| 36415|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 36415|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| 36415|EAP|0402||Blue Cross PPO Select|BCBS UTHCT|||||11.18||| 36415|EAP|0301|IMMUNOASSAY NOS (REF)|Medicare|MEDICARE A & B|0.19||||3.95||| 36415|EAP|0306|SUSCEP-MIC , PER PLATE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||1.46||| 36415|EAP|0301|AST SGOT (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.73||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.66||| 36415|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 36415|EAP|0270|PEDI URINE COLLECTOR (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||0.06||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Managed Medicaid|MOLINA MEDICAID|0.19||||0.19||| 36415|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||619.42||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||4.14||| 36415|EAP|0459||Blue Cross PPO Select|BCBS UTHCT|||||1.65||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.00||||0.08||| 36415|EAP|0320||Cigna|CIGNA OPEN ACCESS PLUS|||||2.16||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.19||| 36415|EAP|0301||ChampVA|CHAMPVA OF CO DENVER|0.19||||117.95||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.28||| 36415|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|0.19||||0.25||| 36415|EAP|0949||Medicare|MEDICARE A & B|181.41||||181.41||| 36415|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 36415|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.73||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Multiplan|WEB TPA|||||1.14||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.07||| 36415|EAP|0307||Blue Cross PPO Select|BCBS UTHCT|||||1.18||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.19||||4.44||| 36415|EAP|0301|CALCITONIN (REF)|Medicare|MEDICARE A & B|0.19||||2.60||| 36415|EAP|0636||Cigna|CIGNA OF TN CHATTANOOGA|||||106.75||| 36415|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.78||| 36415|EAP|0301||Medicaid|MEDICAID|0.19||||1.46||| 36415|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.32||| 36415|EAP|0771||Medicare|MEDICARE A & B|||||0.86||| 36415|EAP|0301|VENIPUNCTURE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||0.00||| 36415|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.19||||0.08||| 36415|EAP|0311||Medicare|MEDICARE A & B|||||0.57||| 36415|EAP|0301|VENIPUNCTURE|Aetna|TRS COORDINATED CARE|||||0.00||| 36415|EAP|0351||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.61||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||27.30||| 36415|EAP|0402|US BREAST BILATERAL,REAL TIME|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.47||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Medicare|MEDICARE A & B|0.19||||0.19||| 36415|EAP|0300|Allergen, Insect, rPol d 5|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.25||| 36415|EAP|0300|NUC ANTIGEN ANTIBODY (REF900)|Medicare|MEDICARE A & B|||||59.19||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||4.14||| 36415|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.63||| 36415|EAP|0390||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.34||| 36415|EAP|0771||Medicare|MEDICARE A & B|||||0.12||| 36415|EAP|0352||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||27.12||| 36415|EAP|0306|CLOSTRIDIUM DIFF CULTURE - REF|Medicare|MEDICARE A & B|||||140.88||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||182.99||| 36415|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.07||| 36415|EAP|0258||Medicare|MEDICARE A & B|||||42.85||| 36415|EAP|0251||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.30||| 36415|EAP|0301|FERRITIN (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||182.99||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.88||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.35||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.91||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||5.25||| 36415|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.19||||1.74||| 36415|EAP|0252|MESALAMINE EC TAB 400 MG|Medicare|MEDICARE A & B|||||13.80||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 36415|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 36415|EAP|0750||Medicare|MEDICARE A & B|||||29.16||| 36415|EAP|0260|IV INFUSION THER,EA ADD'L HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.03||| 36415|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.80||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||1.14||| 36415|EAP|0309|IRL B IGG BILL (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.60||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.45||| 36415|EAP|0272||Managed Medicaid|MEDICAID CSHCN|||||0.07||| 36415|EAP|0255||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||5.69||| 36415|EAP|0260||Blue Cross PPO|BLUE CROSS POS|||||1.81||| 36415|EAP|0361||Medicare|MEDICARE A & B|||||13.40||| 36415|EAP|0459||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||13.15||| 36415|EAP|0301||Managed Medicaid|FAMILY PLANNING GRANT|||||0.30||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|181.41||||181.41||| 36415|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.45||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Aetna|TRS COORDINATED CARE|||||1.77||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.29||| 36415|EAP|0260|IV INFUSION THER,EA ADD'L HR|Medicare|MEDICARE A & B|1.03||||1.03||| 36415|EAP|0260||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.77||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.17||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||0.08||| 36415|EAP|0450||Multiplan|WEB TPA|||||11.19||| 36415|EAP|0271||Managed Medicaid|MEDICAID CSHCN|||||4.90||| 36415|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.34||| 36415|EAP|0300||Medicare|MEDICARE RAILROAD|||||2.00||| 36415|EAP|0302||Aetna|TRS COORDINATED CARE|||||1.33||| 36415|EAP|0306|HERPES SIMPLEX VIRUS BY PCR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.19||| 36415|EAP|0309||NON CONTRACTED|COMMERCIAL OTHER|||||1.16||| 36415|EAP|0255||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.50||| 36415|EAP|0301||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 36415|EAP|0271||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.90||| 36415|EAP|0301|BILIRUBIN; TOTAL|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.14||| 36415|EAP|0251||Medicaid|MEDICAID|||||3.15||| 36415|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 36415|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||47.25||| 36415|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| 36415|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||62.15||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 36415|EAP|0271||Workers Compensation|WC TX MUTUAL INS|||||4.90||| 36415|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 36415|EAP|0610||Medicare|MEDICARE A & B|||||25.88||| 36415|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.99||| 36415|EAP|0258||Blue Cross PPO|BLUE CROSS PPO|||||46.15||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||181.41||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.61||| 36415|EAP|0250||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||9.72||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.19||||0.00||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS POS|||||50.40||| 36415|EAP|0301|VENIPUNCTURE|Medicare|MEDICARE RAILROAD|0.19||||0.00||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS POS|||||17.85||| 36415|EAP|0762||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.00||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.59||| 36415|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| 36415|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 36415|EAP|0343||Medicare|MEDICARE A & B|||||9.08||| 36415|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| 36415|EAP|0949||Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.77||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.29||| 36415|EAP|0271||Medicare|MEDICARE A & B|||||4.90||| 36415|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.17||| 36415|EAP|0483||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||14.21||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BLUE CROSS POS|0.19||||0.86||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.87||| 36415|EAP|0301|AST (SGOT)|Blue Cross PPO|BCBS WALMART|0.19||||1.56||| 36415|EAP|0410||Medicare|MEDICARE A & B|||||2.20||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Workers Compensation|WC GALLAGHER BASSETT|||||0.19||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||160.36||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.47||| 36415|EAP|0981||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||12.60||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.63||| 36415|EAP|0251|LABETALOL HCL 5MG/ML 20ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||110.95||| 36415|EAP|0301|RENAL FUNCTION PANEL|Medicare|MEDICARE A & B|0.19||||157.50||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||2.59||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.94||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.44||| 36415|EAP|0450||Workers Compensation|WC OTHER|||||5.69||| 36415|EAP|0306|HPV THINPREP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.77||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||73.50||| 36415|EAP|0301|IGA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.53||| 36415|EAP|0610|3D RENDERING W/POSTPROCESS MRI|Medicare|MEDICARE A & B|||||9.00||| 36415|EAP|0482||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||13.03||| 36415|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||4.15||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.49||| 36415|EAP|0981||Workers Compensation|WC GALLAGHER BASSETT|||||0.00||| 36415|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|Blue Cross PPO|BLUE CROSS PPO|0.19||||4.14||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.29||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.92||| 36415|EAP|0510|CLINIC VISIT; MID, EST (OCCME)|Workers Compensation|WC OTHER|||||2.50||| 36415|EAP|0410||Medicare|MEDICARE A & B|||||6.37||| 36415|EAP|0762||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.75||| 36415|EAP|0306||Workers Compensation|WC GALLAGHER BASSETT|||||1.32||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Workers Compensation|WC OTHER|||||1.14||| 36415|EAP|0301|CO 2 OR 3 (BICARBONATE)|Medicare|MEDICARE A & B|0.19||||0.90||| 36415|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||266.96||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 36415|EAP|0949||Managed Medicaid|FAMILY PLANNING GRANT|||||213.82||| 36415|EAP|0250||Blue Cross PPO|BLUE CROSS PPO|||||316.05||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||4.19||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||3.14||| 36415|EAP|0250||Blue Cross PPO|BLUE CROSS POS|||||15.40||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||0.00||| 36415|EAP|0762||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.75||| 36415|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 36415|EAP|0312||Medicare|MEDICARE A & B|||||1.25||| 36415|EAP|0981|ER VISIT; LEVEL IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||2.31||| 36415|EAP|0636||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.50||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.38||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||2.59||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 36415|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||0.00||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Workers Compensation|WC TX MUTUAL INS|||||0.19||| 36415|EAP|0272||Workers Compensation|WC TX MUTUAL INS|||||4.90||| 36415|EAP|0301|VENIPUNCTURE|Multiplan|WEB TPA|||||0.00||| 36415|EAP|0730||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.86||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.15||| 36415|EAP|0300||Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 36415|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 36415|EAP|0513||Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Workers Compensation|WC OTHER|||||0.19||| 36415|EAP|0312|LEVEL V-SURG PATH, GROSS & MIC|Medicare|MEDICARE A & B|||||5.97||| 36415|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|0.19||||370.40||| 36415|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.54||| 36415|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE A & B|1.03||||5.69||| 36415|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.54||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Workers Compensation|WC RISK MANAGEMENT|||||0.19||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||182.99||| 36415|EAP|0250||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||42.85||| 36415|EAP|0730||Medicare|MEDICARE RAILROAD|||||3.86||| 36415|EAP|0510||Workers Compensation|WC RISK MANAGEMENT|||||3.79||| 36415|EAP|0510||Aetna|TRS COORDINATED CARE|||||2.50||| 36415|EAP|0305||Medicare|MEDICARE A & B|||||1.38||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.30||| 36415|EAP|0730||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.86||| 36415|EAP|0424||Medicare|MEDICARE A & B|||||2.71||| 36415|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Workers Compensation|WC GALLAGHER BASSETT|||||1.66||| 36415|EAP|0459||Medicaid|MEDICAID|||||5.42||| 36415|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||1.77||| 36415|EAP|0270|IV ADMINISTRATION SET, I-MED T|Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 36415|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.44||| 36415|EAP|0250|HYOSCYAMINE SULFATE 0.125MG/ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.98||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Workers Compensation|WC GALLAGHER BASSETT|||||669.83||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||4.38||| 36415|EAP|0460||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.93||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Workers Compensation|WC GALLAGHER BASSETT|||||2.10||| 36415|EAP|0301|VITAMIN D, 25 HYDROXY|NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.81||| 36415|EAP|0270||Workers Compensation|WC TX MUTUAL INS|||||0.42||| 36415|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BLUE CROSS PPO|||||1.62||| 36415|EAP|0771||Aetna|AETNA EXXON MOBIL|||||0.86||| 36415|EAP|0301|IGA (REF)|Medicare|MEDICARE A & B|0.19||||1.53||| 36415|EAP|0302|MHA-TP (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.22||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||33.49||| 36415|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 36415|EAP|0272||Blue Cross PPO|BCBS WALMART|||||5.25||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.14||| 36415|EAP|0302||Aetna|TRS COORDINATED CARE|||||1.75||| 36415|EAP|0305||Workers Compensation|WC TX MUTUAL INS|||||1.68||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||93.45||| 36415|EAP|0450||Workers Compensation|WC OTHER|||||213.82||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||121.35||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.11||| 36415|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.11||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||200.04||| 36415|EAP|0771||Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 36415|EAP|0450||United Healthcare|UMR|||||4.12||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||2.23||| 36415|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.45||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.25||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross PPO|BCBS WALMART|0.19||||0.19||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.51||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Medicare|MEDICARE PART A|0.19||||0.19||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross PPO|BLUE CROSS POS|0.19||||0.00||| 36415|EAP|0450||United Healthcare|GOLDEN RULE INSURANCE|||||3.45||| 36415|EAP|0391||Medicare|MEDICARE A & B|||||1,370.23||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.19||||0.19||| 36415|EAP|0302|REFLEX RPR TITER (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.45||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0301|VENIPUNCTURE|PHCS|WEB TPA|||||0.00||| 36415|EAP|0352||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||28.51||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.65||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.38||| 36415|EAP|0272||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.07||| 36415|EAP|0301|TOTAL T3 (ARUP)|Medicare|MEDICARE A & B|0.19||||0.58||| 36415|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||3.79||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.60||| 36415|EAP|0450||Medicaid|MEDICAID|||||3.45||| 36415|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 36415|EAP|0252|DILTIAZEM SR CAP 120MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.15||| 36415|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|NON CONTRACTED|COMMERCIAL OTHER|||||5.15||| 36415|EAP|0981||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.00||| 36415|EAP|0301|IGA (REF)|Medicaid|MEDICAID|0.19||||66.60||| 36415|EAP|0214||Blue Cross PPO|BLUE CROSS PPO|||||37.43||| 36415|EAP|0251|CARBAMAZEPINE TAB 200 MG U/D|Blue Cross PPO|BLUE CROSS PPO|||||5.70||| 36415|EAP|0306||Medicaid|MEDICAID|||||7.07||| 36415|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.26||| 36415|EAP|0320|CHEST SPECIAL VIEWS, LAT DECUB|Medicare|MEDICARE A & B|||||3.68||| 36415|EAP|0761||United Healthcare|UMR|||||381.05||| 36415|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.36||| 36415|EAP|0900||Medicare|MEDICARE A & B|||||2.01||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Healthcare|UNITED HEALTHCARE STUDENT RES|||||0.19||| 36415|EAP|0450||Medicaid|MEDICAID|||||7.69||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.46||| 36415|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.50||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 36415|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|0.19||||190.95||| 36415|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BCBS TRANE PPO|0.19||||0.86||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.27||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.32||| 36415|EAP|0252||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.65||| 36415|EAP|0403||United Healthcare|UMR|||||4.83||| 36415|EAP|0352||Medicare|MEDICARE A & B|||||27.12||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.10||| 36415|EAP|0301||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.14||| 36415|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||70.60||| 36415|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.50||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.33||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.16||| 36415|EAP|0301||United Healthcare|UMR|0.19||||1.14||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||363.55||| 36415|EAP|0270||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.90||| 36415|EAP|0258||Medicare|MEDICARE A & B|||||46.15||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.19||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.59||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.64||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 36415|EAP|0510||PHCS|WEB TPA|||||2.64||| 36415|EAP|0301|B-12|NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.42||| 36415|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.22||| 36415|EAP|0260||Medicare|MEDICARE A & B|1.03||||3.45||| 36415|EAP|0305||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.22||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.17||| 36415|EAP|0301|FOLATE, SERUM|NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.41||| 36415|EAP|0949||United Healthcare|UMR|||||213.82||| 36415|EAP|0301|ANTI-DOUBLE STRANDED DNA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||4.14||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0302|IMMONOASSAY QUANT NOS (6596)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.65||| 36415|EAP|0771|ADMIN OF SINGLE VACCINE/TOXOID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 36415|EAP|0352|CT UPPER EXTREMITY; W/ CONTRAS|Medicare|MEDICARE A & B|||||21.69||| 36415|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 36415|EAP|0301|F-ACTIN SM AB IgG ELISA (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.33||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||0.05||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||2.33||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.51||| 36415|EAP|0761||Medicare|MEDICARE A & B|||||1.82||| 36415|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||14.70||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||4.14||| 36415|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Blue Cross PPO|BLUE CROSS POS|0.19||||2.66||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||106.75||| 36415|EAP|0306|HPV THINPREP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.16||| 36415|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.64||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.46||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||2.21||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||2.35||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|United Healthcare|GOLDEN RULE INSURANCE|||||669.83||| 36415|EAP|0450||PHCS|TML GRP INS|||||3.37||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||11.75||| 36415|EAP|0320|LUMBOSACRAL SPINE COMP W/BENDI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.02||| 36415|EAP|0352||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.12||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||2.11||| 36415|EAP|0611||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.47||| 36415|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Medicare|MEDICARE A & B|0.19||||1.10||| 36415|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 36415|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.35||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||5.81||| 36415|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.66||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Tricare|TRICARE WEST UNITED HEALTH|||||9.50||| 36415|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 36415|EAP|0450||United Healthcare|UMR|||||3.45||| 36415|EAP|0301|FOLATE, SERUM|Blue Cross PPO|BCBS WALMART|0.19||||0.41||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||45.15||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||0.25||| 36415|EAP|0450|Treatment of ankle fracture|United Healthcare|GOLDEN RULE INSURANCE|||||35.25||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||58.55||| 36415|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.66||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||9.01||| 36415|EAP|0260||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.24||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.72||| 36415|EAP|0257||Medicare|MEDICARE A & B|3.15||||5.95||| 36415|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|United Healthcare|UMR|||||669.83||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||2.15||| 36415|EAP|0306|NT MAC MIC RWL (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.00||| 36415|EAP|0251|PYRIDOSTIGMINE BROMIDE 60MG TA|Medicare|MEDICARE A & B|6.90||||5.30||| 36415|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.45||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.45||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||56.45||| 36415|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.03||| 36415|EAP|0301|BASIC METABOLIC PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||2.33||| 36415|EAP|0301|VITAMIN B1, PLASMA (REF)|Medicare|MEDICARE A & B|0.19||||0.31||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.07||| 36415|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Medicare|MEDICARE A & B|||||3.54||| 36415|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 36415|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 36415|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.64||| 36415|EAP|0301||Blue Cross PPO|BCBS WALMART|0.19||||0.38||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.77||| 36415|EAP|0611||Medicare|MEDICARE A & B|||||47.04||| 36415|EAP|0251|ESTRADIOL TAB 1 MG 100'S|United Healthcare|UMR|||||3.15||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.73||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.84||| 36415|EAP|0301|VENIPUNCTURE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.00||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Medicare|MEDICARE A & B|||||3.79||| 36415|EAP|0510||United Healthcare|UMR|||||3.26||| 36415|EAP|0301||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.80||| 36415|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Medicare|MEDICARE A & B|||||160.36||| 36415|EAP|0981||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.00||| 36415|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||7.35||| 36415|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|0.19||||2.28||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.00||| 36415|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.22||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.13||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.17||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||34.25||| 36415|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 36415|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.88||| 36415|EAP|0981|ER VISIT; LEVEL IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.02||| 36415|EAP|0251|ATORVASTATIN 40MG TAB PO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.15||| 36415|EAP|0305|DRVVT (REF)|Medicare|MEDICARE A & B|||||0.49||| 36415|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| 36415|EAP|0636||Medicare|MEDICARE RAILROAD|||||15.10||| 36415|EAP|0510||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.64||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.30||| 36415|EAP|0302|ANA TITER|Medicare|MEDICARE A & B|||||2.23||| 36415|EAP|0306|NT MYCO RADID MIC RWL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.60||| 36415|EAP|0761||United Healthcare|GOLDEN RULE INSURANCE|||||0.83||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Medicare|MEDICARE A & B|||||3.26||| 36415|EAP|0252|ATORVASTATIN *LIPITOR* TAB 10|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.15||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||1.14||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||0.19||| 36415|EAP|0311||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.57||| 36415|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.10||| 36415|EAP|0252|EFFEXOR XR 37.5MG CAP SA|United Healthcare|UMR|||||13.30||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|BOONE CHAPMAN|||||0.19||| 36415|EAP|0450||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||669.83||| 36415|EAP|0301|HAPTOGLOBIN, QUANT. (REF)|Medicare|MEDICARE A & B|0.19||||1.98||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||2.45||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Healthcare|UMR|0.19||||0.19||| 36415|EAP|0302|HEP B SURF ANTIGEN(811)|NON CONTRACTED|COMMERCIAL OTHER|||||0.48||| 36415|EAP|0272||PHCS|WEB TPA|||||5.25||| 36415|EAP|0110||Blue Cross PPO|BLUE CROSS PPO|||||21.00||| 36415|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Medicare|MEDICARE A & B|||||0.25||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BCBS WALMART|||||3.45||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||17.15||| 36415|EAP|0306|HEP C RNA, QNT NAAT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 36415|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 36415|EAP|0730||Medicaid|MEDICAID|||||3.86||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||2.33||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.68||| 36415|EAP|0636||Medicare|MEDICARE PART B|||||0.55||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.05||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.55||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||0.89||| 36415|EAP|0272||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.17||| 36415|EAP|0260|IV, THER/PROPH/DIAG IV PUSH|Medicare|MEDICARE A & B|1.03||||669.83||| 36415|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||36.75||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.30||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 36415|EAP|0258||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||37.75||| 36415|EAP|0305||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.68||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Medicare|MEDICARE RAILROAD|||||1.77||| 36415|EAP|0271||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.90||| 36415|EAP|0250|LUBIPROSTONE 24MCG CAPSULE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.22||| 36415|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||292.60||| 36415|EAP|0301|ALT (SGPT)|Blue Cross PPO|BCBS WALMART|0.19||||1.26||| 36415|EAP|0257||Medicare|MEDICARE A & B|3.15||||100.70||| 36415|EAP|0251||Aetna|AETNA EL PASO CLAIMS OFFICE|||||14.20||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||89.25||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.70||| 36415|EAP|0949||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 36415|EAP|0272||Medicare|MEDICARE RAILROAD|||||5.25||| 36415|EAP|0301|VENIPUNCTURE|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.00||| 36415|EAP|0510||United Healthcare|UMR|||||2.64||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.52||| 36415|EAP|0252|FAMOTIDINE 10MG/ML 2ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.50||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.10||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||3.51||| 36415|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||9.50||| 36415|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.37||| 36415|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|United Healthcare|UMR|||||18.68||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||71.40||| 36415|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.51||| 36415|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE A & B|1.03||||1.14||| 36415|EAP|0900||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.01||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||391.92||| 36415|EAP|0252|RISPERIDONE 1MG *RISPERDAL* TA|Medicare|MEDICARE A & B|||||3.15||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS POS|0.19||||4.14||| 36415|EAP|0510||United Healthcare|UMR|||||3.79||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||3.79||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.10||| 36415|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.65||| 36415|EAP|0301||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.07||| 36415|EAP|0480|PACER, DUAL W/PROGRAMMING|Medicare|MEDICARE A & B|||||3.22||| 36415|EAP|0251|TICAGRELOR 90MG TAB ORAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||23.30||| 36415|EAP|0257||Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||57.90||| 36415|EAP|0252||Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.50||| 36415|EAP|0302|IMMUNOFIXATION ELECTR,** URINE|Medicare|MEDICARE A & B|||||4.14||| 36415|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||1.72||| 36415|EAP|0257||Medicare|MEDICARE A & B|3.15||||3.15||| 36415|EAP|0301|F-ACTIN SM AB IgG ELISA (ARUP)|Blue Cross PPO|BLUE CROSS PPO|0.19||||0.50||| 36415|EAP|0460|SPIROMETRY|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.74||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0257||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.50||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.16||| 36415|EAP|0300|FENTANYL/METABOLITE,UR,QUANT|Blue Cross PPO|BLUE CROSS PPO|||||2.29||| 36415|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.25||| 36415|EAP|0320||Medicaid|MEDICAID|||||2.16||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||120.30||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||14.70||| 36415|EAP|0981||NON CONTRACTED|MRAMVA|||||0.00||| 36415|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||62.25||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||2.36||| 36415|EAP|0306|STUDY AEROBIC CULTURE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.25||| 36415|EAP|0510||Aetna|AETNA|||||2.99||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.46||| 36415|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.07||| 36415|EAP|0251||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||27.35||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Medicare|MEDICARE RAILROAD|||||610.42||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Healthcare|GOLDEN RULE INSURANCE|||||0.19||| 36415|EAP|0981|ER VISIT; LEVEL IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 36415|EAP|0920||Medicare|MEDICARE A & B|||||0.00||| 36415|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 36415|EAP|0258||Aetna|AETNA EL PASO CLAIMS OFFICE|||||46.15||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||176.48||| 36415|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.19||||5.81||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.38||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.55||| 36415|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.67||| 36415|EAP|0301|VENIPUNCTURE|NON CONTRACTED|COMMERCIAL OTHER|0.19||||0.00||| 36415|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||2.33||| 36415|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|0.19||||2.63||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.74||| 36415|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.45||| 36415|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|COMMERCIAL OTHER|||||181.41||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.65||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||1.57||| 36415|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.19||||1.14||| 36415|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.24||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.99||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| 36415|EAP|0301|VENIPUNCTURE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.19||||0.00||| 36415|EAP|0981||Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.18||| 36415|EAP|0510|DRAIN/INJ MAJOR JNT/BUR(IMC)|Medicare|MEDICARE A & B|||||6.11||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.19||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||1.22||| 36415|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.45||| 36415|EAP|0252||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||479.05||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||1.73||| 36415|EAP|0301|B-12|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.42||| 36415|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Blue Cross PPO|BCBS WALMART|||||1.77||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||14.20||| 36415|EAP|0450|INJECTION ANTIBIOTIC|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.77||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|Multiplan|WEB TPA OF GRAND PRAIRIE|||||0.19||| 36415|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.25||| 36415|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||50.84||| 36415|EAP|0302|EBV AB TO VCA (IGG) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||129.90||| 36415|EAP|0513||Blue Cross PPO|BCBS WALMART|||||3.79||| 36415|EAP|0301|PROTEIN, RANDOM URINE|Medicare|MEDICARE A & B|0.19||||0.94||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||0.92||| 36415|EAP|0302|QUANTIFERON TB GOLD (REF)|United Healthcare|UMR|||||2.18||| 36415|EAP|0320||Medicare|MEDICARE A & B|||||5.06||| 36415|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.68||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||27.35||| 36415|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.45||| 36415|EAP|0771||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||160.36||| 36415|EAP|0305|PROTHROMBIN TIME (REF)|Medicare|MEDICARE A & B|||||0.49||| 36415|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.17||| 36415|EAP|0271||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.90||| 36415|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| 36415|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.06||| 36415|EAP|0301|OCTREOTIDE (ARUP)|United Healthcare|UMR|0.19||||4.10||| 36415|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|PHCS|WEB TPA|||||1.14||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.56||| 36415|EAP|0306|NT MYCO RADID MIC RWL (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.60||| 36415|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.36||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||5.69||| 36415|EAP|0410||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.20||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Multiplan|WEB TPA OF GRAND PRAIRIE|||||5.51||| 36415|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.70||| 36415|EAP|0981|ER VISIT; LEVEL III|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0312|SURG PATH - LEVEL III|Medicare|MEDICARE A & B|||||0.69||| 36415|EAP|0335||Blue Cross PPO|BLUE CROSS POS|||||4.52||| 36415|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.77||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||63.90||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.25||| 36415|EAP|0302||Medicare|MEDICARE RAILROAD|||||1.11||| 36415|EAP|0320||Blue Cross PPO|BLUE CROSS POS|||||0.88||| 36415|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||48.85||| 36415|EAP|0302|MHA-TP (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.19||| 36415|EAP|0301||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.19||||1.07||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||0.07||| 36415|EAP|0309||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.31||| 36415|EAP|0510||Multiplan|WEB TPA|||||2.64||| 36415|EAP|0258||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.35||| 36415|EAP|0305|PLATELET COUNT, AUTOMATED|Blue Cross PPO|BLUE CROSS PPO|||||0.94||| 36415|EAP|0270|O2 SENSOR ADULT|Medicare|MEDICARE A & B|||||0.31||| 36415|EAP|0307||Blue Cross PPO|BLUE CROSS PPO|||||71.50||| 36415|EAP|0459||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||8.95||| 36415|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Medicare|MEDICARE A & B|5.69||||18.68||| 36415|EAP|0301||United Healthcare|UMR|0.19||||0.86||| 36415|EAP|0270||Medicare|MEDICARE A & B|||||0.23||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||1.03||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.97||| 36415|EAP|0300|INFLUENZA VIRUS MULT TYPES|Medicare|MEDICARE A & B|||||2.10||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BLUE CROSS POS|||||5.51||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.92||| 36415|EAP|0419||Medicare|MEDICARE A & B|||||7.09||| 36415|EAP|0320||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.35||| 36415|EAP|0302||Blue Cross PPO|BCBS WALMART|||||1.34||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||2.28||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||15.40||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 36415|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.15||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||17.80||| 36415|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 36415|EAP|0301||Medicare|MEDICARE RAILROAD|0.19||||2.21||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||1.77||| 36415|EAP|0301||PHCS|TML GRP INS|0.19||||2.35||| 36415|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||0.40||| 36415|EAP|0981||PHCS|WEB TPA|||||0.00||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.77||| 36415|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Medicare|MEDICARE A & B|||||2.99||| 36415|EAP|0300||United Healthcare|UMR|||||0.20||| 36415|EAP|0301|T4, TOTAL|Blue Cross PPO Select|BCBS UTHCT|0.19||||0.25||| 36415|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Medicare|MEDICARE A & B|||||1.66||| 36415|EAP|0482||Blue Cross PPO|BLUE CROSS PPO|||||13.03||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||23.10||| 36415|EAP|0459||Blue Cross PPO|BLUE CROSS PPO|||||5.42||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||182.99||| 36415|EAP|0272||Medicare|MEDICARE RAILROAD|||||17.85||| 36415|EAP|0306||Blue Cross PPO|BCBS WALMART|||||1.66||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||0.34||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||207.50||| 36415|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|||||0.57||| 36415|EAP|0252|SERTRALINE HCL TAB 50 MG|Medicare|MEDICARE A & B|||||10.15||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.62||| 36415|EAP|0309||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.25||| 36415|EAP|0410|VENT SUPPORT INITATION|Medicare|MEDICARE A & B|||||21.68||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||5.81||| 36415|EAP|0730||PHCS|WEB TPA|||||3.86||| 36415|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||1.66||| 36415|EAP|0255||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.50||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.38||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||35.70||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.15||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.40||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||7.27||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||1.14||| 36415|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.69||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||2.11||| 36415|EAP|0302||Medicare|MEDICARE A & B|||||116.50||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||1.44||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.29||| 36415|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||0.25||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|PHCS|WEB TPA OF GRAND PRAIRIE|||||5.51||| 36415|EAP|0300||Medicare|MEDICARE A & B|||||3.18||| 36415|EAP|0307||Blue Cross PPO|BLUE CROSS PPO|||||0.47||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.51||| 36415|EAP|0450||Medicaid|MEDICAID|||||0.00||| 36415|EAP|0252|PYRIDOXINE HCL 25MG TAB|Blue Cross PPO Select|BCBS UTHCT|||||3.15||| 36415|EAP|0949||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||0.86||| 36415|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||1.11||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||5.51||| 36415|EAP|0450|INJECTION ANTIBIOTIC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 36415|EAP|0981||Managed Medicaid|OTHER MEDICAID|||||0.00||| 36415|EAP|0309||Blue Cross PPO|BLUE CROSS POS|||||2.25||| 36415|EAP|0450||PHCS|WEB TPA|||||11.19||| 36415|EAP|0730||NON CONTRACTED|COMMERCIAL OTHER|||||3.86||| 36415|EAP|0306|HPV THINPREP|United Healthcare|UMR|||||0.77||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BCBS WALMART|||||1.14||| 36415|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Blue Cross PPO|BCBS WALMART|||||2.09||| 36415|EAP|0636|CHLORPROMAZINE TAB 100 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||55.35||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||2.39||| 36415|EAP|0301||United Healthcare|GOLDEN RULE INSURANCE|||||1.14||| 36415|EAP|0636|DOPAMINE HCL/DEXTROSE 5% WATER|Medicare|MEDICARE RAILROAD|||||0.46||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||203.45||| 36415|EAP|0305||United Healthcare|UMR|||||96.50||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|NON CONTRACTED|PPO OTHER|||||0.19||| 36415|EAP|0301|VENIPUNCTURE|PHCS|TML GRP INS|0.19||||0.00||| 36415|EAP|0272|CATH TRAY IC 16FR (ER)|Medicare|MEDICARE A & B|||||89.25||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 36415|EAP|0302|CASHEW NUT COMPONENT PANL (REF|Blue Cross PPO|BLUE CROSS POS|||||97.50||| 36415|EAP|0250||Medicare|MEDICARE RAILROAD|||||74.90||| 36415|EAP|0402||Blue Cross PPO|BLUE CROSS PPO|||||3.03||| 36415|EAP|0300|IMMUNOASSAY NONANTIBODY(REF900|Medicare|MEDICARE A & B|||||34.59||| 36415|EAP|0771||Blue Cross PPO|BCBS WALMART|||||0.86||| 36415|EAP|0335||Blue Cross PPO|BLUE CROSS POS|||||10.47||| 36415|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicare|MEDICARE A & B|0.19||||1.63||| 36415|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||181.41||| 36415|EAP|0981||United Healthcare|UMR|||||0.00||| 36415|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.35||| 36415|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|United Healthcare|UMR|||||3.26||| 36415|EAP|0311|FLOW CYTO TC ADD (PATH aSSOC)|Medicare|MEDICARE A & B|||||0.99||| 36415|EAP|0459||Blue Cross PPO|BLUE CROSS PPO|||||3.00||| 36415|EAP|0309||Blue Cross PPO|BLUE CROSS POS|||||3.54||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||74.45||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||2.10||| 36415|EAP|0999|BP CUFF, ADULT MED (GIL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 36415|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||4.90||| 36415|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||619.42||| 36415|EAP|0460||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.74||| 36415|EAP|0272||Multiplan|WEB TPA|||||4.90||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||34.40||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.47||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE RAILROAD|||||2.10||| 36415|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||213.82||| 36415|EAP|0300|COVID19|Medicare|MEDICARE A & B|||||2.00||| 36415|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 36415|EAP|0450||Medicaid|MEDICAID|||||7.27||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.11||| 36415|EAP|0302|REFLEX RPR TITER (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.45||| 36415|EAP|0761||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.82||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 36415|EAP|0981||PHCS|WEB TPA OF GRAND PRAIRIE|||||0.00||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||181.41||| 36415|EAP|0251|CILOSTAZOL 50MG, PO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.90||| 36415|EAP|0301|5-HIAA PLASMA (ARUP)|Medicare|MEDICARE A & B|0.19||||7.10||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||21.30||| 36415|EAP|0302|BORD PERTUSSIS AB IGG BY IMMUB|Blue Cross PPO|BLUE CROSS PPO|||||0.67||| 36415|EAP|0301||Medicare|MEDICARE A & B|0.19||||1.31||| 36415|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||129.90||| 36415|EAP|0251|CYANOCOBALAMIN 500MCG TABLET|United Healthcare|UMR|||||3.15||| 36415|EAP|0510|CLIN VISIT; LOW, EST (GIC)|Medicare|MEDICARE A & B|||||2.25||| 36415|EAP|0390||United Healthcare|UMR|||||9.34||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||0.98||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.22||| 36415|EAP|0513||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 36415|EAP|0309||Medicare|MEDICARE A & B|||||2.25||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.82||| 36415|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|United Healthcare|UMR|||||2.11||| 36415|EAP|0331||Medicare|MEDICARE A & B|||||213.82||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.70||| 36415|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.69||| 36415|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||363.55||| 36415|EAP|0949||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||181.41||| 36415|EAP|0771||Blue Cross PPO|BLUE CROSS POS|||||0.86||| 36415|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.50||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||8.60||| 36415|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||3.00||| 36415|EAP|0306|NT MAC MIC RWL (REF)|Medicare|MEDICARE A & B|||||3.00||| 36415|EAP|0450||Blue Cross PPO|BCBS WALMART|||||3.45||| 36415|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.50||| 36415|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 36415|EAP|0311||Medicare|MEDICARE A & B|||||1.68||| 36415|EAP|0305||Blue Cross PPO|BLUE CROSS POS|||||1.68||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||669.83||| 36415|EAP|0510|CLINIC VISIT; HIGH MODERATE, C|United Healthcare|GOLDEN RULE INSURANCE|||||6.83||| 36415|EAP|0251||Medicare|MEDICARE A & B|6.90||||3.15||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 36415|EAP|0301||United Healthcare|UMR|0.19||||1.72||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||3.48||| 36415|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.10||| 36415|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 36415|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BCBS WALMART|||||2.50||| 36415|EAP|0306||Medicare|MEDICARE A & B|||||0.49||| 36415|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross PPO|BCBS WALMART|||||3.26||| 36415|EAP|0610|MRI EXTREMITY W/WO CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||36.09||| 36415|EAP|0419||Blue Cross PPO|BLUE CROSS PPO|||||7.09||| 36415|EAP|0251|CEPHALEXIN CAP 500MG|Medicare|MEDICARE A & B|6.90||||4.75||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 36415|EAP|0762||NON CONTRACTED|COMMERCIAL OTHER|||||0.75||| 36415|EAP|0510||United Healthcare|AARP OF GA ATLANTA|||||2.64||| 36415|EAP|0306||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.11||| 36415|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|0.19||||1.14||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.19||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS POS|||||2.23||| 36415|EAP|0272||Medicare|MEDICARE A & B|||||0.19||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS POS|||||0.41||| 36415|EAP|0404||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||64.02||| 36415|EAP|0920||Medicare|MEDICARE A & B|||||0.98||| 36415|EAP|0305||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.78||| 36415|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.30||| 36415|EAP|0301|ACETYLCHOLIN, ERYTH (ARUP)|Blue Cross PPO Select|BCBS UTHCT|0.19||||2.46||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||1.65||| 36415|EAP|0255||Medicare|MEDICARE A & B|||||7.50||| 36415|EAP|0459||Blue Cross PPO|BCBS WALMART|||||5.42||| 36415|EAP|0320||United Healthcare|UMR|||||2.35||| 36415|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||107.70||| 36415|EAP|0250||Medicare|MEDICARE A & B|||||292.60||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||34.40||| 36415|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO Select|BCBS UTHCT|0.19||||1.46||| 36415|EAP|0762||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.00||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||2.15||| 36415|EAP|0510||United Healthcare|UMR|||||4.38||| 36415|EAP|0450||Medicare|MEDICARE RAILROAD|||||11.19||| 36415|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||206.30||| 36415|EAP|0301|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE STUDENT RES|||||0.00||| 36415|EAP|0300||NON CONTRACTED|COMMERCIAL OTHER|||||0.72||| 36415|EAP|0942||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.56||| 36415|EAP|0301|RAST:ELM, CHINESE (REF)|Medicare|MEDICARE A & B|0.19||||29.92||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.16||| 36415|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 36415|EAP|0771||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.86||| 36415|EAP|0335||Blue Cross PPO|BLUE CROSS POS|||||213.82||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.41||| 36415|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||234.50||| 36415|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||13.35||| 36415|EAP|0252||Medicare|MEDICARE A & B|||||14.10||| 36415|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 36415|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 36415|EAP|0301|VENIPUNCTURE, ROUTINE|United Healthcare|AARP OF GA ATLANTA|||||0.19||| 36415|EAP|0309|IRL B IGM BILL (ARUP)|Medicare|MEDICARE A & B|||||1.57||| 36415|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||1.03||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||0.45||| 36415|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.77||| 36415|EAP|0306||United Healthcare|UMR|||||1.38||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||1.63||| 36415|EAP|0370|GENERAL ANESTHESIA 15 MIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.76||| 36415|EAP|0513||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 36415|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.04||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||5.31||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||1.75||| 36415|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.19||||1.75||| 36415|EAP|0258||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.42||| 36415|EAP|0949||Blue Cross PPO|BCBS WALMART|||||213.82||| 36415|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Medicare|MEDICARE A & B|||||2.25||| 36415|EAP|0301|VENIPUNCTURE|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.19||||0.00||| 36415|EAP|0320||United Healthcare|UMR|||||2.16||| 36415|EAP|0981|ER VISIT; LEVEL III|Medicare|MEDICARE A & B|0.00||||0.00||| 36415|EAP|0301||United Healthcare|UMR|0.19||||1.11||| 36415|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||610.42||| 36415|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 36415|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 36415|EAP|0301|VENIPUNCTURE|United Healthcare|UMR|0.19||||0.00||| 36415|EAP|0301|AMYLASE, SERUM|Blue Cross PPO Select|BCBS UTHCT|0.19||||1.75||| 36415|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.27||| 36415|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.90||| 36415|EAP|0352|CT CHEST HIGH RES|Medicare|MEDICARE A & B|||||23.22||| 36415|EAP|0258||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||42.85||| 36415|EAP|0403||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.83||| 36415|EAP|0450||Medicare|MEDICARE A & B|5.69||||1.81||| 36415|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.19||||295.60||| 36415|EAP|0301||United Healthcare|UMR|0.19||||110.50||| 36415|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 36415|EAP|0257||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||10.50||| 36415|EAP|0306||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.38||| 36415|EAP|0636||Medicare|MEDICARE RAILROAD|||||14.70||| 36415|EAP|0450||United Healthcare|UMR|||||197.62||| 36416|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 36416|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 36416|EAP|0352||Medicare|MEDICARE A & B|||||1.06||| 36416|EAP|0403||Medicare|MEDICARE A & B|||||0.82||| 36416|EAP|0301|FINGER, HEEL STICK|NON CONTRACTED|BOONE CHAPMAN|||||0.08||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Medicare|MEDICARE A & B|||||160.36||| 36416|EAP|0949||Medicare|MEDICARE A & B|||||213.82||| 36416|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 36416|EAP|0301|FINGER, HEEL STICK|Multiplan|WEB TPA|||||0.08||| 36416|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 36416|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 36416|EAP|0510||Multiplan|WEB TPA|||||2.50||| 36416|EAP|0301|FINGER, HEEL STICK|NON CONTRACTED|COMMERCIAL OTHER|||||0.08||| 36416|EAP|0403||Medicare|MEDICARE A & B|||||4.83||| 36416|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Medicare|MEDICARE A & B|||||0.86||| 36416|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 36416|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Medicare|MEDICARE A & B|||||0.56||| 36416|EAP|0920||Medicare|MEDICARE A & B|||||0.98||| 36416|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.25||| 36416|EAP|0510||Medicare|MEDICARE A & B|||||3.13||| 36416|EAP|0305||NON CONTRACTED|COMMERCIAL OTHER 2|||||1.22||| 36416|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 36416|EAP|0460||Medicare|MEDICARE A & B|||||4.74||| 36416|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Medicare|MEDICARE A & B|||||2.50||| 36416|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| 36416|EAP|0771||Medicare|MEDICARE A & B|||||0.86||| 36416|EAP|0636||Medicare|MEDICARE A & B|||||45.15||| 36416|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||0.86||| 36416|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 36416|EAP|0510||Medicare|MEDICARE A & B|||||6.11||| 36416|EAP|0301|FINGER, HEEL STICK|Medicare|MEDICARE PART B|||||0.08||| 36416|EAP|0920||Managed Medicaid|FAMILY PLANNING GRANT|||||0.98||| 36416|EAP|0301|DRUG SCREEN QUAL; SINGLE DRUG|Medicare|MEDICARE A & B|0.08||||1.91||| 36416|EAP|0306||Medicare|MEDICARE A & B|||||1.74||| 36416|EAP|0300||Medicare|MEDICARE A & B|||||0.09||| 36416|EAP|0311||Medicare|MEDICARE A & B|||||0.57||| 36416|EAP|0301||Medicare|MEDICARE A & B|0.08||||1.63||| 36416|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||45.15||| 36416|EAP|0301|FINGER, HEEL STICK|Medicare|MEDICARE PART A|||||0.08||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Medicaid|MEDICAID|||||0.09||| 36416|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| 36416|EAP|0301||Medicare|MEDICARE A & B|0.08||||0.19||| 36416|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Medicare|MEDICARE RAILROAD|||||0.09||| 36416|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.63||| 36416|EAP|0301|FINGER, HEEL STICK|Medicare|MEDICARE A & B|0.08||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|Medicare|MEDICARE RAILROAD|||||0.08||| 36416|EAP|0250||Medicare|MEDICARE A & B|||||334.48||| 36416|EAP|0920||Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 36416|EAP|0301|FINGER, HEEL STICK|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.08||| 36416|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.63||| 36416|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||131.25||| 36416|EAP|0510||PHCS|WEB TPA|||||2.50||| 36416|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.08||| 36416|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.22||| 36416|EAP|0301|FINGER, HEEL STICK|PHCS|WEB TPA|||||0.08||| 36416|EAP|0510||United Healthcare|UMR|||||2.50||| 36416|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|United Healthcare|UMR|||||0.09||| 36416|EAP|0301|FINGER, HEEL STICK|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|United Healthcare|UMR|||||0.08||| 36416|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.09||| 36416|EAP|0301|FINGER, HEEL STICK|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.08||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.09||| 36416|EAP|0482||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||13.03||| 36416|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.26||| 36416|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.11||| 36416|EAP|0301|FINGER, HEEL STICK|United Healthcare|GOLDEN RULE INSURANCE|||||0.08||| 36416|EAP|0636||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||45.15||| 36416|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.96||| 36416|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 36416|EAP|0301|FINGER, HEEL STICK|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.08||| 36416|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 36416|EAP|0771||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.86||| 36416|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.15||| 36416|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 36416|EAP|0301|FINGER, HEEL STICK|Managed Medicaid|FAMILY PLANNING GRANT|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|Managed Medicaid|MEDICAID CSHCN|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|Managed Medicaid|SUPERIOR STAR MCD|||||0.08||| 36416|EAP|0352||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23.22||| 36416|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.86||| 36416|EAP|0301|FINGER, HEEL STICK|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.08||| 36416|EAP|0403||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.82||| 36416|EAP|0771||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||160.36||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.09||| 36416|EAP|0942||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.48||| 36416|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.22||| 36416|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.08||| 36416|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 36416|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 36416|EAP|0300||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.09||| 36416|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Managed Medicaid|FAMILY PLANNING GRANT|||||0.09||| 36416|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 36416|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.07||| 36416|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| 36416|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 36416|EAP|0510||Cigna|NALC HLTH BENEFIT|||||2.50||| 36416|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 36416|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|ChampVA|CHAMPVA OF CO DENVER|||||0.70||| 36416|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||2.64||| 36416|EAP|0301|FINGER, HEEL STICK|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.08||| 36416|EAP|0771||ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 36416|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|ChampVA|CHAMPVA OF CO DENVER|||||408.85||| 36416|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 36416|EAP|0301|FINGER, HEEL STICK|Cigna|CIGNA OPEN ACCESS PLUS|||||0.08||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||160.36||| 36416|EAP|0301|FINGER, HEEL STICK|ChampVA|CHAMPVA OF CO DENVER|||||0.08||| 36416|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 36416|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.26||| 36416|EAP|0301|FINGER, HEEL STICK|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.08||| 36416|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.19||| 36416|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.09||||0.09||| 36416|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 36416|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.63||| 36416|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 36416|EAP|0949||Cigna|NALC HLTH BENEFIT|||||213.82||| 36416|EAP|0771||Cigna|CIGNA OPEN ACCESS PLUS|||||0.86||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.09||||0.09||| 36416|EAP|0301|FINGER, HEEL STICK|Cigna|NALC HLTH BENEFIT|||||0.08||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.09||| 36416|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.75||| 36416|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.19||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Cigna|CIGNA OPEN ACCESS PLUS|||||160.36||| 36416|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||1.63||| 36416|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.22||| 36416|EAP|0301|FINGER, HEEL STICK|Cigna|CIGNA OTHER|||||0.08||| 36416|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||0.70||| 36416|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 36416|EAP|0301|FINGER, HEEL STICK|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.08||| 36416|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| 36416|EAP|0301|FINGER, HEEL STICK|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.08||| 36416|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.22||| 36416|EAP|0311||Cigna|CIGNA OF TN CHATTANOOGA|||||0.60||| 36416|EAP|0300|BENZODIAZEPINES CON/QUANT (ARU|Medicare|MEDICARE A & B|||||0.87||| 36416|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 36416|EAP|0301|FINGER, HEEL STICK|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|Cigna|CIGNA OF TN CHATTANOOGA|||||0.08||| 36416|EAP|0510||Cigna|CIGNA OTHER|||||2.64||| 36416|EAP|0300|CAPILLARY BLOOD DRAW ONC|Medicare|MEDICARE A & B|||||0.09||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Blue Cross PPO|BLUE CROSS PPO|||||0.09||| 36416|EAP|0771||Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 36416|EAP|0301|FINGER, HEEL STICK|Medicaid|MEDICAID|||||0.08||| 36416|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.63||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross PPO|BLUE CROSS PPO|||||0.08||| 36416|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 36416|EAP|0510||Aetna|AETNA|||||2.64||| 36416|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.60||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Blue Cross PPO|BLUE CROSS POS|||||0.09||| 36416|EAP|0301||Medicare|MEDICARE A & B|0.08||||1.73||| 36416|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 36416|EAP|0301|FINGER, HEEL STICK|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.08||| 36416|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||327.55||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Medicare|MEDICARE A & B|||||0.09||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.08||| 36416|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.07||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 36416|EAP|0920||Medicare|MEDICARE A & B|||||3.35||| 36416|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross PPO|BCBS TRANE PPO|||||0.08||| 36416|EAP|0301|FINGER, HEEL STICK|Aetna|AETNA|||||0.08||| 36416|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.60||| 36416|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 36416|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross PPO|BLUE CROSS POS|||||0.08||| 36416|EAP|0949||Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 36416|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER 2|||||160.36||| 36416|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross PPO|BCBS WALMART|||||0.08||| 36416|EAP|0320|DIAG DIGI BRST TOMO,UNILAT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 36416|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.29||| 36416|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 36416|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE A & B|||||2.50||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Blue Cross PPO|BCBS WALMART|||||0.09||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.09||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.09||| 36416|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| 36416|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 36416|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 36416|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 36416|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 36416|EAP|0301|FINGER, HEEL STICK|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.08||| 36416|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.99||| 36416|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 36416|EAP|0510||Blue Cross PPO|BCBS WALMART|||||3.26||| 36416|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.09||| 36416|EAP|0510||Medicare|MEDICARE RAILROAD|||||2.50||| 36416|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 36416|EAP|0305||Blue Cross PPO|BLUE CROSS POS|||||1.22||| 36416|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 36416|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 36416|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.25||| 36416|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 36416|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 36416|EAP|0300|CAPILLARY BLOOD DRAW|Blue Cross PPO Select|BCBS UTHCT|||||0.09||| 36416|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 36416|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.64||| 36416|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 36416|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 36416|EAP|0301|FINGER, HEEL STICK|Blue Cross PPO Select|BCBS UTHCT|||||0.08||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Blue Cross PPO|BLUE CROSS PPO|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|Blue Cross PPO|BLUE CROSS PPO|1,370.23||||1,370.23||| 36430|EAP|0390||Blue Cross PPO|BLUE CROSS PPO|||||19.94||| 36430|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Aetna|AETNA EL PASO CLAIMS OFFICE|1,370.23||||||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1,370.23||||1,370.23||| 36430|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.07||| 36430|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 36430|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 36430|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.19||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|Managed Medicaid|SUPERIOR STAR MCD|||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Humana Medicare Advantage|HUMANA MEDICARE PPO|1,370.23||||1,370.23||| 36430|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.27||| 36430|EAP|0271||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|Humana Medicare Advantage|HUMANA MEDICARE PPO|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1,370.23||||1,370.23||| 36430|EAP|0762||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.75||| 36430|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 36430|EAP|0391||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1,370.23||||1,370.23||| 36430|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|United Healthcare|UMR|||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Veterans Affairs|VETERANS CHOICE - TRI WEST|1,370.23||||||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Blue Cross PPO|BLUE CROSS POS|||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1,370.23||| 36430|EAP|0272||Medicare|MEDICARE A & B|||||12.60||| 36430|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Medicaid|MEDICAID|1,370.23||||||| 36430|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 36430|EAP|0272||Medicare|MEDICARE A & B|||||45.15||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|NON CONTRACTED|COMMERCIAL OTHER|||||1,370.23||| 36430|EAP|0391|TRANSFUSION BLOOD/BLOOD COMPON|Medicare|MEDICARE A & B|1,370.23||||1,370.23||| 36430|EAP|0391||Medicare|MEDICARE A & B|1,370.23||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|NON CONTRACTED|COMMERCIAL OTHER|||||1,370.23||| 36430|EAP|0391|TRANSFUSION, BLOOD AND BLOOD C|Medicare|MEDICARE A & B|1,370.23||||1,370.23||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|Medicare|MEDICARE A & B|||||68.57||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||68.57||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||68.57||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||68.57||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|Blue Cross PPO Select|BCBS UTHCT|||||68.57||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||68.57||| 36475|EAP|0761|ENDOVENOUR ABLA THERAPY INCOMP|Blue Cross PPO|BLUE CROSS PPO|||||68.57||| 36482|EAP|0510|ENDOVEN THER CHEM ADHES 1ST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||124.22||| 36482|EAP|0510|ENDOVEN THER CHEM ADHES 1ST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||124.22||| 36482|EAP|0510|ENDOVEN THER CHEM ADHES 1ST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||124.22||| 36482|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.50||| 36482|EAP|0510|ENDOVEN THER CHEM ADHES 1ST|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||124.22||| 36482|EAP|0510|ENDOVEN THER CHEM ADHES 1ST|Medicare|MEDICARE A & B|||||124.22||| 36483|EAP|0510|ENDOVEN THER CHEM ADHES SBSQ|Medicare|MEDICARE A & B|||||14.08||| 36561|EAP|0481|**INSRT SUBCUTANEOUS PORT; 5YR|Medicare|MEDICARE A & B|55.67||||||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Cigna|NALC HLTH BENEFIT|23.47||||||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|ChampVA|CHAMPVA OF CO DENVER|||||23.47||| 36569|EAP|0450|INSRT PERI CVC, 5YRS + (ER)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.23||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Humana Medicare Advantage|HUMANA MEDICARE PPO|23.47||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|23.47||||||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Blue Cross PPO|BLUE CROSS PPO|23.47||||23.47||| 36569|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.54||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|23.47||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Aetna|AETNA EL PASO CLAIMS OFFICE|23.47||||||| 36569|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|23.47||||||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|23.47||||||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Medicaid|MEDICAID|23.47||||||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Medicare|MEDICARE A & B|23.47||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|NON CONTRACTED|COMMERCIAL OTHER 2|||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Medicare|MEDICARE A & B|18.42||||23.47||| 36569|EAP|0360|PICC LINE INSERTION, 5 YRS+|Medicare|MEDICARE PART A|23.47||||||| 36591|EAP|0510|DRAW BLOOD OFF VENOUS DEVICE|Blue Cross PPO|BLUE CROSS PPO|||||381.05||| 36593|EAP|0761|DECLOT VASCULAR DEVICE|Medicare|MEDICARE A & B|||||1,031.99||| 36593|EAP|0761|DECLOT VASCULAR DEVICE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1,031.99||| 36593|EAP|0761|DECLOT VASCULAR DEVICE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1,031.99||| 36593|EAP|0761|DECLOT VASCULAR DEVICE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,031.99||| 36593|EAP|0761|DECLOT VASCULAR DEVICE|Blue Cross PPO|BLUE CROSS POS|||||1,031.99||| 36593|EAP|0761|DECLOT VASCULAR DEVICE|Blue Cross PPO|BLUE CROSS PPO|||||1,031.99||| 36598|EAP|0361|INJ W/FLUOR, EVAL CV DEVICE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.18||| 36598|EAP|0361|INJ W/FLUOR, EVAL CV DEVICE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.18||| 36598|EAP|0361|INJ W/FLUOR, EVAL CV DEVICE|Blue Cross PPO|BLUE CROSS PPO|||||5.18||| 36598|EAP|0361|INJ W/FLUOR, EVAL CV DEVICE|Medicare|MEDICARE A & B|||||5.18||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|PHCS|WEB TPA|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|United Healthcare|UMR|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|PHCS|TML GRP INS|1.82||||||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Managed Medicaid|FAMILY PLANNING GRANT|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Managed Medicaid|SUPERIOR STAR MCD|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Medicaid|MEDICAID|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Multiplan|TML GRP INS|1.82||||||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|NON CONTRACTED|COMMERCIAL OTHER 2|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Medicare|MEDICARE A & B|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|NON CONTRACTED|COMMERCIAL OTHER|1.82||||1.82||| 36600|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Managed Medicaid|OTHER MEDICAID|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Medicare|MEDICARE RAILROAD|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Medicare|MEDICARE PART A|1.82||||||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Multiplan|WEB TPA|||||1.82||| 36600|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Aetna|AETNA EL PASO CLAIMS OFFICE|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Blue Cross PPO|BLUE CROSS POS|||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Blue Cross PPO|BCBS WALMART|1.82||||1.82||| 36600|EAP|0981||United Healthcare|UMR|||||0.00||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Blue Cross PPO|BLUE CROSS PPO|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|ChampVA|CHAMPVA OF CO DENVER|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Blue Cross PPO Select|BCBS UTHCT|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Cigna|NALC HLTH BENEFIT|1.82||||||| 36600|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.39||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Cigna|CIGNA OF TN CHATTANOOGA|1.82||||1.82||| 36600|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.82||||1.82||| 36600|EAP|0761|ARTERIAL PUNCTURE,BLOOD FOR DX|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||1.82||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Medicare|MEDICARE A & B|30,307.90|13888.57|13888.57|13888.57|||| 375|DRG||DIGESTIVE MALIGNANCY W CC|Medicaid|MEDICAID|43,845.11|15898.24|15898.24|15898.24|||| 379|DRG||G.I. HEMORRHAGE W/O CC/MCC|Medicare|MEDICARE A & B|20,517.20|6986.91|6986.91|6986.91|||| 38505|EAP|0272|QUICKCORE BX SET 20GA 9CM|Medicare|MEDICARE A & B|||||0.96||| 38505|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 38505|EAP|0320|NEEDLE BX, LYMPH NODE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.63||| 38505|EAP|0320|NEEDLE BX, LYMPH NODE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.63||| 38505|EAP|0320|NEEDLE BX, LYMPH NODE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||9.63||| 38505|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 38505|EAP|0272||Medicare|MEDICARE A & B|||||0.59||| 38505|EAP|0320|NEEDLE BX, LYMPH NODE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.63||| 38505|EAP|0320|NEEDLE BX, LYMPH NODE|Medicare|MEDICARE A & B|||||9.63||| 38505|EAP|0320|NEEDLE BX, LYMPH NODE|Aetna|AETNA|||||9.63||| 389|DRG||G.I. OBSTRUCTION W CC|Medicare|MEDICARE A & B|34,167.23|8089.63|8089.63|8089.63|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Medicare|MEDICARE A & B|18,583.08|10566.56|10566.56|10566.56|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|16,583.56|3154.47|7599.81|2798.76|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicare|MEDICARE A & B|16,560.08|7599.81|7599.81|2798.76|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|24,013.26|7153.16|7599.81|2798.76|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|16,535.20|2798.76|7599.81|2798.76|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|30,721.93|8294.37|8294.37|8294.37|||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Multiplan|TML GRP INS|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Medicare|MEDICARE A & B|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Cigna|CIGNA OTHER|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Cigna|CIGNA OF TN CHATTANOOGA|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|NON CONTRACTED|COMMERCIAL OTHER|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Blue Cross PPO|BLUE CROSS PPO|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|ChampVA|CHAMPVA OF CO DENVER|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Blue Cross PPO Select|BCBS UTHCT|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Blue Cross PPO|BCBS TRANE PPO|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|PHCS|TML GRP INS|||||0.08||| 41001|EAP|0270|**EDUCATIONAL MATERIALS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.08||| 41250|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 42400|EAP|0320|BX OF SALIVARY GLAND - NEEDLE|Medicare|MEDICARE A & B|||||7.75||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||98.70||| 43229|EAP|0750|ESOPHAGOSCOPY WITH ABLATION|Medicare|MEDICARE A & B|||||53.08||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||11.55||| 43229|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||38.54||| 43229|EAP|0278||Medicare|MEDICARE A & B|||||391.65||| 43229|EAP|0750||Medicare|MEDICARE A & B|||||29.16||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 43229|EAP|0272||Medicare|MEDICARE A & B|||||0.38||| 43235|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Medicare|MEDICARE A & B|||||213.82||| 43235|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Cigna|CIGNA OF TN CHATTANOOGA|||||19.98||| 43235|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 43235|EAP|0300||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.18||| 43235|EAP|0301|PH, FECAL (REF)|Medicare|MEDICARE A & B|||||0.76||| 43235|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|NON CONTRACTED|COMMERCIAL OTHER|||||19.98||| 43235|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Medicare|MEDICARE A & B|||||3.10||| 43235|EAP|0305||Medicare|MEDICARE A & B|||||0.78||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||19.98||| 43235|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 43235|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.55||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||19.98||| 43235|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||21.30||| 43235|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.46||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Cigna|CIGNA OPEN ACCESS PLUS|||||19.98||| 43235|EAP|0730||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.86||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.98||| 43235|EAP|0306||Medicare|MEDICARE A & B|||||0.68||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Blue Cross PPO|BCBS TRANE PPO|||||19.98||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Blue Cross PPO Select|BCBS UTHCT|||||19.98||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Aetna|TRS COORDINATED CARE|||||19.98||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.98||| 43235|EAP|0301||Medicare|MEDICARE A & B|||||2.28||| 43235|EAP|0305||Medicare|MEDICARE A & B|||||1.55||| 43235|EAP|0252||Blue Cross PPO|BLUE CROSS PPO|||||61.80||| 43235|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 43235|EAP|0306||Medicare|MEDICARE A & B|||||0.91||| 43235|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||19.98||| 43235|EAP|0306||Medicare|MEDICARE A & B|||||1.30||| 43235|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.42||| 43235|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 43235|EAP|0730|ECG RYTHM STRIP|Medicare|MEDICARE A & B|||||1.82||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|19.98||||19.98||| 43235|EAP|0306||Medicare|MEDICARE A & B|||||1.39||| 43235|EAP|0301||Medicare|MEDICARE A & B|||||0.26||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Blue Cross PPO|BLUE CROSS PPO|||||19.98||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.98||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||19.98||| 43235|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.44||| 43235|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 43235|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Medicare|MEDICARE A & B|||||4,789.20||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|ChampVA|CHAMPVA OF CO DENVER|||||19.98||| 43235|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.78||| 43235|EAP|0312||Medicare|MEDICARE A & B|||||2.40||| 43235|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.96||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|19.98||||19.98||| 43235|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||21.30||| 43235|EAP|0306||Medicare|MEDICARE A & B|||||0.40||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Blue Cross PPO|BLUE CROSS POS|||||19.98||| 43235|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 43235|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.14||| 43235|EAP|0636||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||21.30||| 43235|EAP|0450||Medicare|MEDICARE A & B|||||7.27||| 43235|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Medicare|MEDICARE A & B|||||2.50||| 43235|EAP|0636|FULVESTRANT 250MG/25MG SYRING|Medicare|MEDICARE A & B|||||1,775.20||| 43235|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.66||| 43235|EAP|0636||Cigna|CIGNA OF TN CHATTANOOGA|||||21.30||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.98||| 43235|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||1.44||| 43235|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 43235|EAP|0450||Medicare|MEDICARE A & B|||||0.00||| 43235|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Medicare|MEDICARE A & B|19.98||||19.98||| 43235|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 43235|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Medicare|MEDICARE A & B|||||2.48||| 43235|EAP|0750|UPPER GI ENDOSC/DIAGN W/WO BX|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||19.98||| 43235|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 43236|EAP|0750|UGI W SUBMUCOS INJ|Medicare|MEDICARE A & B|||||19.98||| 43236|EAP|0750|UGI W SUBMUCOS INJ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.98||| 43236|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 43237|EAP|0750|ENDOSCOPIC US EXAM, ESOPH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||29.16||| 43237|EAP|0750|ENDOSCOPIC US EXAM, ESOPH|Blue Cross PPO|BLUE CROSS POS|||||29.16||| 43237|EAP|0750|ENDOSCOPIC US EXAM, ESOPH|Medicare|MEDICARE A & B|||||29.16||| 43237|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 43237|EAP|0750|ENDOSCOPIC US EXAM, ESOPH|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||29.16||| 43237|EAP|0750|ENDOSCOPIC US EXAM, ESOPH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.16||| 43237|EAP|0750|ENDOSCOPIC US EXAM, ESOPH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||29.16||| 43238|EAP|0750|UGI W US-FNA OF ESOPH|Medicare|MEDICARE A & B|||||29.16||| 43238|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 43238|EAP|0311||Medicare|MEDICARE A & B|||||3.81||| 43238|EAP|0750|UGI W US-FNA OF ESOPH|Blue Cross PPO|BLUE CROSS PPO|||||29.16||| 43239|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.44||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||11.55||| 43239|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 43239|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Blue Cross PPO Select|BCBS UTHCT|||||19.98||| 43239|EAP|0307||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.18||| 43239|EAP|0309||Cigna|CIGNA OF TN CHATTANOOGA|||||0.73||| 43239|EAP|0272|DRESSING 2 X 2 2'S (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 43239|EAP|0402||Blue Cross PPO Select|BCBS UTHCT|||||14.97||| 43239|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.30||| 43239|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.61||| 43239|EAP|0272|IMED TUBING (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.17||| 43239|EAP|0272|EXTENSION MICROBORE (JLOOP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.07||| 43239|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||2.73||| 43239|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.14||| 43239|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.39||| 43239|EAP|0312|SPECIAL STAINS - GROUP 1|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.40||| 43239|EAP|0271|WRAP COBAN 2 (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 43239|EAP|0999||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 43239|EAP|0272|IVCATH 20GA X 1.25 (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 43239|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.99||| 43239|EAP|0272|IV START KIT (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 43239|EAP|0750||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.16||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.07||| 43239|EAP|0352||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||27.12||| 43239|EAP|0750||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Cigna|CIGNA OPEN ACCESS PLUS|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.98||| 43239|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.86||| 43239|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||32.55||| 43239|EAP|0352||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.51||| 43239|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.46||| 43239|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.10||| 43239|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.62||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.06||| 43239|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||669.83||| 43239|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.70||| 43239|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 43239|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||12.62||| 43239|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.99||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.98||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Aetna|AETNA EXXON MOBIL|||||19.98||| 43239|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 43239|EAP|0750||Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.18||| 43239|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 43239|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 43239|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.38||| 43239|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 43239|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Aetna|AETNA|||||19.98||| 43239|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.19||| 43239|EAP|0255||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 43239|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.20||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||19.98||| 43239|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.96||| 43239|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.68||| 43239|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.40||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||19.98||| 43239|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.40||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.98||| 43239|EAP|0636||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||21.30||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||19.98||| 43239|EAP|0312||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.96||| 43239|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||12.20||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Blue Cross PPO|BLUE CROSS POS|||||19.98||| 43239|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 43239|EAP|0750||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.90||| 43239|EAP|0312||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||3.96||| 43239|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.35||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|United Healthcare|UMR|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||19.98||| 43239|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.55||| 43239|EAP|0312|SPECIAL STAINS - GROUP 1|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.40||| 43239|EAP|0310|SURG PATH; CONS & RPT PREP|Medicare|MEDICARE A & B|||||2.52||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Blue Cross PPO|BLUE CROSS PPO|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Blue Cross PPO|BCBS TRANE PPO|||||19.98||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.98||| 43239|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 43239|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 43239|EAP|0750||NON CONTRACTED|COMMERCIAL OTHER|||||19.98||| 43239|EAP|0750||Medicare|MEDICARE A & B|||||19.98||| 43239|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 43239|EAP|0312|IMMUNO, PER INITAL SINGLE AB|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.99||| 43239|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 43239|EAP|0370||Medicare|MEDICARE A & B|||||7.02||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.98||| 43239|EAP|0750||Medicare|MEDICARE A & B|||||29.16||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||19.98||| 43239|EAP|0370||Medicare|MEDICARE A & B|||||1.76||| 43239|EAP|0301||Medicare|MEDICARE A & B|||||1.14||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Medicare|MEDICARE A & B|||||19.98||| 43239|EAP|0750||Medicare|MEDICARE A & B|||||20.18||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Medicare|MEDICARE RAILROAD|||||19.98||| 43239|EAP|0310|IMMUNIHISTO 2ND (GENOPTIX|Medicare|MEDICARE A & B|||||2.61||| 43239|EAP|0301||Medicare|MEDICARE A & B|||||1.07||| 43239|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 43239|EAP|0311||Medicare|MEDICARE A & B|||||2.56||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||4.50||| 43239|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Medicare|MEDICARE A & B|||||4.99||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 43239|EAP|0310|IMMUNIHISTOCHEMISTRY (GENOPTIX|Medicare|MEDICARE A & B|||||2.76||| 43239|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.75||| 43239|EAP|0301||Medicare|MEDICARE A & B|||||0.96||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|NON CONTRACTED|COMMERCIAL OTHER|||||19.98||| 43239|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.30||| 43239|EAP|0300||Medicare|MEDICARE A & B|||||3.18||| 43239|EAP|0636||Medicare|MEDICARE A & B|||||9.75||| 43239|EAP|0312||Medicare|MEDICARE RAILROAD|||||3.96||| 43239|EAP|0312||Medicare|MEDICARE A & B|||||1.25||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||0.38||| 43239|EAP|0750|UPPER GI ENDOSCOPY, W/BIOPSY|Cigna|CIGNA OF TN CHATTANOOGA|||||19.98||| 43239|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.91||| 43239|EAP|0301||Medicare|MEDICARE A & B|||||2.42||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||25.20||| 43239|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 43239|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 43239|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 43239|EAP|0312|SPECIAL STAINS - GROUP 1|Medicare|MEDICARE A & B|||||2.40||| 43242|EAP|0750|UGI W USG FNA OR BX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||29.16||| 43242|EAP|0750|UGI W USG FNA OR BX|Blue Cross PPO|BLUE CROSS PPO|||||29.16||| 43242|EAP|0750|UGI W USG FNA OR BX|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||29.16||| 43242|EAP|0750|UGI W USG FNA OR BX|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||29.16||| 43242|EAP|0750|UGI W USG FNA OR BX|Medicare|MEDICARE A & B|||||29.16||| 43244|EAP|0750|UPPER GI ENDOSCOPY/LIGATION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.16||| 43245|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Medicare|MEDICARE A & B|||||29.16||| 43247|EAP|0750|ESOPH ENDOSCOPY, DILATION|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.98||| 43247|EAP|0750|ESOPH ENDOSCOPY, DILATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.98||| 43247|EAP|0750|ESOPH ENDOSCOPY, DILATION|Medicare|MEDICARE A & B|||||19.98||| 43248|EAP|0450||Medicare|MEDICARE A & B|||||0.00||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|United Healthcare|UMR|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.98||| 43248|EAP|0636||Medicare|MEDICARE A & B|||||34.40||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|NON CONTRACTED|COMMERCIAL OTHER|||||19.98||| 43248|EAP|0370||Medicare|MEDICARE A & B|||||7.02||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Blue Cross PPO Select|BCBS UTHCT|||||19.98||| 43248|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 43248|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 43248|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||19.98||| 43248|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Medicare|MEDICARE A & B|||||0.65||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Blue Cross PPO|BLUE CROSS POS|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Aetna|AETNA EXXON MOBIL|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Aetna|AETNA|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Blue Cross PPO|BLUE CROSS PPO|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Medicare|MEDICARE A & B|||||19.98||| 43248|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Medicare|MEDICARE A & B|||||4.15||| 43248|EAP|0272||Medicare|MEDICARE A & B|||||11.55||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.98||| 43248|EAP|0450|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|||||213.82||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Medicare|MEDICARE RAILROAD|||||19.98||| 43248|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Cigna|CIGNA OPEN ACCESS PLUS|||||19.98||| 43248|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 43248|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 43249|EAP|0750|ESOPH ENDOSCOPY, DILATION|Blue Cross PPO|BLUE CROSS PPO|||||29.16||| 43249|EAP|0750|ESOPH ENDOSCOPY, DILATION|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||29.16||| 43249|EAP|0750|ESOPH ENDOSCOPY, DILATION|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||29.16||| 43249|EAP|0750|ESOPH ENDOSCOPY, DILATION|Medicare|MEDICARE A & B|||||29.16||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.16||| 43251|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|United Healthcare|UMR|||||29.16||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|Blue Cross PPO Select|BCBS UTHCT|||||29.16||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|Blue Cross PPO|BLUE CROSS PPO|||||29.16||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||29.16||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||29.16||| 43251|EAP|0750|OPERATIVE UPPER GI ENDOSCOPY|Medicare|MEDICARE A & B|||||29.16||| 43254|EAP|0450|EGD; ENDO MUCOSAL RESECTION|Medicare|MEDICARE A & B|||||29.16||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||32.55||| 43259|EAP|0750||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||29.16||| 43259|EAP|0750||Blue Cross PPO|BLUE CROSS PPO|||||29.16||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||11.55||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||0.38||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 43259|EAP|0750||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.16||| 43259|EAP|0750||Medicare|MEDICARE A & B|||||29.16||| 43259|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||8.87||| 43259|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 43260|EAP|0750|ENDO CHOLANGIOPANCREATOGRAPH|Medicare|MEDICARE A & B|||||53.08||| 43264|EAP|0750|ENDO CHOLANGIOPANCREATOGRAPH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||53.08||| 43270|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||29.16||| 43270|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||29.16||| 43270|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||29.16||| 43270|EAP|0750|UPPER GI ENDOSCOPY, OPERATIVE|Medicare|MEDICARE A & B|||||29.16||| 43275|EAP|0750|ERCP: REML OF FB OR TUBE/STEN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||53.08||| 43762|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 43762|EAP|0450|CHANGE OF GASTROSTOMY TUBE|Medicare|MEDICARE A & B|||||6.25||| 43762|EAP|0750|CHANGE GASTROSTOMY TUBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.36||| 43762|EAP|0750|CHANGE GASTROSTOMY TUBE|Medicare|MEDICARE A & B|||||5.36||| 43762|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Medicare|MEDICARE A & B|12,280.20|8274.82|8274.82|1151.65|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Blue Cross PPO Select|BCBS UTHCT|11,966.77|1151.65|8274.82|1151.65|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Blue Cross PPO|BLUE CROSS PPO|26,385.38|4606.59|8274.82|1151.65|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Medicare|MEDICARE A & B|19,228.79|6740.655|6740.655|34.62|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Cigna|CIGNA OF TN CHATTANOOGA|15,825.98|34.62|6740.655|34.62|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Blue Cross PPO|BLUE CROSS PPO|85.42|3298.41|6740.655|34.62|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|15,287.14|2301.92|6740.655|34.62|||| 44388|EAP|0750|COLONOSCOPY THROUGH STOMA|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 44388|EAP|0750|COLONOSCOPY THROUGH STOMA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 44389|EAP|0750|COLONOSCOPY THRU STOMA W BX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 44394|EAP|0750|COLONOSCOPY,STOMA;W REM SNARE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 44401|EAP|0750|COLONOSCOPY,STOMA; W ABLATION|Medicare|MEDICARE A & B|||||20.18||| 44401|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 44404|EAP|0750||Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| 44404|EAP|0750|COLONOSCOPY THRU STOMA w/INJ|Cigna|CIGNA OF TN CHATTANOOGA|||||23.63||| 44404|EAP|0750|COLONOSCOPY THRU STOMA w/INJ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||23.63||| 45330|EAP|0750|DIAGNOSTIC SIGMOIDOSCOPY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.20||| 45330|EAP|0750|DIAGNOSTIC SIGMOIDOSCOPY|Blue Cross PPO|BLUE CROSS PPO|||||13.20||| 45330|EAP|0750||Blue Cross PPO|BLUE CROSS PPO|||||13.20||| 45330|EAP|0750|DIAGNOSTIC SIGMOIDOSCOPY|Medicare|MEDICARE A & B|||||13.20||| 45330|EAP|0750|DIAGNOSTIC SIGMOIDOSCOPY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.20||| 45331|EAP|0750|SIGMOIDOSCOPY AND BIOPSY|Medicare|MEDICARE A & B|||||13.20||| 45331|EAP|0750|SIGMOIDOSCOPY AND BIOPSY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.20||| 45335|EAP|0750|SIGMOIDSCOPE FLEX W/DIR SUBM I|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.20||| 45338|EAP|0750|SIGMOIDOSCOPY W/TUMOR REMOVE|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 45338|EAP|0750|SIGMOIDOSCOPY W/TUMOR REMOVE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 45341|EAP|0750|SIGMOIDOSCOPY W/ULTRASOUND|Medicare|MEDICARE A & B|||||20.18||| 45346|EAP|0750|SIGMOIDOSCOPY,FLEX; W/ABLATION|United Healthcare|UMR|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Medicare|MEDICARE A & B|20.18||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|NON CONTRACTED|COMMERCIAL OTHER|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 45378|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.37||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.18||| 45378|EAP|0750|DIAG COLONOSCOPY ATTEMPTED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 45378|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.18||| 45378|EAP|0750||Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 45378|EAP|0750||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross PPO|BLUE CROSS POS|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|ChampVA|CHAMPVA OF CO DENVER|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Cigna|CIGNA OPEN ACCESS PLUS|||||20.18||| 45378|EAP|0750|DIAG COLONOSCOPY ATTEMPTED|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Cigna|NALC HLTH BENEFIT|||||20.18||| 45378|EAP|0750|DIAG COLONOSCOPY ATTEMPTED|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross PPO|BCBS WALMART|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross PPO|BCBS TRANE PPO|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||20.18||| 45378|EAP|0750|DIAG COLONOSCOPY ATTEMPTED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 45378|EAP|0750|DIAG COLONOSCOPY ATTEMPTED|Medicare|MEDICARE A & B|20.18||||20.18||| 45378|EAP|0750||Medicare|MEDICARE A & B|20.18||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|United Healthcare|UMR|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.18||| 45378|EAP|0750|DIAG COLONOSCOPY ATTEMPTED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| 45378|EAP|0750|DIAGNOSTIC COLONOSCOPY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| 45380|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.18||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|United Healthcare|UMR|||||20.18||| 45380|EAP|0312||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.96||| 45380|EAP|0450|ACUITY POINT 1|Medicare|MEDICARE A & B|||||0.00||| 45380|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 45380|EAP|0450|ACUITY POINT 7|Medicare|MEDICARE A & B|||||0.00||| 45380|EAP|0450|ACUITY POINT 10|Medicare|MEDICARE A & B|||||0.00||| 45380|EAP|0312|HPV IN-SITU HYBRIDIZATION-REF|Medicare|MEDICARE A & B|||||4.70||| 45380|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||2.31||| 45380|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||3.00||| 45380|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Medicare|MEDICARE A & B|||||20.18||| 45380|EAP|0312||Medicare|MEDICARE A & B|||||4.99||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.18||| 45380|EAP|0450|ACUITY POINT 15|Medicare|MEDICARE A & B|||||0.00||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Blue Cross PPO|BCBS TRANE PPO|||||20.18||| 45380|EAP|0981|ER VISIT; LEVEL III|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 45380|EAP|0300|INSITU HIBRIDIZATION(FISH)(REF|Medicare|MEDICARE A & B|||||1.90||| 45380|EAP|0301|SHWACHMAN-DIA SYN (SBDS)AMBRY|Medicare|MEDICARE A & B|||||13.60||| 45380|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| 45380|EAP|0310||Medicare|MEDICARE A & B|||||1.84||| 45380|EAP|0310||Medicare|MEDICARE A & B|||||1.68||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.18||| 45380|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.35||| 45380|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 45380|EAP|0307||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.18||| 45380|EAP|0450|ACUITY POINT 5|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 45380|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.27||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| 45380|EAP|0312||ChampVA|CHAMPVA OF CO DENVER|||||3.96||| 45380|EAP|0450|ACUITY POINT 15|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 45380|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 45380|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.66||| 45380|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.14||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|ChampVA|CHAMPVA OF CO DENVER|||||20.18||| 45380|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 45380|EAP|0450|ACUITY POINT 10|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 45380|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Cigna|CIGNA OPEN ACCESS PLUS|||||20.18||| 45380|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 45380|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 45380|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 45380|EAP|0450|ACUITY POINT 7|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|20.18||||20.18||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 45380|EAP|0310||Medicare|MEDICARE A & B|||||1.74||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 45380|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Blue Cross PPO|BLUE CROSS POS|||||20.18||| 45380|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||0.19||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|NON CONTRACTED|COMMERCIAL OTHER|||||20.18||| 45380|EAP|0301|MAGNESIUM|Medicare|MEDICARE A & B|||||1.29||| 45380|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.49||| 45380|EAP|0312|MORPH ANALYS (FISH) MULT (GEN)|Medicare|MEDICARE A & B|||||4.99||| 45380|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.52||| 45380|EAP|0981|ER VISIT; LEVEL III|Medicare|MEDICARE A & B|||||0.00||| 45380|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicare|MEDICARE A & B|||||7.27||| 45380|EAP|0312||Medicare|MEDICARE A & B|||||1.25||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.18||| 45380|EAP|0450|ACUITY POINT 5|Medicare|MEDICARE A & B|||||0.00||| 45380|EAP|0750|COLONOSCOPY AND BIOPSY|Medicaid|MEDICAID|20.18||||||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Blue Cross PPO|BLUE CROSS POS|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Medicare|MEDICARE A & B|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Blue Cross PPO|BCBS WALMART|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| 45381|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Multiplan|WEB TPA|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|NON CONTRACTED|COMMERCIAL OTHER|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|PHCS|WEB TPA|||||20.18||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|Medicaid|MEDICAID|20.18||||||| 45381|EAP|0750|COLONSCOPY,SUBMUCOUS INJ|United Healthcare|UMR|||||20.18||| 45381|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 45382|EAP|0750|COLONOSCOPY/CONTROL BLEEDING|Medicare|MEDICARE A & B|||||20.18||| 45385|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 45385|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 45385|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.42||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|ChampVA|CHAMPVA OF CO DENVER|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 45385|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 45385|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||20.18||| 45385|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|PHCS|WEB TPA|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Cigna|CIGNA OPEN ACCESS PLUS|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|United Healthcare|UMR|||||20.18||| 45385|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Medicare|MEDICARE A & B|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.18||| 45385|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Medicaid|MEDICAID|20.18||||||| 45385|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|NON CONTRACTED|COMMERCIAL OTHER|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Multiplan|WEB TPA|||||20.18||| 45385|EAP|0312||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.96||| 45385|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Aetna|AETNA|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| 45385|EAP|0312||ChampVA|CHAMPVA OF CO DENVER|||||3.96||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross PPO|BLUE CROSS POS|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross PPO|BCBS WALMART|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.18||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 45385|EAP|0300|QUANTIFERON TB GOLD|Blue Cross PPO Select|BCBS UTHCT|||||0.63||| 45385|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||21.30||| 45385|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|20.18||||20.18||| 45385|EAP|0300||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.18||| 45388|EAP|0750|COLONOSCOPY, LESION REMOVAL|Medicare|MEDICARE A & B|||||20.18||| 45388|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 45388|EAP|0750|COLONOSCOPY, LESION REMOVAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| 47000|EAP|0360|BIOPSY LIVER|Medicare|MEDICARE A & B|||||15.94||| 47531|EAP|0360|INJ PROC, CHOLANGIOGRAPHY|Medicare|MEDICARE A & B|||||77.08||| 49082|EAP|0450|ABDOMINAL PARACENTESIS W/O IMG|Medicare|MEDICARE A & B|2,725.25||||2,725.25||| 49082|EAP|0450||Medicare|MEDICARE A & B|2,725.25||||2,725.25||| 49083|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.69||| 49083|EAP|0360||Blue Cross PPO|BLUE CROSS PPO|||||18.84||| 49083|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 49083|EAP|0360||Blue Cross PPO Select|BCBS UTHCT|||||18.84||| 49083|EAP|0360|ABDOMINAL PARACENTESIS W/IMAGI|Blue Cross PPO Select|BCBS UTHCT|||||18.84||| 49083|EAP|0360||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||18.84||| 49083|EAP|0360|ABDOMINAL PARACENTESIS W/IMAGI|Blue Cross PPO|BLUE CROSS PPO|||||18.84||| 49083|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.81||| 49083|EAP|0360||Blue Cross PPO|BLUE CROSS POS|18.84||||18.84||| 49083|EAP|0360||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|18.84||||18.84||| 49083|EAP|0360||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||18.84||| 49083|EAP|0260||NON CONTRACTED|COMMERCIAL OTHER|||||5.69||| 49083|EAP|0360||Medicare|MEDICARE A & B|18.84||||18.84||| 49083|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 49083|EAP|0360||NON CONTRACTED|COMMERCIAL OTHER|||||18.84||| 49083|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.03||| 49083|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 49465|EAP|0320|CONTRAST INJ, RAD EVAL TUBE|Medicare|MEDICARE A & B|6.08||||6.08||| 49465|EAP|0320|CONTRAST INJ, RAD EVAL TUBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.08||| 51600|EAP|0761|INJECTION CYSTOGRAPHY|Blue Cross PPO|BLUE CROSS PPO|||||12.92||| 51701|EAP|0761|INSERT NON-DWELL BLADDER CATH|United Healthcare|UMR|||||381.05||| 51701|EAP|0761||Blue Cross PPO|BCBS WALMART|||||0.83||| 51701|EAP|0761|INSERT NON-DWELL BLADDER CATH|Medicare|MEDICARE A & B|||||381.05||| 51701|EAP|0510||Blue Cross PPO|BCBS WALMART|||||3.26||| 51701|EAP|0761|INSERT NON-DWELL BLADDER CATH|Blue Cross PPO|BCBS WALMART|||||381.05||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.32||||2.32||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.32||||2.32||| 51702|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.32||||4.15||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.32||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Medicaid|MEDICAID|||||2.32||| 51702|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 51702|EAP|0761|INSRT TEMP INDWL BLADDER CATH|Medicare|MEDICARE A & B|||||1.95||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Blue Cross PPO|BLUE CROSS PPO|||||2.32||| 51702|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.32||| 51702|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Medicare|MEDICARE A & B|2.32||||2.32||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.32||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.32||| 51702|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Blue Cross PPO Select|BCBS UTHCT|||||2.32||| 51702|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.32||||0.00||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.32||||2.32||| 51702|EAP|0450|INSRT TEMP INDWL BLADDER CATH|NON CONTRACTED|COMMERCIAL OTHER|||||2.32||| 51702|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 51705|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||23.10||| 51705|EAP|0761|CHANGE OF CYSTOSTOMY TUBE SIMP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.83||| 51705|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.36||| 51705|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 51705|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.14||| 51705|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.38||| 51705|EAP|0761|CHANGE OF CYSTOSTOMY TUBE SIMP|Medicare|MEDICARE A & B|||||5.83||| 51705|EAP|0272|CATH FOLEY 18FR 5CC RED LATEX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.42||| 51729|EAP|0920|CYSTOMETROGRAM W/VP & UP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.35||| 51729|EAP|0920|CYSTOMETROGRAM W/VP & UP|Medicare|MEDICARE A & B|||||6.35||| 51729|EAP|0920||United Healthcare|UMR|||||4.18||| 51729|EAP|0920|CYSTOMETROGRAM W/VP & UP|United Healthcare|UMR|||||6.35||| 51729|EAP|0920|CYSTOMETROGRAM W/VP & UP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.35||| 51729|EAP|0920||United Healthcare|UMR|||||2.24||| 51736|EAP|0999||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 51736|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.98||| 51736|EAP|0761||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.83||| 51736|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||23.10||| 51736|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.05||| 51736|EAP|0920||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.69||| 51736|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||37.63||| 51736|EAP|0920||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.69||| 51736|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.64||| 51736|EAP|0920||Medicare|MEDICARE A & B|||||2.69||| 51736|EAP|0920|SIMPLE UROFLOWMETRY (URO)|Medicare|MEDICARE A & B|||||2.69||| 51736|EAP|0920||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.69||| 51736|EAP|0920||Blue Cross PPO|BLUE CROSS PPO|||||2.69||| 51736|EAP|0920||Blue Cross PPO|BLUE CROSS POS|||||2.69||| 51736|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 51736|EAP|0920||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.69||| 51736|EAP|0761||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.83||| 51736|EAP|0920||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.69||| 51741|EAP|0920|COMPLEX UROFLOWMETRY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.24||| 51741|EAP|0920|COMPLEX UROFLOWMETRY|Medicare|MEDICARE A & B|||||2.24||| 51741|EAP|0920|COMPLEX UROFLOWMETRY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.24||| 51741|EAP|0920|COMPLEX UROFLOWMETRY|United Healthcare|UMR|||||2.24||| 51784|EAP|0920|EMG URODYNAMICS|United Healthcare|UMR|||||2.24||| 51784|EAP|0920|EMG URODYNAMICS|Medicare|MEDICARE A & B|||||2.24||| 51784|EAP|0920|EMG URODYNAMICS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.24||| 51784|EAP|0920|EMG URODYNAMICS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.24||| 51797|EAP|0920|INTRAABDOMINAL PRESSURE TEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.18||| 51797|EAP|0920|INTRAABDOMINAL PRESSURE TEST|Medicare|MEDICARE A & B|||||4.18||| 51797|EAP|0920|INTRAABDOMINAL PRESSURE TEST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.18||| 51797|EAP|0920|INTRAABDOMINAL PRESSURE TEST|United Healthcare|UMR|||||4.18||| 51798|EAP|0761|US PV RESIDUAL URINE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Tricare|TRICARE WEST UNITED HEALTH|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|PHCS|WEB TPA|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Medicare|MEDICARE A & B|0.83||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|United Healthcare|UMR|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.83||| 51798|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 51798|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 51798|EAP|0761|US PV RESIDUAL URINE|NON CONTRACTED|COMMERCIAL OTHER|||||0.83||| 51798|EAP|0306||Medicare|MEDICARE A & B|||||1.36||| 51798|EAP|0761|US PV RESIDUAL URINE|United Healthcare|GOLDEN RULE INSURANCE|||||0.83||| 51798|EAP|0306||Medicare|MEDICARE A & B|||||1.32||| 51798|EAP|0761|US PV RESIDUAL URINE|Medicaid|MEDICAID|||||0.83||| 51798|EAP|0250||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||408.85||| 51798|EAP|0307||Medicare|MEDICARE A & B|||||1.18||| 51798|EAP|0311|CYTO, NON-GYN LIQUID BASED|Medicare|MEDICARE A & B|||||2.56||| 51798|EAP|0761|US PV RESIDUAL URINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.83||| 51798|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 51798|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross PPO Select|BCBS UTHCT|||||0.83||| 51798|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.98||| 51798|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23.10||| 51798|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.60||| 51798|EAP|0999||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 51798|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23,466.50||| 51798|EAP|0761|US PV RESIDUAL URINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.83||| 51798|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 51798|EAP|0761|US PV RESIDUAL URINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.83||| 51798|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| 51798|EAP|0510|IM INJ OF ANTIBIOTIC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 51798|EAP|0761|US PV RESIDUAL URINE|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||0.83||| 51798|EAP|0301||Medicare|MEDICARE A & B|||||0.60||| 51798|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||37.63||| 51798|EAP|0761|US PV RESIDUAL URINE|Multiplan|WEB TPA|||||0.83||| 51798|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.64||| 51798|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 51798|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||37.63||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross PPO|BLUE CROSS PPO|||||0.83||| 51798|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 51798|EAP|0761|US PV RESIDUAL URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross PPO|BCBS TRANE PPO|||||0.83||| 51798|EAP|0761||Medicare|MEDICARE A & B|0.83||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.83||| 51798|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.79||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross PPO|BLUE CROSS POS|||||0.83||| 51798|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 51798|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||6.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Aetna|AETNA US HEALTHCARE PA|||||0.83||| 51798|EAP|0761|US PV RESIDUAL URINE|Blue Cross PPO|BCBS WALMART|||||0.83||| 51798|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.83||| 51798|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 51798|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 51798|EAP|0761|US PV RESIDUAL URINE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.83||| 52000|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 52000|EAP|0510|CYSTOSCOPY|Medicare|MEDICARE A & B|||||37.63||| 52000|EAP|0510|CYSTOSCOPY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||37.63||| 52000|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 52000|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 52000|EAP|0510|CYSTOSCOPY|Blue Cross PPO|BLUE CROSS PPO|||||37.63||| 52000|EAP|0510|CYSTOSCOPY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||37.63||| 52000|EAP|0510|CYSTOSCOPY|Cigna|CIGNA OF TN CHATTANOOGA|||||37.63||| 52000|EAP|0272||Medicare|MEDICARE A & B|||||0.05||| 52000|EAP|0272||Medicare|MEDICARE A & B|||||23.10||| 52000|EAP|0272||Medicare|MEDICARE A & B|||||0.98||| 52000|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 52000|EAP|0510||United Healthcare|UMR|||||2.50||| 52000|EAP|0510|CYSTOSCOPY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||37.63||| 52000|EAP|0510|CYSTOSCOPY|United Healthcare|UMR|||||37.63||| 52000|EAP|0510|CYSTOSCOPY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||37.63||| 52310|EAP|0510|CYSTOSCOPY W/ REMOVAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||43.95||| 52310|EAP|0510|CYSTOSCOPY W/ REMOVAL|Cigna|CIGNA OF TN CHATTANOOGA|||||43.95||| 52310|EAP|0510|CYSTOSCOPY W/ REMOVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||43.95||| 52310|EAP|0510||Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.64||| 52310|EAP|0510|CYSTOSCOPY W/ REMOVAL|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||43.95||| 52441|EAP|0360||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||684.14||| 52442|EAP|0360|CYSTOURETHROSCOPY ADJ IMPLANT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||182.04||| 540|DRG||OSTEOMYELITIS W CC|Medicare|MEDICARE A & B|36,200.21|10205.37|21688.88|10205.37|||| 540|DRG||OSTEOMYELITIS W CC|NON CONTRACTED|COMMERCIAL OTHER|54,222.20|21688.88|21688.88|10205.37|||| 541|DRG||OSTEOMYELITIS W/O CC/MCC|Medicaid|MEDICAID|30,778.80|11160.39|11160.39|11160.39|||| 55700|EAP|0402|US GUIDED NEEDLE PLACEMENT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.77||| 55700|EAP|0360|BIOPSY,PROSTATE; NEEDLE/PUNCH,|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||41.50||| 55700|EAP|0360|BIOPSY,PROSTATE; NEEDLE/PUNCH,|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||41.50||| 55700|EAP|0360|BIOPSY,PROSTATE; NEEDLE/PUNCH,|Medicare|MEDICARE A & B|||||41.50||| 55700|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 55700|EAP|0360|BIOPSY,PROSTATE; NEEDLE/PUNCH,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||41.50||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|Medicare|MEDICARE A & B|20,296.45|8365.58|8365.58|8365.58|||| 56420|EAP|0450|I & D BARTHOLIN'S GLAND ABSCES|Medicare|MEDICARE A & B|||||4.99||| 56501|EAP|0510|DEST OF LESION, VULVA; SIMP|Medicare|MEDICARE A & B|||||30.55||| 566|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC|Managed Medicaid|SUPERIOR STAR MCD|22,245.50|8066.22|8066.22|8066.22|||| 56605|EAP|0510|VULVA BIOPSY; SINGLE LESION|Medicare|MEDICARE A & B|||||7.05||| 56605|EAP|0312||Medicare|MEDICARE A & B|||||3.96||| 56605|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 56605|EAP|0306|HPV HIGH RISK PCR (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.82||| 56605|EAP|0510|VULVA BIOPSY; SINGLE LESION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.05||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Medicare|MEDICARE A & B|21,223.20|12504.665|12504.665|7839.27|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|12,931.75|7839.27|12504.665|7839.27|||| 57420|EAP|0510|EXAM OF VAG W/SCOPE|Managed Medicaid|FAMILY PLANNING GRANT|||||4.26||| 57421|EAP|0510|EXAM/BIOPSY OF VAG W/SCOPE|Managed Medicaid|FAMILY PLANNING GRANT|||||4.26||| 57454|EAP|0510|COLPO/W BX OR ECC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.23||| 57454|EAP|0510|COLPO/W BX OR ECC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.23||| 57454|EAP|0510|COLPO/W BX OR ECC|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.23||| 57454|EAP|0312||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.96||| 57454|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 57454|EAP|0510|COLPO/W BX OR ECC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.23||| 57454|EAP|0510|COLP CERVIX W BX & CURETT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.23||| 57455|EAP|0510|BIOPSY OF CERVIX W/SCOPE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.62||| 57455|EAP|0510|BIOPSY OF CERVIX W/SCOPE|Managed Medicaid|FAMILY PLANNING GRANT|||||4.62||| 57455|EAP|0510|BIOPSY OF CERVIX W/SCOPE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.62||| 57456|EAP|0510|CERV COLP W EC CURETT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.01||| 57456|EAP|0510|CERV COLP W EC CURETT|Managed Medicaid|FAMILY PLANNING GRANT|||||7.32||| 57456|EAP|0510|CERV COLP W EC CURETT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||7.32||| 57456|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 57461|EAP|0510|CONZ OF CERVIX W/SCOPE LEEP|Managed Medicaid|FAMILY PLANNING GRANT|||||26.51||| 57500|EAP|0510|CERVICAL BIOPSY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.01||| 57522|EAP|0312||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||5.97||| 57522|EAP|0360|CONIZATION OF CERVIX|Blue Cross PPO|BLUE CROSS POS|||||5,946.93||| 57522|EAP|0360|CONIZATION OF CERVIX|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||67.51||| 581|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC|United Healthcare|UMR|18,065.93|48|48|48|||| 58100|EAP|0510|ENDOMETRIAL BX, WO CERV DILATA|Managed Medicaid|FAMILY PLANNING GRANT|||||4.40||| 58100|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 58100|EAP|0510|ENDOMETRIAL BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.40||| 58100|EAP|0510|ENDOMETRIAL BIOPSY|Managed Medicaid|FAMILY PLANNING GRANT|||||4.40||| 58100|EAP|0510|ENDOMETRIAL BIOPSY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.40||| 58100|EAP|0510|ENDOMETRIAL BIOPSY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.15||| 58100|EAP|0510|ENDOMETRIAL BIOPSY|Blue Cross PPO|BLUE CROSS PPO|||||2.15||| 58100|EAP|0510|ENDOMETRIAL BIOPSY|Medicare|MEDICARE A & B|||||4.40||| 58100|EAP|0510|ENDOMETRIAL BX, WO CERV DILATA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||35.59||| 58100|EAP|0510|ENDOMETRIAL BX, WO CERV DILATA|Blue Cross PPO|BLUE CROSS PPO|||||4.40||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Blue Cross PPO Select|BCBS UTHCT|||||1.79||| 58300|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.25||| 58300|EAP|0311||Managed Medicaid|FAMILY PLANNING GRANT|||||0.60||| 58300|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||4.05||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.79||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Blue Cross PPO|BLUE CROSS POS|||||1.79||| 58300|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 58300|EAP|0510||United Healthcare|UMR|||||2.64||| 58300|EAP|0510||United Healthcare|UMR|||||4.05||| 58300|EAP|0301||United Healthcare|UMR|||||1.14||| 58300|EAP|0510|INSERTION IUD FOR CONTRACEPTIO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.00||| 58300|EAP|0510|INSERTION IUD FOR CONTRACEPTIO|United Healthcare|UMR|||||1.00||| 58300|EAP|0510|REMOVE INTRAUTERINE DEVICE|United Healthcare|UMR|||||4.05||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.79||| 58300|EAP|0510|INSERTION IUD FOR CONTRACEPTIO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.00||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|NON CONTRACTED|COMMERCIAL OTHER|||||1.79||| 58300|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| 58300|EAP|0510|REMOVAL OF INTRAUTERINE DEVICE|Blue Cross PPO|BLUE CROSS PPO|||||4.05||| 58300|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.82||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Blue Cross PPO|BCBS WALMART|||||1.79||| 58300|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.05||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Blue Cross PPO|BLUE CROSS PPO|||||1.79||| 58300|EAP|0510|INSERTION IUD FOR CONTRACEPTIO|Blue Cross PPO|BLUE CROSS PPO|||||1.00||| 58300|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 58300|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||4.05||| 58300|EAP|0510|INSERTION IUD FOR CONTRACEPTIO|Managed Medicaid|MOLINA MEDICAID|||||1.00||| 58300|EAP|0940||Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.79||| 58300|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Managed Medicaid|MOLINA MEDICAID|||||1.79||| 58300|EAP|0510|INSERT INTRAUTERINE DEVICE|Aetna|AETNA|||||1.79||| 58300|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 58300|EAP|0510|INSERTION IUD FOR CONTRACEPTIO|Managed Medicaid|FAMILY PLANNING GRANT|||||1.00||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVICE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.05||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVICE|Managed Medicaid|FAMILY PLANNING GRANT|||||4.05||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVI|Blue Cross PPO Select|BCBS UTHCT|||||4.05||| 58301|EAP|0510||United Healthcare|UMR|||||4.05||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVI|Cigna|CIGNA OF TN CHATTANOOGA|||||4.05||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVICE|United Healthcare|UMR|||||4.05||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVI|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.05||| 58301|EAP|0636||Managed Medicaid|FAMILY PLANNING GRANT|||||12.30||| 58301|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVICE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.05||| 58301|EAP|0510|REMOVAL OF INTRAUTERINE DEVI|Blue Cross PPO|BLUE CROSS PPO|||||4.05||| 58301|EAP|0510||Managed Medicaid|FAMILY PLANNING GRANT|||||1.00||| 58301|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.05||| 58340|EAP|0360|CATHETER INTRODUCTION HYSTERO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.59||| 60100|EAP|0402||Blue Cross PPO Select|BCBS UTHCT|||||9.62||| 60100|EAP|0361|BIOPSY THYROID|Blue Cross PPO Select|BCBS UTHCT|||||9.97||| 60100|EAP|0361|BIOPSY THYROID|Blue Cross PPO|BLUE CROSS PPO|||||9.97||| 60100|EAP|0361|BIOPSY THYROID|Blue Cross PPO|BLUE CROSS POS|||||9.97||| 60100|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.62||| 60100|EAP|0360||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.55||| 60100|EAP|0361|BIOPSY THYROID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.97||| 60100|EAP|0361|BIOPSY THYROID|Aetna|AETNA|||||9.97||| 60100|EAP|0360||Blue Cross PPO Select|BCBS UTHCT|||||15.55||| 60100|EAP|0361|BIOPSY THYROID|Medicare|MEDICARE A & B|||||9.97||| 60100|EAP|0361|BIOPSY THYROID|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.97||| 60100|EAP|0361|BIOPSY THYROID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.97||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE A & B|18,830.53|8114.31|8114.31|64|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|33,553.40|7755.23|8114.31|64|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|98.54|2872.3|8114.31|64|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE PART A|16,797.31|8114.31|8114.31|64|||| 603|DRG||CELLULITIS W/O MCC|United Healthcare|UMR|21,365.60|64|8114.31|64|||| 603|DRG||CELLULITIS W/O MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|27,018.65|7746.34|8114.31|64|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|14,603.85|5295.36|8114.31|64|||| 60300|EAP|0360|ASPIRATION/INJECTION THYROID C|Medicare|MEDICARE A & B|||||6.14||| 607|DRG||MINOR SKIN DISORDERS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|13,347.76|2518.46|8139.96|2518.46|||| 607|DRG||MINOR SKIN DISORDERS W/O MCC|Medicare|MEDICARE A & B|45,727.90|8139.96|8139.96|2518.46|||| 62270|EAP|0510|LUMBAR PUNCTURE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.51||| 62270|EAP|0320|DX LMBR SPI PNXR W/FLUOR/CT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||16.89||| 62270|EAP|0450|LUMBAR PUNCTURE|Medicare|MEDICARE A & B|8.63||||||| 62270|EAP|0360|SPINAL PUNCTURE, LUMBAR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.90||| 62270|EAP|0450|LUMBAR PUNCTURE|Blue Cross PPO|BLUE CROSS PPO|||||8.63||| 62270|EAP|0360||Medicare|MEDICARE A & B|||||6.90||| 62270|EAP|0450|LUMBAR PUNCTURE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.63||| 62270|EAP|0320|FLUORO GUIDE LOCAL - SPINE DIA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.49||| 62270|EAP|0450|LUMBAR PUNCTURE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||8.63||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Medicare|MEDICARE A & B|31,442.39|12420.93|12420.93|12420.93|||| 62328|EAP|0320|DX LMBR SPI PNXR W/FLUOR/CT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||16.89||| 637|DRG||DIABETES W MCC|Medicare|MEDICARE A & B|30,964.23|11716.7|11716.7|11716.7|||| 638|DRG||DIABETES W CC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|22,648.15|3231.5|19539.05|3231.5|||| 638|DRG||DIABETES W CC|Aetna|AETNA EL PASO CLAIMS OFFICE|25,585.35|11183.86|19539.05|3231.5|||| 638|DRG||DIABETES W CC|Medicare|MEDICARE A & B|11,971.73|8510.68|19539.05|3231.5|||| 638|DRG||DIABETES W CC|Medicaid|MEDICAID|53,885.97|19539.05|19539.05|3231.5|||| 638|DRG||DIABETES W CC|Blue Cross PPO|BLUE CROSS PPO|34,395.16|3578.39|19539.05|3231.5|||| 638|DRG||DIABETES W CC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|37,572.05|13623.63|19539.05|3231.5|||| 639|DRG||DIABETES W/O CC/MCC|Medicare|MEDICARE A & B|25,016.43|6779.19|6779.19|6779.19|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Medicare|MEDICARE A & B|43,789.05|10620.54|10620.54|9893.85|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|47,822.55|10093.12|10620.54|9893.85|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|32,456.60|9893.85|10620.54|9893.85|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|56,270.29|2785.79|14037.11|2785.79|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|27,020.13|9797.5|14037.11|2785.79|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Medicare|MEDICARE A & B|22,563.99|7569.99|14037.11|2785.79|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|78,884.25|14037.11|14037.11|2785.79|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Medicaid|MEDICAID|29,549.35|10714.59|14037.11|2785.79|||| 643|DRG||ENDOCRINE DISORDERS W MCC|Medicare|MEDICARE A & B|42,548.85|13249.42|13249.42|13249.42|||| 644|DRG||ENDOCRINE DISORDERS W CC|Medicare|MEDICARE A & B|33,385.20|9242.44|9242.44|9242.44|||| 64455|EAP|0510|N BLOCK INJ PLANTAR DIGIT|Medicare|MEDICARE A & B|||||2.02||| 645|DRG||ENDOCRINE DISORDERS W/O CC/MCC|Medicare|MEDICARE A & B|22,126.21|7622.97|7622.97|7622.97|||| 64640|EAP|0510|DEST BY NEURO AGENT PN OR BRAN|Medicare|MEDICARE A & B|||||14.89||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Medicare|MEDICARE A & B|27,851.10|7442.63|7442.63|7442.63|||| 683|DRG||RENAL FAILURE W CC|Medicare|MEDICARE A & B|21,257.75|8595.04|8595.04|3404.89|||| 683|DRG||RENAL FAILURE W CC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|19,979.74|3404.89|8595.04|3404.89|||| 683|DRG||RENAL FAILURE W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|21,338.30|7896.85|8595.04|3404.89|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Medicare|MEDICARE A & B|18,090.43|6738.755|6738.755|6738.755|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicare|MEDICARE A & B|27,601.35|9837.47|9837.47|9837.47|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|29,783.04|7366.64|11071.55|3284.165|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|30,300.15|3284.165|11071.55|3284.165|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER|11,071.55|11071.55|11071.55|3284.165|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|26,171.88|7447.57|11071.55|3284.165|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Medicare|MEDICARE A & B|16,688.10|7783.32|11071.55|3284.165|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18,573.75|6734.84|11071.55|3284.165|||| 69209|EAP|0510||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.50||| 69209|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||1.50||| 69209|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 69209|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 69209|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.50||| 69209|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.50||| 69209|EAP|0510|REM;IMP EAR WAX UNIL (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.50||| 69209|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||1.50||| 69209|EAP|0510|REMOVAL IMPACTED CERUMEN UNI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.50||| 69209|EAP|0510||Medicare|MEDICARE A & B|||||1.50||| 69209|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.50||| 69209|EAP|0510|REM;IMP EAR WAX UNIL (IMC)|Medicare|MEDICARE A & B|||||1.50||| 69210|EAP|0510|CERUMEN EXTRACTION|Medicare|MEDICARE A & B|||||2.25||| 69210|EAP|0510|CERUMEN EXTRACTION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.25||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Medicare|MEDICARE A & B|23,504.80|13205.31|13205.31|12017.86|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|25,380.88|12017.86|13205.31|12017.86|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Medicare|MEDICARE A & B|36,195.85|9460.46|9460.46|9460.46|||| 70110|EAP|0320|MANDIBLE; COMP MINIMUM 4 VIEWS|Blue Cross PPO|BLUE CROSS POS|||||1.36||| 70110|EAP|0320|MANDIBLE; COMP MINIMUM 4 VIEWS|Medicare|MEDICARE A & B|||||3.83||| 70110|EAP|0320|MANDIBLE; COMP MINIMUM 4 VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.36||| 70150|EAP|0320|FACIAL BONES; COMP MINIMUM 3 V|Blue Cross PPO|BLUE CROSS POS|||||4.22||| 70150|EAP|0320|FACIAL BONES; COMP MINIMUM 3 V|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.22||||||| 70150|EAP|0320|FACIAL BONES; COMP MINIMUM 3 V|Blue Cross PPO|BLUE CROSS PPO|||||4.22||| 70150|EAP|0320|FACIAL BONES; COMP MINIMUM 3 V|Medicare|MEDICARE A & B|4.22||||||| 70150|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 70160|EAP|0320|NASAL BONES; MINIMUM 3 VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||3.62||| 70160|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 70160|EAP|0320|NASAL BONES; MINIMUM 3 VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||3.62||| 70160|EAP|0320|NASAL BONES; MINIMUM 3 VIEWS|Medicare|MEDICARE A & B|||||3.62||| 70160|EAP|0320|NASAL BONES; MINIMUM 3 VIEWS|Cigna|CIGNA OPEN ACCESS PLUS|||||0.88||| 70160|EAP|0320|NASAL BONES; MINIMUM 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER|||||3.62||| 70160|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 70160|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 70160|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Multiplan|WEB TPA|||||2.04||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|PHCS|WEB TPA|||||2.04||| 70210|EAP|0510||PHCS|WEB TPA|||||4.38||| 70210|EAP|0510||Multiplan|WEB TPA|||||4.38||| 70210|EAP|0410|NEBULIZATION TREATMENT(CFC)|PHCS|WEB TPA|||||2.20||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Blue Cross PPO Select|BCBS UTHCT|||||1.02||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Blue Cross PPO|BLUE CROSS POS|||||2.04||| 70210|EAP|0410|NEBULIZATION TREATMENT(CFC)|Multiplan|WEB TPA|||||2.20||| 70210|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.19||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.04||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 70210|EAP|0320|SINUS, WATER'S VIEW ONLY, 1 VI|Blue Cross PPO|BCBS WALMART|||||0.00||| 70220|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 70220|EAP|0320|SINUS, SERIES|Blue Cross PPO|BCBS WALMART|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Blue Cross PPO|BCBS TRANE PPO|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.08||| 70220|EAP|0320|SINUS, SERIES|ChampVA|CHAMPVA OF CO DENVER|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 70220|EAP|0306||Medicare|MEDICARE A & B|||||0.83||| 70220|EAP|0306||Medicare|MEDICARE A & B|||||0.40||| 70220|EAP|0320|SINUS, SERIES|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 70220|EAP|0306||Medicare|MEDICARE A & B|||||3.47||| 70220|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 70220|EAP|0320|SINUS, SERIES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 70220|EAP|0320|SINUS, SERIES|Medicare|MEDICARE A & B|||||0.00||| 70220|EAP|0306||Multiplan|WEB TPA|||||1.66||| 70220|EAP|0320|SINUS, SERIES|Multiplan|WEB TPA|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 70220|EAP|0306||Medicare|MEDICARE A & B|||||1.54||| 70220|EAP|0320||PHCS|WEB TPA|||||2.35||| 70220|EAP|0320|SINUS, SERIES|PHCS|WEB TPA|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Cigna|CIGNA OF TN CHATTANOOGA|||||2.16||| 70220|EAP|0320|SINUS, SERIES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 70220|EAP|0320|SINUS, SERIES|United Healthcare|UMR|||||2.16||| 70220|EAP|0320|SINUS, SERIES|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.16||||||| 70220|EAP|0306||PHCS|WEB TPA|||||1.66||| 70220|EAP|0320|SINUS, SERIES|Medicaid|MEDICAID|||||0.00||| 70220|EAP|0320||Multiplan|WEB TPA|||||2.35||| 70220|EAP|0320|SINUS, SERIES|NON CONTRACTED|COMMERCIAL OTHER|||||2.16||| 70250|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|NON CONTRACTED|COMMERCIAL OTHER|||||2.16||| 70250|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|Medicare|MEDICARE A & B|||||2.16||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.16||||2.16||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 70250|EAP|0320|SKULL; LESS THAN 4 VIEWS|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.36||| 70260|EAP|0320|SKULL; MINIMUM 4 VIEWS|United Healthcare|UMR|||||4.57||| 70260|EAP|0320|SKULL; MINIMUM 4 VIEWS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.36||| 70260|EAP|0320|SKULL; MINIMUM 4 VIEWS|Medicare|MEDICARE A & B|||||4.57||| 70360|EAP|0320|NECK, SOFT TISSUE|Medicaid|MEDICAID|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|PHCS|WEB TPA|||||3.12||| 70360|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 70360|EAP|0301||Medicaid|MEDICAID|||||129.20||| 70360|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| 70360|EAP|0320|NECK, SOFT TISSUE|Managed Medicaid|OTHER MEDICAID|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|Multiplan|WEB TPA|||||3.12||| 70360|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.38||| 70360|EAP|0320|NECK, SOFT TISSUE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.12||| 70360|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||4.38||| 70360|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| 70360|EAP|0320|NECK, SOFT TISSUE|NON CONTRACTED|COMMERCIAL OTHER|||||3.12||| 70360|EAP|0510||Managed Medicaid|MOLINA MEDICAID|||||3.26||| 70360|EAP|0320|NECK, SOFT TISSUE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|Managed Medicaid|MOLINA MEDICAID|||||3.12||| 70360|EAP|0320||NON CONTRACTED|COMMERCIAL OTHER|||||3.12||| 70360|EAP|0320||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.12||| 70360|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Medicaid|MEDICAID|||||4.38||| 70360|EAP|0460||Medicaid|MEDICAID|||||4.74||| 70360|EAP|0320|NECK, SOFT TISSUE|Blue Cross PPO Select|BCBS UTHCT|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|ChampVA|CHAMPVA OF CO DENVER|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|Medicare|MEDICARE A & B|3.12||||3.12||| 70360|EAP|0320||Managed Medicaid|MOLINA MEDICAID|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|United Healthcare|UMR|||||3.12||| 70360|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||3.12||| 70360|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 70360|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Blue Cross PPO|BCBS TRANE PPO|||||160.36||| 70360|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 70360|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross PPO|BCBS TRANE PPO|||||4.38||| 70360|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| 70360|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 70360|EAP|0320|NECK, SOFT TISSUE|Blue Cross PPO|BLUE CROSS PPO|||||3.12||| 70360|EAP|0320||Medicaid|MEDICAID|||||3.12||| 70360|EAP|0320||Medicaid|MEDICAID|||||2.35||| 70360|EAP|0320|NECK, SOFT TISSUE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.56||| 70360|EAP|0410||Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 70360|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 70360|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 70360|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 70360|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 70360|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||3.12||| 70360|EAP|0320|NECK, SOFT TISSUE|Blue Cross PPO|BLUE CROSS POS|||||3.12||| 70360|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 70360|EAP|0320|NECK, SOFT TISSUE|Blue Cross PPO|BCBS TRANE PPO|||||3.12||| 70360|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||4.38||| 70450|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.19||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||20.61||| 70450|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 70450|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||20.61||| 70450|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 70450|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.18||| 70450|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 70450|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 70450|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.12||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Veterans Affairs|VETERANS CHOICE - TRI WEST|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|United Healthcare|UMR|||||20.61||| 70450|EAP|0981||PHCS|WEB TPA|||||0.00||| 70450|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.15||| 70450|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||213.82||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|PHCS|WEB TPA|||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|United Healthcare|GOLDEN RULE INSURANCE|||||20.61||| 70450|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.36||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|20.61||||20.61||| 70450|EAP|0351||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Aetna|AETNA EL PASO CLAIMS OFFICE|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Blue Cross PPO|BCBS WALMART|||||20.61||| 70450|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 70450|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.12||| 70450|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.51||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Blue Cross PPO|BLUE CROSS POS|||||20.61||| 70450|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 70450|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 70450|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 70450|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.61||| 70450|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 70450|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Cigna|CIGNA OF TN CHATTANOOGA|||||20.61||| 70450|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Cigna|CIGNA OPEN ACCESS PLUS|||||20.61||| 70450|EAP|0730||Cigna|CIGNA OPEN ACCESS PLUS|||||3.86||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Cigna|CIGNA OTHER|||||20.61||| 70450|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||669.83||| 70450|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 70450|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Blue Cross PPO Select|BCBS UTHCT|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|ChampVA|CHAMPVA OF CO DENVER|||||20.61||| 70450|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.11||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|20.61||||20.61||| 70450|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||20.61||| 70450|EAP|0352||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.81||| 70450|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 70450|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 70450|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.14||| 70450|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 70450|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.32||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.18||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Humana Medicare Advantage|HUMANA MEDICARE PPO|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Managed Medicaid|SUPERIOR STAR MCD|||||20.61||| 70450|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.66||| 70450|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.14||| 70450|EAP|0307||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.69||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.20||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.27||| 70450|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.36||| 70450|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 70450|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 70450|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 70450|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.51||| 70450|EAP|0351||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|20.61||||20.61||| 70450|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.39||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||20.61||| 70450|EAP|0450||Multiplan|WEB TPA|||||181.41||| 70450|EAP|0274||NON CONTRACTED|MRAMVA|||||0.51||| 70450|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.09||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Medicare|MEDICARE PART A|20.61||||||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Medicare|MEDICARE A & B|20.61||||20.61||| 70450|EAP|0351||Medicare|MEDICARE A & B|20.61||||20.61||| 70450|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 70450|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||4.18||| 70450|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 70450|EAP|0981||Multiplan|WEB TPA|||||0.00||| 70450|EAP|0610||Medicare|MEDICARE A & B|||||42.62||| 70450|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.36||| 70450|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.70||| 70450|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||4.15||| 70450|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||4.36||| 70450|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 70450|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 70450|EAP|0450|SMPL REP S/N/A/G/TR/E; 2.5CM/<|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.36||| 70450|EAP|0636||Medicare|MEDICARE A & B|||||11.50||| 70450|EAP|0636||Medicare|MEDICARE A & B|||||63.90||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|20.61||||20.61||| 70450|EAP|0320||Medicare|MEDICARE A & B|||||2.04||| 70450|EAP|0343||Medicare|MEDICARE A & B|||||2.90||| 70450|EAP|0320||Medicare|MEDICARE A & B|||||2.16||| 70450|EAP|0272|SKIN STAPLER PROMIMATE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.05||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||3.75||| 70450|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||4.96||| 70450|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||4.20||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Medicare|MEDICARE RAILROAD|||||20.61||| 70450|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||5.51||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||4.36||| 70450|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 70450|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 70450|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||0.19||| 70450|EAP|0450||Medicare|MEDICARE A & B|||||0.00||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|NON CONTRACTED|COMMERCIAL OTHER|20.61||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Multiplan|WEB TPA|||||20.61||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|NON CONTRACTED|MRAMVA|||||20.61||| 70450|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 70450|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||3.45||| 70450|EAP|0611||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||29.47||| 70450|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 70450|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.20||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Blue Cross PPO|BLUE CROSS PPO|20.61||||20.61||| 70450|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||14.70||| 70450|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 70450|EAP|0272||Medicare|MEDICARE A & B|||||0.21||| 70450|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 70450|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||22.05||| 70450|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Medicaid|MEDICAID|||||20.61||| 70450|EAP|0771||Managed Medicaid|SUPERIOR STAR MCD|||||160.36||| 70450|EAP|0301||Medicare|MEDICARE A & B|||||1.02||| 70450|EAP|0981||Medicaid|MEDICAID|||||0.00||| 70450|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 70450|EAP|0270||Medicare|MEDICARE A & B|||||0.07||| 70450|EAP|0450||Medicaid|MEDICAID|||||181.41||| 70450|EAP|0251||Medicare|MEDICARE A & B|||||9.75||| 70450|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 70450|EAP|0771||Medicaid|MEDICAID|||||160.36||| 70450|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||20.61||| 70450|EAP|0272||Medicare|MEDICARE A & B|||||0.19||| 70450|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 70450|EAP|0351|CT HEAD OR BRAIN WITHOUT CONTR|Workers Compensation|WC OTHER|||||20.61||| 70450|EAP|0771||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||160.36||| 70450|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| 70450|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 70450|EAP|0450||Workers Compensation|WC OTHER|||||197.62||| 70450|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 70450|EAP|0450||PHCS|WEB TPA|||||181.41||| 70450|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.20||| 70460|EAP|0351||Blue Cross PPO|BLUE CROSS PPO|||||23.44||| 70460|EAP|0351||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23.44||| 70470|EAP|0351||United Healthcare|UMR|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|Medicare|MEDICARE A & B|27.03||||27.03||| 70470|EAP|0351||Managed Medicaid|FAMILY PLANNING GRANT|||||27.03||| 70470|EAP|0351||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||27.03||| 70470|EAP|0351||Managed Medicaid|MOLINA MEDICAID|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|Blue Cross PPO Select|BCBS UTHCT|||||27.03||| 70470|EAP|0351||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|Blue Cross PPO|BLUE CROSS PPO|||||27.03||| 70470|EAP|0351||Blue Cross PPO|BLUE CROSS PPO|||||27.03||| 70470|EAP|0351|CT HEAD OR BRAIN WITH & WITHOU|Blue Cross PPO|BLUE CROSS POS|||||27.03||| 70480|EAP|0351|CT SKULL IAC/POST FOSSA W/O CO|Medicare|MEDICARE A & B|||||16.94||| 70480|EAP|0351|CT SKULL IAC/POST FOSSA W/O CO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||16.94||| 70480|EAP|0351|CT SKULL IAC/POST FOSSA W/O CO|NON CONTRACTED|COMMERCIAL OTHER|||||16.94||| 70481|EAP|0351|CT SKULL IAC/POST FOSSA WITH C|Medicare|MEDICARE A & B|||||17.50||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross PPO|BCBS WALMART|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||18.15||| 70486|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||1.13||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||18.15||| 70486|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.54||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||18.15||| 70486|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.35||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross PPO|BCBS TRANE PPO|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||18.15||| 70486|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 70486|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Managed Medicaid|SUPERIOR STAR MCD|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.15||||18.15||| 70486|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.99||| 70486|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.20||| 70486|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.26||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||18.15||| 70486|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|United Healthcare|UMR|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||18.15||| 70486|EAP|0403||Blue Cross PPO|BLUE CROSS PPO|||||4.83||| 70486|EAP|0403||Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 70486|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.86||| 70486|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 70486|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Medicaid|MEDICAID|||||18.15||| 70486|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 70486|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 70486|EAP|0510||Medicare|MEDICARE A & B|||||3.79||| 70486|EAP|0924||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.81||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Medicare|MEDICARE RAILROAD|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Medicare|MEDICARE PART A|18.15||||||| 70486|EAP|0510|OFFICE OUTPATIENT NEW 30 MIN|Medicare|MEDICARE A & B|||||2.99||| 70486|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|||||18.15||| 70486|EAP|0351|CT MAXILLOFACIAL W0/CONTRAST|Medicare|MEDICARE A & B|18.15||||18.15||| 70486|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 70486|EAP|0460||Medicare|MEDICARE A & B|||||4.74||| 70486|EAP|0460||Medicare|MEDICARE A & B|||||3.65||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|Medicare|MEDICARE A & B|||||23.68||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|Managed Medicaid|SUPERIOR STAR MCD|||||23.68||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||23.68||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23.68||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||23.68||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|ChampVA|CHAMPVA OF CO DENVER|||||23.68||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRAST|Blue Cross PPO|BCBS WALMART|||||23.68||| 70490|EAP|0352|CT NECK WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||20.73||| 70490|EAP|0352|CT NECK WITHOUT CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.73||| 70490|EAP|0352|CT NECK WITHOUT CONTRAST|Medicare|MEDICARE A & B|||||20.73||| 70491|EAP|0352|CT NECK W/CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|PHCS|TML GRP INS|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|United Healthcare|GOLDEN RULE INSURANCE|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Medicare|MEDICARE RAILROAD|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Multiplan|TML GRP INS|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Medicare|MEDICARE A & B|23.77||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|ChampVA|CHAMPVA OF CO DENVER|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Managed Medicaid|MOLINA MEDICAID|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|23.77||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Managed Medicaid|SUPERIOR STAR MCD|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Blue Cross PPO|BLUE CROSS PPO|23.77||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23.77||| 70491|EAP|0352|CT NECK W/CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.77||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Blue Cross PPO|BLUE CROSS POS|||||21.21||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Blue Cross PPO|BLUE CROSS PPO|||||21.21||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||21.21||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||21.21||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|21.21||||||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Managed Medicaid|SUPERIOR STAR MCD|||||21.21||| 70496|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|NON CONTRACTED|COMMERCIAL OTHER|||||21.21||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Medicare|MEDICARE A & B|21.21||||21.21||| 70496|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 70496|EAP|0350|CT ANGIO HEAD W/WO CONT|Workers Compensation|WC OTHER|||||21.21||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|NON CONTRACTED|COMMERCIAL OTHER|||||22.46||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Medicare|MEDICARE A & B|22.46||||22.46||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Blue Cross PPO Select|BCBS UTHCT|||||22.46||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|22.46||||||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Managed Medicaid|MOLINA MEDICAID|||||22.46||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.46||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Blue Cross PPO|BLUE CROSS PPO|||||22.46||| 70498|EAP|0350|CT ANGIOGRAPHY NECK W/WO CONT|Blue Cross PPO|BLUE CROSS POS|||||22.46||| 70543|EAP|0610|MRI; ORBIT/ FACE/NECK; W/O TO|Blue Cross PPO|BLUE CROSS POS|||||37.48||| 70543|EAP|0610|MRI; ORBIT/ FACE/NECK; W/O TO|Aetna|TRS COORDINATED CARE|||||37.48||| 70543|EAP|0610|MRI; ORBIT/ FACE/NECK; W/O TO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||37.48||| 70543|EAP|0610|MRI; ORBIT/ FACE/NECK; W/O TO|Medicare|MEDICARE A & B|||||37.48||| 70544|EAP|0610|MRA; BRAIN WITHOUT CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||25.88||| 70544|EAP|0610|MRA; BRAIN WITHOUT CONTRAST|Medicare|MEDICARE A & B|25.88||||25.88||| 70544|EAP|0610||Humana Medicare Advantage|HUMANA MEDICARE PPO|25.88||||||| 70544|EAP|0610|MRA; BRAIN WITHOUT CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||25.88||| 70544|EAP|0610|MRA; BRAIN WITHOUT CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||25.88||| 70544|EAP|0610|MRA; BRAIN WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||25.88||| 70544|EAP|0610|MRA; BRAIN WITHOUT CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||25.88||| 70544|EAP|0610||Aetna|AETNA EL PASO CLAIMS OFFICE|25.88||||||| 70547|EAP|0610|MRA; NECK WITHOUT CONTRAST MAT|Blue Cross PPO Select|BCBS UTHCT|||||27.21||| 70547|EAP|0610|MRA; NECK WITHOUT CONTRAST MAT|Medicare|MEDICARE A & B|||||27.21||| 70549|EAP|0610|MRA; NECK WITH & WITHOUT CONTR|Medicare|MEDICARE A & B|||||46.67||| 70549|EAP|0610|MRA; NECK WITH & WITHOUT CONTR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||46.67||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||29.47||| 70551|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Blue Cross PPO|BCBS TRANE PPO|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||29.47||| 70551|EAP|0612||Blue Cross PPO|BLUE CROSS POS|||||31.12||| 70551|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Medicare|MEDICARE A & B|29.47||||29.47||| 70551|EAP|0611|MRI; BRAIN W/O CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|29.47||||29.47||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|NON CONTRACTED|COMMERCIAL OTHER|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Medicare|MEDICARE A & B|47.04||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|47.04||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Medicaid|MEDICAID|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|47.04||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||47.04||| 70553|EAP|0255||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.80||| 70553|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 70553|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Aetna|TRS COORDINATED CARE|||||47.04||| 70553|EAP|0949||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Aetna|AETNA EL PASO CLAIMS OFFICE|47.04||||47.04||| 70553|EAP|0255||Blue Cross PPO|BLUE CROSS PPO|||||2.40||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Blue Cross PPO|BLUE CROSS PPO|||||47.04||| 70553|EAP|0352||Blue Cross PPO|BLUE CROSS PPO|||||28.51||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Blue Cross PPO|BLUE CROSS POS|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Blue Cross PPO|BCBS TRANE PPO|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||47.04||| 70553|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Humana Medicare Advantage|HUMANA MEDICARE PPO|47.04||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Cigna|CIGNA OF TN CHATTANOOGA|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|Blue Cross PPO Select|BCBS UTHCT|||||47.04||| 70553|EAP|0611|MRI; BRAIN WITH & WITHOUT CONT|ChampVA|CHAMPVA OF CO DENVER|||||47.04||| 70553|EAP|0255||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 70553|EAP|0352||Blue Cross PPO|BLUE CROSS PPO|||||27.12||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Humana Medicare Advantage|HUMANA MEDICARE PPO|50,288.10|8622.26|9217.58|8622.26|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Medicare|MEDICARE A & B|41,740.84|9217.58|9217.58|8622.26|||| 71010|EAP|0360|OR TIME; GENERAL SURGERY; ADD'|Blue Cross PPO|BLUE CROSS PPO|||||7.43||| 71010|EAP|0272|CLORAPREP APPLICATOR|Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 71010|EAP|0258|0.9% NORMAL SALINE BTL 1000 ML|Blue Cross PPO|BLUE CROSS PPO|||||0.05||| 71010|EAP|0270|C-ARM DRAPE|Blue Cross PPO|BLUE CROSS PPO|||||0.22||| 71010|EAP|0360|OR TIME; GENERAL SURGICAL, 1ST|Blue Cross PPO|BLUE CROSS PPO|||||35.10||| 71010|EAP|0270|DISPOSABLE BEDDING|Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 71010|EAP|0272|PACK, BASIC|Blue Cross PPO|BLUE CROSS PPO|||||1.55||| 71010|EAP|0270|CHEST/BREAST DRAPE #29420|Blue Cross PPO|BLUE CROSS PPO|||||0.20||| 71010|EAP|0272|PREP TRAY|Blue Cross PPO|BLUE CROSS PPO|||||0.16||| 71010|EAP|0270|CONMED THERMOG BOVIE PAD#7-382|Blue Cross PPO|BLUE CROSS PPO|||||23.08||| 71010|EAP|0272|BIOGEL GLOVES|Blue Cross PPO|BLUE CROSS PPO|||||0.06||| 71010|EAP|0272|BIOGEL INDICATORS|Blue Cross PPO|BLUE CROSS PPO|||||0.06||| 71010|EAP|0278|POWER PORT ISP 8FR BARD|Blue Cross PPO|BLUE CROSS PPO|||||1,200.50||| 71010|EAP|0272|ULAR NERVE PROTECTORS|Blue Cross PPO|BLUE CROSS PPO|||||0.20||| 71010|EAP|0272|TRIFLEX GLOVES|Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 71010|EAP|0272|SUTURE - MINOR|Blue Cross PPO|BLUE CROSS PPO|||||2.70||| 71035|EAP|0320||Medicare|MEDICARE A & B|3.68||||3.68||| 71045|EAP|0320|CHEST, ONE DECUB|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.69||| 71045|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 71045|EAP|0320|CHEST, ONE DECUB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.69||||3.69||| 71045|EAP|0450||Managed Medicaid|OTHER MEDICAID|||||4.15||| 71045|EAP|0320|CHEST, ONE DECUB|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|3.69||||||| 71045|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|Managed Medicaid|MOLINA MEDICAID|3.69||||3.69||| 71045|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.69||||2.04||| 71045|EAP|0320|CHEST, ONE DECUB|Managed Medicaid|SUPERIOR STAR MCD|||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Cigna|CIGNA OF TN CHATTANOOGA|||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Cigna|CIGNA OPEN ACCESS PLUS|||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|ChampVA|CHAMPVA OF CO DENVER|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.69||||3.69||| 71045|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 71045|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 71045|EAP|0301||Blue Cross PPO|BCBS WALMART|||||0.19||| 71045|EAP|0320|CHEST, ONE DECUB|Aetna|AETNA EL PASO CLAIMS OFFICE|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross PPO|BLUE CROSS POS|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross PPO|BCBS TRANE PPO|3.69||||3.69||| 71045|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 71045|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 71045|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.19||| 71045|EAP|0320|CHEST, ONE DECUB|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.69||||3.69||| 71045|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|Workers Compensation|WC GALLAGHER BASSETT|||||3.69||| 71045|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.15||| 71045|EAP|0320|CHEST, ONE DECUB|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.69||||3.69||| 71045|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|United Healthcare|UMR|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|PHCS|TML GRP INS|3.69||||||| 71045|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.15||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross PPO|BCBS WALMART|3.69||||3.69||| 71045|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 71045|EAP|0306||Medicare|MEDICARE A & B|||||1.96||| 71045|EAP|0301||Medicaid|MEDICAID|||||0.19||| 71045|EAP|0250||Medicare|MEDICARE A & B|||||3.15||| 71045|EAP|0305||Medicare|MEDICARE A & B|||||0.78||| 71045|EAP|0270||Medicare|MEDICARE A & B|||||4.90||| 71045|EAP|0320|CHEST, ONE DECUB|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.69||| 71045|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 71045|EAP|0270||Medicare|MEDICARE A & B|||||0.05||| 71045|EAP|0305||Medicare|MEDICARE A & B|||||1.55||| 71045|EAP|0300|INFLUENZA VIRUS MULT TYPES|Medicare|MEDICARE A & B|||||2.10||| 71045|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 71045|EAP|0981||Managed Medicaid|OTHER MEDICAID|||||0.00||| 71045|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 71045|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 71045|EAP|0251||Medicare|MEDICARE A & B|||||86.20||| 71045|EAP|0320|CHEST, ONE DECUB|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross PPO Select|BCBS UTHCT|3.69||||3.69||| 71045|EAP|0300||Medicare|MEDICARE A & B|||||55.36||| 71045|EAP|0981||Medicaid|MEDICAID|||||0.00||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||1.68||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||1.75||| 71045|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||1.61||| 71045|EAP|0305||Medicare|MEDICARE A & B|||||0.94||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross PPO|BLUE CROSS PPO|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|3.69||||3.69||| 71045|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| 71045|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.69||||3.69||| 71045|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 71045|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|PHCS|WEB TPA|||||3.69||| 71045|EAP|0306||Medicare|MEDICARE A & B|||||1.54||| 71045|EAP|0258||Medicare|MEDICARE A & B|||||42.85||| 71045|EAP|0402||Medicaid|MEDICAID|||||3.03||| 71045|EAP|0302||Medicare|MEDICARE A & B|||||1.11||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||2.21||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||3.51||| 71045|EAP|0305||Medicare|MEDICARE A & B|||||2.77||| 71045|EAP|0305||Medicare|MEDICARE A & B|||||1.38||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||2.59||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 71045|EAP|0309||Medicare|MEDICARE A & B|||||5.39||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 71045|EAP|0306||Medicare|MEDICARE A & B|||||3.15||| 71045|EAP|0306||Medicare|MEDICARE A & B|||||0.72||| 71045|EAP|0320|CHEST, ONE DECUB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.69||||3.69||| 71045|EAP|0250||Medicare|MEDICARE A & B|||||3.20||| 71045|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||1.58||| 71045|EAP|0300||Medicare|MEDICARE A & B|||||1.40||| 71045|EAP|0402||Medicaid|MEDICAID|||||11.22||| 71045|EAP|0450||Medicaid|MEDICAID|||||181.41||| 71045|EAP|0320|CHEST, ONE DECUB|Medicaid|MEDICAID|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Medicare|MEDICARE PART A|3.69||||||| 71045|EAP|0636||Medicare|MEDICARE A & B|||||25.55||| 71045|EAP|0251|ACETYLCYSTEINE 20%, 4ML INH/PO|Medicare|MEDICARE A & B|||||42.60||| 71045|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|Medicare|MEDICARE A & B|3.69||||3.69||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 71045|EAP|0320|CHEST, ONE DECUB|Multiplan|TML GRP INS|3.69||||||| 71045|EAP|0730||Medicare|MEDICARE A & B|||||1.82||| 71045|EAP|0320|CHEST, ONE DECUB|NON CONTRACTED|COMMERCIAL OTHER|3.69||||3.69||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||1.77||| 71045|EAP|0320|CHEST, ONE DECUB|Cigna|NALC HLTH BENEFIT|3.69||||||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||0.00||| 71045|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 71045|EAP|0636||Medicare|MEDICARE A & B|||||14.70||| 71045|EAP|0320|CHEST, ONE DECUB|Managed Medicaid|MEDICAID CSHCN|||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Managed Medicaid|OTHER MEDICAID|||||3.69||| 71045|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 71045|EAP|0320|CHEST, ONE DECUB|NON CONTRACTED|MRAMVA|||||3.69||| 71045|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 71045|EAP|0761||Medicare|MEDICARE A & B|||||1.82||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||1.14||| 71045|EAP|0320|CHEST, ONE DECUB|Multiplan|WEB TPA|||||3.69||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||11.19||| 71045|EAP|0450||Medicare|MEDICARE A & B|||||5.69||| 71045|EAP|0320|CHEST, ONE DECUB|NON CONTRACTED|PPO OTHER|||||3.69||| 71045|EAP|0412||Medicare|MEDICARE A & B|||||2.20||| 71045|EAP|0636||Medicare|MEDICARE A & B|||||11.75||| 71045|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 71045|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 71045|EAP|0320|CHEST, ONE DECUB|NON CONTRACTED|COMMERCIAL OTHER 2|3.69||||3.69||| 71045|EAP|0320|CHEST, ONE DECUB|Medicare|MEDICARE RAILROAD|3.69||||3.69||| 71045|EAP|0301||Medicare|MEDICARE A & B|||||182.99||| 71046|EAP|0510||Multiplan|WEB TPA|||||2.64||| 71046|EAP|0320|XRAY, CHEST PA AND LAT|Medicare|MEDICARE A & B|2.35||||0.55||| 71046|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Optum Behavioral Health|OPTUM|2.35||||||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Medicare|MEDICARE PART A|2.35||||2.35||| 71046|EAP|0510||Medicare|MEDICARE A & B|||||2.99||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Multiplan|WEB TPA OF GRAND PRAIRIE|||||2.35||| 71046|EAP|0730||Multiplan|WEB TPA|||||3.86||| 71046|EAP|0510|CLIN VISIT;HIGH,EST (INFD)|Medicare|MEDICARE A & B|||||3.26||| 71046|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 71046|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 71046|EAP|0260||Multiplan|WEB TPA|||||213.82||| 71046|EAP|0510||Multiplan|WEB TPA|||||2.50||| 71046|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Multiplan|WEB TPA|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Medicare|MEDICARE RAILROAD|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|NON CONTRACTED|COMMERCIAL OTHER|2.35||||2.35||| 71046|EAP|0410||Medicare|MEDICARE A & B|||||2.20||| 71046|EAP|0510||Medicare|MEDICARE PART A|||||2.50||| 71046|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 71046|EAP|0401||Medicare|MEDICARE A & B|||||5.45||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|NON CONTRACTED|MRAMVA|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Multiplan|TML GRP INS|||||2.35||| 71046|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 71046|EAP|0401||Medicare|MEDICARE A & B|||||0.82||| 71046|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 71046|EAP|0352||Medicare|MEDICARE A & B|||||1.06||| 71046|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 71046|EAP|0402||Medicare|MEDICARE A & B|||||3.74||| 71046|EAP|0510||Medicare|MEDICARE A & B|||||4.38||| 71046|EAP|0309||Medicare|MEDICARE A & B|||||3.54||| 71046|EAP|0309||Medicare|MEDICARE A & B|||||2.25||| 71046|EAP|0306||Medicaid|MEDICAID|||||1.66||| 71046|EAP|0306||Medicaid|MEDICAID|||||1.38||| 71046|EAP|0306||Medicaid|MEDICAID|||||1.09||| 71046|EAP|0260||Medicare|MEDICARE A & B|||||181.41||| 71046|EAP|0450||Medicaid|MEDICAID|||||213.82||| 71046|EAP|0981||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 71046|EAP|0981||Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||0.00||| 71046|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 71046|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||117.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Medicaid|MEDICAID|2.35||||2.35||| 71046|EAP|0251||Medicaid|MEDICAID|||||7.50||| 71046|EAP|0636||Managed Medicaid|SUPERIOR STAR MCD|||||17.75||| 71046|EAP|0412||Medicaid|MEDICAID|||||2.20||| 71046|EAP|0251|OMEPRAZOLE DR CAP *PRILOSEC* 2|Medicaid|MEDICAID|||||15.30||| 71046|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE A & B|||||2.11||| 71046|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE RAILROAD|||||2.11||| 71046|EAP|0730||Managed Medicaid|SUPERIOR STAR MCD|||||3.86||| 71046|EAP|0981||Medicaid|MEDICAID|||||0.00||| 71046|EAP|0306||Medicare|MEDICARE RAILROAD|||||1.38||| 71046|EAP|0250||Medicaid|MEDICAID|||||3.20||| 71046|EAP|0305||Medicare|MEDICARE A & B|||||0.78||| 71046|EAP|0301||Medicaid|MEDICAID|||||129.20||| 71046|EAP|0305||Medicare|MEDICARE A & B|||||1.55||| 71046|EAP|0251||Medicare|MEDICARE A & B|||||20.10||| 71046|EAP|0251||Medicaid|MEDICAID|||||3.15||| 71046|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.86||| 71046|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||3.60||| 71046|EAP|0450||Medicaid|MEDICAID|||||0.00||| 71046|EAP|0306|SUSCEP-PANEL - RES CF|Medicare|MEDICARE A & B|||||0.96||| 71046|EAP|0730||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.86||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||1.32||| 71046|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.83||| 71046|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.40||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||3.00||| 71046|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.19||| 71046|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.38||| 71046|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.86||| 71046|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.26||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 71046|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.54||| 71046|EAP|0309||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.25||| 71046|EAP|0510||United Healthcare|UMR|||||2.50||| 71046|EAP|0510||PHCS|WEB TPA|||||2.64||| 71046|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.19||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.35||| 71046|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 71046|EAP|0260||PHCS|WEB TPA|||||213.82||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.35||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||2.11||| 71046|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.51||| 71046|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.50||| 71046|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.25||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|United Healthcare|GOLDEN RULE INSURANCE|||||117.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.35||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|PHCS|WEB TPA|||||2.35||| 71046|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 71046|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 71046|EAP|0410||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.20||| 71046|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|PHCS|TML GRP INS|||||2.35||| 71046|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.10||| 71046|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.35||||2.35||| 71046|EAP|0403||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.82||| 71046|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.47||| 71046|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.30||| 71046|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||30.90||| 71046|EAP|0510||United Healthcare|UMR|||||3.26||| 71046|EAP|0510||PHCS|WEB TPA|||||2.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|PHCS|WEB TPA OF GRAND PRAIRIE|||||2.35||| 71046|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 71046|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Workers Compensation|WC OTHER|||||2.35||| 71046|EAP|0981||Workers Compensation|DO NOT USE----ENABLE COMP|||||0.00||| 71046|EAP|0450||Workers Compensation|WC OTHER|||||181.41||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Workers Compensation|DO NOT USE----ENABLE COMP|||||2.35||| 71046|EAP|0450||Workers Compensation|DO NOT USE----ENABLE COMP|||||213.82||| 71046|EAP|0260||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||213.82||| 71046|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 71046|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 71046|EAP|0403||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.83||| 71046|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 71046|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||181.41||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Tricare|TRICARE WEST UNITED HEALTH|||||2.35||| 71046|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.45||| 71046|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||4.74||| 71046|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.50||| 71046|EAP|0510||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| 71046|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.19||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross PPO|BCBS WALMART|||||2.35||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 71046|EAP|0419||Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.54||| 71046|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 71046|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||3.54||| 71046|EAP|0460||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.82||| 71046|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 71046|EAP|0309||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.38||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.35||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.40||| 71046|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 71046|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 71046|EAP|0636|OMALIZUMAB 150MG SYR 5MG|Blue Cross PPO|BLUE CROSS PPO|||||66.35||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||3.60||| 71046|EAP|0309||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.31||| 71046|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 71046|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 71046|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 71046|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 71046|EAP|0510|IV PUSH NEW SUBS/DRUG EA|Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 71046|EAP|0251||Blue Cross PPO Select|BCBS UTHCT|||||24.40||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross PPO|BLUE CROSS POS|||||2.35||| 71046|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 71046|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||2.82||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross PPO|BCBS TRANE PPO|||||2.35||| 71046|EAP|0419||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||7.09||| 71046|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 71046|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.38||| 71046|EAP|0410||Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 71046|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 71046|EAP|0419||Blue Cross PPO|BLUE CROSS PPO|||||7.09||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 71046|EAP|0460||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.35||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||4.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross PPO|BLUE CROSS PPO|2.35||||2.35||| 71046|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.79||| 71046|EAP|0730||PHCS|WEB TPA|||||3.86||| 71046|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 71046|EAP|0450||Blue Cross PPO|BCBS WALMART|||||213.82||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||3.47||| 71046|EAP|0252||Blue Cross PPO Select|BCBS UTHCT|||||17.95||| 71046|EAP|0410||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.20||| 71046|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 71046|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.83||| 71046|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 71046|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Blue Cross PPO|BLUE CROSS PPO|||||2.11||| 71046|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 71046|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.20||| 71046|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.38||| 71046|EAP|0260||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 71046|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||197.62||| 71046|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|||||2.35||| 71046|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.99||| 71046|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.38||| 71046|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 71046|EAP|0419||Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.09||| 71046|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 71046|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| 71046|EAP|0260||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||213.82||| 71046|EAP|0307||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.25||| 71046|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 71046|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.05||| 71046|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 71046|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 71046|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 71046|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.35||||2.35||| 71046|EAP|0270||Medicare|MEDICARE A & B|||||0.05||| 71046|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 71046|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Aetna|AETNA|||||2.35||| 71046|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.15||| 71046|EAP|0306|NT MYCO RADID MIC RWL (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.60||| 71046|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||181.41||| 71046|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 71046|EAP|0510||Medicaid|MEDICAID|||||3.26||| 71046|EAP|0306|SUSCEP PANEL - BASIC CF|Medicare|MEDICARE A & B|||||0.96||| 71046|EAP|0949||United Healthcare|UMR|||||213.82||| 71046|EAP|0410||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.20||| 71046|EAP|0260||Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 71046|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| 71046|EAP|0949||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.35||||2.35||| 71046|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.94||| 71046|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.33||| 71046|EAP|0306||Medicare|MEDICARE A & B|||||0.96||| 71046|EAP|0251||Medicaid|MEDICAID|||||128.10||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|2.35||||2.35||| 71046|EAP|0410||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.20||| 71046|EAP|0309||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.54||| 71046|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.25||| 71046|EAP|0250||Blue Cross PPO|BLUE CROSS PPO|||||3.15||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|United Healthcare|UMR|||||2.35||| 71046|EAP|0410|NEBULIZATION TREATMENT(CFC)|Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 71046|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Aetna|AETNA EXXON MOBIL|||||117.50||| 71046|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 71046|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||3.14||| 71046|EAP|0460||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.21||| 71046|EAP|0460|DIFF CAP - SINGLE BREATH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.14||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Aetna|AETNA US HEALTHCARE PA|||||2.35||| 71046|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.05||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Aetna|TRS COORDINATED CARE|||||117.50||| 71046|EAP|0419||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.63||| 71046|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.50||| 71046|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 71046|EAP|0510||Aetna|AETNA EXXON MOBIL|||||2.50||| 71046|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 71046|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.26||| 71046|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 71046|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||3.00||| 71046|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.50||| 71046|EAP|0306||Cigna|NALC HLTH BENEFIT|||||1.38||| 71046|EAP|0410||Cigna|CIGNA OF TN CHATTANOOGA|||||2.20||| 71046|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 71046|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||4.38||| 71046|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.82||| 71046|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.35||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 71046|EAP|0260||Cigna|NALC HLTH BENEFIT|||||213.82||| 71046|EAP|0771||Cigna|CIGNA OPEN ACCESS PLUS|||||160.36||| 71046|EAP|0306||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.38||| 71046|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|||||1.68||| 71046|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 71046|EAP|0309||Medicare|MEDICARE A & B|||||1.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.35||| 71046|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.00||| 71046|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.38||| 71046|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.54||| 71046|EAP|0450||Medicaid|MEDICAID|||||7.27||| 71046|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||197.62||| 71046|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 71046|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Blue Cross PPO Select|BCBS UTHCT|2.35||||2.35||| 71046|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 71046|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||5.69||| 71046|EAP|0636||Medicaid|MEDICAID|||||34.40||| 71046|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 71046|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||1.77||| 71046|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 71046|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.35||| 71046|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 71046|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 71046|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 71046|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.35||||2.35||| 71046|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.29||| 71046|EAP|0301|MALDI-TOFF FUNGAL ID|Medicaid|MEDICAID|||||129.20||| 71046|EAP|0306||Medicaid|MEDICAID|||||3.15||| 71046|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 71046|EAP|0309||Cigna|CIGNA OF TN CHATTANOOGA|||||2.25||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Cigna|NALC HLTH BENEFIT|2.35||||2.35||| 71046|EAP|0419||Medicare|MEDICARE A & B|||||7.09||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|ChampVA|CHAMPVA OF CO DENVER|2.35||||2.35||| 71046|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 71046|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.15||| 71046|EAP|0460||Medicare|MEDICARE A & B|||||8.25||| 71046|EAP|0352||Medicare|MEDICARE A & B|||||23.22||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.35||| 71046|EAP|0410|NEBULIZER TREATMENT (INFD)|Medicare|MEDICARE A & B|||||2.20||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Medicare|MEDICARE A & B|2.35||||2.35||| 71046|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||2.11||| 71046|EAP|0460||Medicare|MEDICARE A & B|||||4.74||| 71046|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| 71046|EAP|0510||Cigna|NALC HLTH BENEFIT|||||2.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|OTHER MEDICAID|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|MEDICAID CSHCN|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.35||||2.35||| 71046|EAP|0309||Cigna|CIGNA OF TN CHATTANOOGA|||||3.54||| 71046|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 71046|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||1.14||| 71046|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| 71046|EAP|0258||Managed Medicaid|SUPERIOR STAR MCD|||||41.10||| 71046|EAP|0942||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.05||| 71046|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 71046|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.25||| 71046|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||213.82||| 71046|EAP|0250||Managed Medicaid|SUPERIOR STAR MCD|||||42.85||| 71046|EAP|0636||Medicare|MEDICARE A & B|||||30.90||| 71046|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 71046|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 71046|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.99||| 71046|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 71046|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|SUPERIOR STAR MCD|||||2.35||| 71046|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.05||| 71046|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.74||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.35||| 71046|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.25||| 71046|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||7.27||| 71046|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||197.62||| 71046|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.35||| 71046|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 71046|EAP|0510|CLINIC VISIT;MID,NEW (CF)|Managed Medicaid|OTHER MEDICAID|||||2.99||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|MOLINA MEDICAID|||||2.35||| 71046|EAP|0320|CHEST, 2 VIEWS (PA & LAT)|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.35||| 71048|EAP|0320|CHEST, 4 VIEWS (PA/LAT + OBLIQ|Medicare|MEDICARE A & B|||||3.15||| 71048|EAP|0320|CHEST, 4 VIEWS (PA/LAT + OBLIQ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.15||| 71048|EAP|0320|CHEST, 4 VIEWS (PA/LAT + OBLIQ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 71100|EAP|0320|RIBS, RIGHT|Workers Compensation|DO NOT USE----ENABLE COMP|||||4.08||| 71100|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.25||| 71100|EAP|0320|RIBS, RIGHT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.08||| 71100|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 71100|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 71100|EAP|0320|RIBS, RIGHT|Medicare|MEDICARE RAILROAD|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|NON CONTRACTED|MRAMVA|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Medicare|MEDICARE A & B|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Blue Cross PPO|BLUE CROSS PPO|4.08||||4.08||| 71100|EAP|0320|RIBS, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Blue Cross PPO|BCBS WALMART|||||4.08||| 71100|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 71100|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 71100|EAP|0320|RIBS, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.08||| 71100|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 71100|EAP|0320|RIBS, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 71100|EAP|0320|RIBS, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.08||| 71100|EAP|0320|RIBS, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Cigna|CIGNA OF TN CHATTANOOGA|||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Blue Cross PPO Select|BCBS UTHCT|||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Cigna|CIGNA OPEN ACCESS PLUS|||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.80||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.80||| 71101|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.80||| 71101|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Blue Cross PPO|BCBS WALMART|||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.80||| 71101|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||181.41||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Medicare|MEDICARE A & B|||||4.80||| 71101|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|NON CONTRACTED|COMMERCIAL OTHER|||||4.80||| 71101|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 71101|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 71101|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||213.82||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.80||| 71101|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 71101|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.80||| 71101|EAP|0320|RIBS, UNIL INCL PA CHEST|NON CONTRACTED|MRAMVA|||||4.80||| 71101|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 71101|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 71110|EAP|0320|RIBS, BILATERAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 71110|EAP|0320|RIBS, BILATERAL|Medicare|MEDICARE A & B|||||2.16||| 71110|EAP|0320|RIBS, BILATERAL|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 71110|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 71110|EAP|0320|RIBS, BILATERAL|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 71110|EAP|0320|RIBS, BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.16||| 71110|EAP|0320|RIBS, BILATERAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.16||||||| 71110|EAP|0320|RIBS, BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 71110|EAP|0320|RIBS, BILATERAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 71110|EAP|0320|RIBS, BILATERAL|Medicaid|MEDICAID|||||2.16||| 71110|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 71111|EAP|0320|4 VW BILAT RIBS W PA CHEST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.06||| 71111|EAP|0320|4 VW BILAT RIBS W PA CHEST|Medicare|MEDICARE A & B|||||4.06||| 71111|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 71111|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 71111|EAP|0274||Medicare|MEDICARE A & B|||||56.70||| 71120|EAP|0320|STERNUM; MINIMUM 2 VIEWS|Medicare|MEDICARE A & B|||||3.16||| 71250|EAP|0510||Aetna|AETNA|||||2.64||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.22||| 71250|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 71250|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 71250|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 71250|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23.22||| 71250|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 71250|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 71250|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 71250|EAP|0636||Blue Cross PPO|BLUE CROSS POS|||||45.15||| 71250|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 71250|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.38||| 71250|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||3.00||| 71250|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 71250|EAP|0771||Blue Cross PPO|BLUE CROSS POS|||||160.36||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross PPO|BLUE CROSS POS|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross PPO|BCBS WALMART|||||23.22||| 71250|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 71250|EAP|0352|CT CHEST HIGH RES|Cigna|NALC HLTH BENEFIT|||||23.22||| 71250|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||3.00||| 71250|EAP|0309||Blue Cross PPO Select|BCBS UTHCT|||||2.25||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross PPO|BLUE CROSS PPO|23.22||||23.22||| 71250|EAP|0309||Blue Cross PPO Select|BCBS UTHCT|||||3.54||| 71250|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.66||| 71250|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||2.11||| 71250|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.38||| 71250|EAP|0352|CT CHEST HIGH RES|Cigna|CIGNA OF TN CHATTANOOGA|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Cigna|CIGNA OPEN ACCESS PLUS|||||23.22||| 71250|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.74||| 71250|EAP|0352|CT CHEST HIGH RES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|23.22||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross PPO|BCBS TRANE PPO|||||23.22||| 71250|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 71250|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 71250|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 71250|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| 71250|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.82||| 71250|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.35||| 71250|EAP|0352|CT CHEST HIGH RES|Humana Medicare Advantage|HUMANA MEDICARE PPO|23.22||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Blue Cross PPO Select|BCBS UTHCT|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|ChampVA|CHAMPVA OF CO DENVER|||||23.22||| 71250|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 71250|EAP|0352|CT CHEST HIGH RES|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|23.22||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Workers Compensation|WC OTHER|||||23.22||| 71250|EAP|0510||United Healthcare|UMR|||||2.64||| 71250|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||3.54||| 71250|EAP|0352|CT CHEST HIGH RES|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|23.22||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Veterans Affairs|VETERANS CHOICE - TRI WEST|23.22||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|United Healthcare|UMR|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|23.22||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||23.22||| 71250|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 71250|EAP|0309||Medicare|MEDICARE A & B|||||2.25||| 71250|EAP|0352|CT CHEST HIGH RES|Medicaid|MEDICAID|23.22||||||| 71250|EAP|0306||Medicare|MEDICARE A & B|||||2.11||| 71250|EAP|0306||Medicare|MEDICARE A & B|||||3.00||| 71250|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 71250|EAP|0309||Medicare|MEDICARE A & B|||||3.54||| 71250|EAP|0260||Medicare|MEDICARE A & B|||||213.82||| 71250|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 71250|EAP|0306||Medicare|MEDICARE A & B|||||0.40||| 71250|EAP|0352|CT CHEST HIGH RES|Aetna|AETNA|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||23.22||| 71250|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 71250|EAP|0352|CT CHEST HIGH RES|NON CONTRACTED|MRAMVA|||||23.22||| 71250|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 71250|EAP|0352|CT CHEST HIGH RES|NON CONTRACTED|COMMERCIAL OTHER|||||23.22||| 71250|EAP|0352|CT CHEST HIGH RES|Medicare|MEDICARE A & B|23.22||||23.22||| 71250|EAP|0510|CLINIC VISIT; MID, EST (URO)|Medicare|MEDICARE A & B|||||2.50||| 71250|EAP|0510||Medicare|MEDICARE RAILROAD|||||2.50||| 71250|EAP|0250||Medicare|MEDICARE A & B|||||3.15||| 71250|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE A & B|||||2.50||| 71250|EAP|0761|US PV RESIDUAL URINE|Medicare|MEDICARE A & B|||||0.83||| 71250|EAP|0460||Medicare|MEDICARE A & B|||||8.25||| 71250|EAP|0352||Medicare|MEDICARE A & B|23.22||||19.08||| 71250|EAP|0410||Medicare|MEDICARE A & B|||||2.20||| 71250|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 71250|EAP|0352|CT CHEST HIGH RES|Medicare|MEDICARE RAILROAD|||||23.22||| 71250|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 71250|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 71250|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Medicare|MEDICARE A & B|27.12||||27.12||| 71260|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Medicare|MEDICARE A & B|||||3.79||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Medicare|MEDICARE RAILROAD|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|NON CONTRACTED|MRAMVA|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Medicare|MEDICARE PART A|27.12||||||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Multiplan|TML GRP INS|||||27.12||| 71260|EAP|0255||Medicare|MEDICARE A & B|||||5.25||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Medicaid|MEDICAID|||||27.12||| 71260|EAP|0301||Medicare|MEDICARE A & B|||||0.92||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|NON CONTRACTED|COMMERCIAL OTHER|||||27.12||| 71260|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|27.12||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|PHCS|TML GRP INS|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||27.12||| 71260|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Humana Medicare Advantage|HUMANA MEDICARE PPO|27.12||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|ChampVA|CHAMPVA OF CO DENVER|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Cigna|CIGNA OF TN CHATTANOOGA|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross PPO|BCBS TRANE PPO|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross PPO|BCBS WALMART|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross PPO|BLUE CROSS POS|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Cigna|CIGNA OPEN ACCESS PLUS|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross PPO|BLUE CROSS PPO|27.12||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross PPO Select|BCBS UTHCT|||||27.12||| 71260|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||50.40||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|NON CONTRACTED|COMMERCIAL OTHER 2|||||27.12||| 71260|EAP|0352||Medicare|MEDICARE A & B|27.12||||28.51||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|27.12||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|27.12||||27.12||| 71260|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||27.12||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Aetna|AETNA|||||27.12||| 71260|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 71260|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||17.85||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|Managed Medicaid|SUPERIOR STAR MCD|||||27.12||| 71260|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.55||| 71260|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.45||| 71260|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||36.75||| 71260|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 71260|EAP|0352|CT CHEST (THORAX) WITH CONTRAS|United Healthcare|UMR|||||27.12||| 71270|EAP|0352|CT CHEST W/WO CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||33.11||| 71270|EAP|0352|CT CHEST W/WO CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||33.11||| 71270|EAP|0352|CT CHEST W/WO CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||33.11||| 71270|EAP|0352|CT CHEST W/WO CONTRAST|Medicare|MEDICARE A & B|||||33.11||| 71270|EAP|0352|CT CHEST W/WO CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||33.11||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Veterans Affairs|VETERANS CHOICE - TRI WEST|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|United Healthcare|UMR|||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||29.32||| 71275|EAP|0981||Medicaid|MEDICAID|||||0.00||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Medicaid|MEDICAID|||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Medicare|MEDICARE RAILROAD|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Medicare|MEDICARE PART A|29.32||||||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Medicare|MEDICARE A & B|29.32||||29.32||| 71275|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 71275|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||5.25||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|NON CONTRACTED|COMMERCIAL OTHER|||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|ChampVA|CHAMPVA OF CO DENVER|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Cigna|CIGNA OF TN CHATTANOOGA|||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross PPO Select|BCBS UTHCT|29.32||||29.32||| 71275|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||0.07||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||29.32||| 71275|EAP|0510||Medicare|MEDICARE A & B|||||2.99||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Humana Medicare Advantage|HUMANA MEDICARE PPO|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|29.32||||29.32||| 71275|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 71275|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.27||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|29.32||||29.32||| 71275|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||70.60||| 71275|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 71275|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Aetna|AETNA EL PASO CLAIMS OFFICE|29.32||||29.32||| 71275|EAP|0255||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.00||| 71275|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.07||| 71275|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 71275|EAP|0921||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.00||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross PPO|BLUE CROSS PPO|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross PPO|BCBS WALMART|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross PPO|BCBS TRANE PPO|29.32||||29.32||| 71275|EAP|0350|COMPUTED TOMOGRAPHIC ANGIOGRAP|Blue Cross PPO|BLUE CROSS POS|29.32||||29.32||| 72040|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 72040|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 72040|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.07||| 72040|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|United Healthcare|UMR|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Blue Cross PPO|BCBS TRANE PPO|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Blue Cross PPO|BLUE CROSS PPO|2.16||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.16||| 72040|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 72040|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.08||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.16||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|NON CONTRACTED|COMMERCIAL OTHER|||||2.16||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Medicare|MEDICARE A & B|2.16||||2.16||| 72040|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|NON CONTRACTED|MRAMVA|||||2.16||| 72040|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 72040|EAP|0636||Workers Compensation|WC OTHER|||||55.40||| 72040|EAP|0981||Workers Compensation|WC TRAVELERS|||||0.00||| 72040|EAP|0636||Workers Compensation|WC OTHER|||||10.50||| 72040|EAP|0320|SPINE, CERVICAL; AP & LATERAL|Workers Compensation|WC TRAVELERS|||||2.16||| 72040|EAP|0450||Workers Compensation|WC TRAVELERS|||||213.82||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|United Healthcare|UMR|||||0.00||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Medicaid|MEDICAID|||||1.72||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Medicare|MEDICARE A & B|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|NON CONTRACTED|COMMERCIAL OTHER|||||3.44||| 72050|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Cigna|CIGNA OPEN ACCESS PLUS|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Cigna|CIGNA OF TN CHATTANOOGA|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Blue Cross PPO Select|BCBS UTHCT|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||3.44||| 72050|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.72||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.44||| 72050|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 72050|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||213.82||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Aetna|AETNA EXXON MOBIL|||||0.00||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.44||| 72050|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 72050|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||1.36||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Blue Cross PPO|BLUE CROSS POS|||||3.44||| 72050|EAP|0320|CERVICAL SPINE; 4 OR 5 VIEWS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.44||| 72052|EAP|0320|SPINE, C (CERVICAL) 6 OR MORE|Blue Cross PPO|BCBS WALMART|||||3.44||| 72052|EAP|0320|SPINE, C (CERVICAL) 6 OR MORE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.44||| 72052|EAP|0320|SPINE, C (CERVICAL) 6 OR MORE|Blue Cross PPO Select|BCBS UTHCT|||||3.44||| 72052|EAP|0320|SPINE, C (CERVICAL) 6 OR MORE|Medicare|MEDICARE A & B|||||3.44||| 72052|EAP|0320|SPINE, C (CERVICAL) 6 OR MORE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.44||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Workers Compensation|WC TRAVELERS|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Workers Compensation|WC OTHER|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|United Healthcare|UMR|||||4.84||| 72072|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.84||| 72072|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Medicaid|MEDICAID|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Medicare|MEDICARE A & B|4.84||||4.84||| 72072|EAP|0320||Medicare|MEDICARE A & B|4.84||||1.36||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|NON CONTRACTED|COMMERCIAL OTHER|||||1.36||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Cigna|CIGNA OPEN ACCESS PLUS|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|NON CONTRACTED|MRAMVA|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Blue Cross PPO Select|BCBS UTHCT|||||4.84||| 72072|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|ChampVA|CHAMPVA OF CO DENVER|||||4.84||| 72072|EAP|0320||Cigna|CIGNA OPEN ACCESS PLUS|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Cigna|CIGNA OF TN CHATTANOOGA|||||1.36||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Cigna|CIGNA OF TN CHATTANOOGA|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.84||| 72072|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.36||| 72072|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Managed Medicaid|MOLINA MEDICAID|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Managed Medicaid|SUPERIOR STAR MCD|||||4.84||| 72072|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.84||| 72072|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.10||| 72072|EAP|0320||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.36||| 72072|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|4.84||||3.10||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Blue Cross PPO|BCBS WALMART|||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Blue Cross PPO|BLUE CROSS PPO|4.84||||4.84||| 72072|EAP|0320|SPINE, T (THORACIC) AP/LAT W/S|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.84||| 72074|EAP|0320|SPINE; THORACIC, 4 VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||5.77||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Medicaid|MEDICAID|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Aetna|TRS COORDINATED CARE|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Cigna|CIGNA OPEN ACCESS PLUS|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Blue Cross PPO Select|BCBS UTHCT|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Cigna|CIGNA OF TN CHATTANOOGA|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Managed Medicaid|MOLINA MEDICAID|||||1.63||| 72081|EAP|0320|RAD EXAM,SPINE,THOR/LUMB;1 VW|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.63||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 72100|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 72100|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 72100|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Managed Medicaid|MOLINA MEDICAID|||||2.16||| 72100|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.55||| 72100|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||197.62||| 72100|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.15||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 72100|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||181.41||| 72100|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||181.41||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|ChampVA|CHAMPVA OF CO DENVER|||||2.16||| 72100|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Aetna|TRS COORDINATED CARE|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 72100|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 72100|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross PPO|BCBS WALMART|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross PPO|BCBS TRANE PPO|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Workers Compensation|WC OTHER|||||2.16||| 72100|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Workers Compensation|WC TRAVELERS|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|United Healthcare|UMR|||||0.00||| 72100|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.16||| 72100|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||181.41||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.16||| 72100|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|United Healthcare|AARP OF GA ATLANTA|||||0.00||| 72100|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|NON CONTRACTED|MRAMVA|||||2.16||| 72100|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|NON CONTRACTED|COMMERCIAL OTHER|2.16||||2.16||| 72100|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 72100|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Medicare|MEDICARE A & B|2.16||||2.16||| 72100|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 72100|EAP|0320|SPINE, LUMBOSACRAL; 2 OR 3VIEW|Medicaid|MEDICAID|||||2.16||| 72100|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 72100|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 72100|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 72100|EAP|0450||Medicaid|MEDICAID|||||213.82||| 72100|EAP|0981||Medicaid|MEDICAID|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Medicaid|MEDICAID|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.44||| 72110|EAP|0450||NON CONTRACTED|MRAMVA|||||213.82||| 72110|EAP|0981||NON CONTRACTED|MRAMVA|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Medicare|MEDICARE A & B|||||3.44||| 72110|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|NON CONTRACTED|MRAMVA|||||3.44||| 72110|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.44||| 72110|EAP|0450||United Healthcare|UMR|||||181.41||| 72110|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.15||| 72110|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 72110|EAP|0981||United Healthcare|UMR|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.44||| 72110|EAP|0320||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.44||| 72110|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||27.30||| 72110|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.50||| 72110|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|United Healthcare|UMR|||||3.44||| 72110|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Workers Compensation|WC OTHER|||||3.44||| 72110|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.64||| 72110|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 72110|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross PPO|BLUE CROSS PPO|3.44||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross PPO|BCBS WALMART|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.44||| 72110|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross PPO|BLUE CROSS POS|||||3.44||| 72110|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||197.62||| 72110|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.44||| 72110|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross PPO|BCBS TRANE PPO|||||1.72||| 72110|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.44||| 72110|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.44||| 72110|EAP|0320||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.44||| 72110|EAP|0320||Medicare|MEDICARE A & B|||||2.04||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Aetna|AETNA|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|ChampVA|CHAMPVA OF CO DENVER|||||3.44||| 72110|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Cigna|CIGNA OF TN CHATTANOOGA|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|NON CONTRACTED|COMMERCIAL OTHER|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.72||| 72110|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Cigna|CIGNA OPEN ACCESS PLUS|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Blue Cross PPO Select|BCBS UTHCT|||||3.44||| 72110|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 72110|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.44||| 72110|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Managed Medicaid|SUPERIOR STAR MCD|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.44||| 72110|EAP|0320|SPINE, LS (LUMBO-SACRAL)MIN 4V|Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 72110|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.55||| 72114|EAP|0320|LUMBOSACRAL SPINE COMP W/BENDI|Blue Cross PPO Select|BCBS UTHCT|||||6.02||| 72114|EAP|0320|LUMBOSACRAL SPINE COMP W/BENDI|Blue Cross PPO|BLUE CROSS PPO|||||6.02||| 72114|EAP|0320|LUMBOSACRAL SPINE COMP W/BENDI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.02||| 72114|EAP|0320|LUMBOSACRAL SPINE COMP W/BENDI|Medicare|MEDICARE A & B|||||6.02||| 72114|EAP|0320|LUMBOSACRAL SPINE COMP W/BENDI|NON CONTRACTED|MRAMVA|||||6.02||| 72125|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Medicaid|MEDICAID|||||23.81||| 72125|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 72125|EAP|0270||NON CONTRACTED|MRAMVA|||||0.07||| 72125|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 72125|EAP|0450||NON CONTRACTED|MRAMVA|||||213.82||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|NON CONTRACTED|MRAMVA|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|NON CONTRACTED|COMMERCIAL OTHER|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Medicare|MEDICARE A & B|23.81||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Workers Compensation|WC TRAVELERS|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Workers Compensation|WC OTHER|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|23.81||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|PHCS|WEB TPA|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.81||| 72125|EAP|0981||NON CONTRACTED|MRAMVA|||||0.00||| 72125|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 72125|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Blue Cross PPO|BLUE CROSS POS|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Blue Cross PPO|BLUE CROSS PPO|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23.81||| 72125|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 72125|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Multiplan|WEB TPA|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Managed Medicaid|SUPERIOR STAR MCD|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Humana Medicare Advantage|HUMANA MEDICARE PPO|23.81||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Blue Cross PPO Select|BCBS UTHCT|23.81||||23.81||| 72125|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 72125|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|ChampVA|CHAMPVA OF CO DENVER|||||23.81||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Cigna|CIGNA OTHER|||||23.81||| 72125|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 72125|EAP|0352|CT SPINE (CERVICAL) W/O CONTRA|Cigna|CIGNA OPEN ACCESS PLUS|||||23.81||| 72125|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 72126|EAP|0352|CT SPINE/CERVICAL WITH CONTRAS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|25.00||||||| 72126|EAP|0352|CT SPINE/CERVICAL WITH CONTRAS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||25.00||| 72128|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|NON CONTRACTED|COMMERCIAL OTHER|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Medicare|MEDICARE A & B|21.84||||21.84||| 72128|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|NON CONTRACTED|MRAMVA|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Workers Compensation|WC OTHER|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Blue Cross PPO|BLUE CROSS PPO|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Blue Cross PPO Select|BCBS UTHCT|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||21.84||| 72128|EAP|0352|CT SPINE (THORACIC) W/O CONTRA|Managed Medicaid|SUPERIOR STAR MCD|||||21.84||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Blue Cross PPO Select|BCBS UTHCT|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Managed Medicaid|SUPERIOR STAR MCD|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|ChampVA|CHAMPVA OF CO DENVER|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|24.37||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Blue Cross PPO|BLUE CROSS PPO|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||24.37||| 72131|EAP|0450||Workers Compensation|WC OTHER|||||213.82||| 72131|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Workers Compensation|WC OTHER|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|Medicare|MEDICARE A & B|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|NON CONTRACTED|COMMERCIAL OTHER|||||24.37||| 72131|EAP|0352|CT SPINE (LUMBOSACRAL)W/O CONT|NON CONTRACTED|MRAMVA|||||24.37||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.12||| 72141|EAP|0612|MRI SPINAL CANAL CERV WO CONTR|Medicare|MEDICARE A & B|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Medicare|MEDICARE A & B|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Blue Cross PPO|BCBS TRANE PPO|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||31.12||| 72141|EAP|0612|MRI SPINAL CANAL CERV WO CONTR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.12||| 72141|EAP|0612|MRI; C-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.12||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||32.43||| 72146|EAP|0612|MRI THORACIC SPINE WO CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||32.43||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||32.43||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||32.43||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||32.43||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||32.43||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||32.43||| 72146|EAP|0612|MRI; T-SPINE W/O CONTRAST|Medicare|MEDICARE A & B|||||32.43||| 72146|EAP|0612|MRI THORACIC SPINE WO CONTRAST|Medicare|MEDICARE A & B|||||32.43||| 72147|EAP|0612|MRI SPINAL CANAL/CONTENTS W/CO|Medicare|MEDICARE A & B|31.76||||||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||31.50||| 72148|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| 72148|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.83||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|ChampVA|CHAMPVA OF CO DENVER|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Cigna|CIGNA OPEN ACCESS PLUS|||||31.50||| 72148|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||31.50||| 72148|EAP|0612|MRI LUMBAR SPINE WO CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.50||| 72148|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Workers Compensation|DO NOT USE----ENABLE COMP|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Managed Medicaid|MOLINA MEDICAID|||||31.50||| 72148|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|Medicare|MEDICARE A & B|31.50||||31.50||| 72148|EAP|0612|MRI LUMBAR SPINE WO CONTRAST|Medicare|MEDICARE A & B|31.50||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||31.50||| 72148|EAP|0612|MRI; L-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|||||31.50||| 72148|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 72149|EAP|0612|MRI LUMBAR SPINE W/CONTRAST|Medicare|MEDICARE A & B|38.62||||||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Blue Cross PPO Select|BCBS UTHCT|||||44.00||| 72156|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 72156|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|44.00||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS PPO|44.00||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS POS|||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||44.00||| 72156|EAP|0612|MRI; C-SPINE WITH & WITHOUT CO|Medicare|MEDICARE A & B|||||44.00||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Medicare|MEDICARE A & B|||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Medicaid|MEDICAID|||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS PPO|||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS POS|||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|50.84||||50.84||| 72157|EAP|0612|MRI; T-SPINE WITH & WITHOUT CO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||50.84||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|ChampVA|CHAMPVA OF CO DENVER|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|48.14||||||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS POS|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS PPO|48.14||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Medicaid|MEDICAID|48.14||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||48.14||| 72158|EAP|0612|MRI; L-SPINE WITH & WITHOUT CO|Medicare|MEDICARE A & B|48.14||||48.14||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Medicare|MEDICARE A & B|2.16||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Medicaid|MEDICAID|||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Workers Compensation|WC TRAVELERS|||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Blue Cross PPO|BLUE CROSS POS|||||2.16||| 72170|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 72170|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 72170|EAP|0320|PELVIS AP VIEW ONLY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 72170|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.51||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.16||| 72170|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||1.77||| 72170|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 72170|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.16||| 72170|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.16||| 72170|EAP|0320|PELVIS AP VIEW ONLY|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.50||||4.50||| 72190|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 72190|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Workers Compensation|WC OTHER|||||4.50||| 72190|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 72190|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|Medicare|MEDICARE A & B|4.50||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|NON CONTRACTED|MRAMVA|||||4.50||| 72190|EAP|0320|PELVIS, 3 OR MORE VIEWS|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 72190|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 72190|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 72190|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 72192|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|NON CONTRACTED|MRAMVA|||||23.12||| 72192|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Medicare|MEDICARE A & B|23.12||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Medicaid|MEDICAID|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|23.12||||||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Managed Medicaid|SUPERIOR STAR MCD|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|23.12||||||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|23.12||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.12||| 72192|EAP|0350|CT PELVIS WITHOUT CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||23.12||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|United Healthcare|UMR|25.94||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|||||25.94||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Medicare|MEDICARE A & B|25.94||||25.94||| 72195|EAP|0610|MRI; PELVIS WITHOUT CONTRAST|Medicare|MEDICARE A & B|||||29.21||| 72195|EAP|0610|MRI; PELVIS WITHOUT CONTRAST|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||29.21||| 72195|EAP|0610|MRI; PELVIS WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||29.21||| 72195|EAP|0610|MRI; PELVIS WITHOUT CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||29.21||| 72195|EAP|0610||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||42.62||| 72195|EAP|0255||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.80||| 72195|EAP|0610|MRI; PELVIS WITHOUT CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||29.21||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Blue Cross PPO Select|BCBS UTHCT|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Cigna|CIGNA OPEN ACCESS PLUS|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS PPO|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Blue Cross PPO|BCBS WALMART|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||44.33||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Managed Medicaid|SUPERIOR STAR MCD|44.33||||||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|44.33||||||| 72197|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Medicare|MEDICARE A & B|||||44.33||| 72202|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|Medicare|MEDICARE A & B|||||3.78||| 72202|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.78||| 72202|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|Blue Cross PPO|BLUE CROSS PPO|||||3.78||| 72202|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|Aetna|AETNA|||||3.78||| 72202|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.78||| 72202|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.36||| 72202|EAP|0320|SACROILIAC JOINTS; MINIMUM 3 V|Blue Cross PPO Select|BCBS UTHCT|||||3.78||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Blue Cross PPO Select|BCBS UTHCT|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Managed Medicaid|SUPERIOR STAR MCD|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.35||| 72220|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Blue Cross PPO|BCBS TRANE PPO|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Blue Cross PPO|BLUE CROSS PPO|||||211.50||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Workers Compensation|WC OTHER|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|United Healthcare|UMR|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.88||| 72220|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Medicare|MEDICARE RAILROAD|||||3.35||| 72220|EAP|0320|SACRUM & COCCYX; MINIMUM 2 VIE|Medicare|MEDICARE A & B|3.35||||3.35||| 73000|EAP|0320|CLAVICLE; COMPLETE|Medicare|MEDICARE A & B|||||3.50||| 73000|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73000|EAP|0320|CLAVICLE; COMPLETE|Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 73000|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 73000|EAP|0320|CLAVICLE; COMPLETE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.50||| 73000|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73000|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||181.41||| 73000|EAP|0320|CLAVICLE; COMPLETE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.50||| 73000|EAP|0320|CLAVICLE; COMPLETE|Blue Cross PPO Select|BCBS UTHCT|||||3.50||| 73000|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73000|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73000|EAP|0320|CLAVICLE; COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.50||| 73030|EAP|0320|SHOULDER, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Managed Medicaid|MOLINA MEDICAID|||||2.16||| 73030|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73030|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 73030|EAP|0320|SHOULDER, RIGHT|Managed Medicaid|FAMILY PLANNING GRANT|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 73030|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||213.82||| 73030|EAP|0320|SHOULDER, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73030|EAP|0320|SHOULDER, RIGHT|Cigna|CIGNA BEHAVIORAL HEALTH|||||2.16||| 73030|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73030|EAP|0320|SHOULDER, RIGHT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.16||| 73030|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 73030|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 73030|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 73030|EAP|0320|SHOULDER, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.16||| 73030|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 73030|EAP|0320|SHOULDER, RIGHT|Blue Cross PPO Select|BCBS UTHCT|2.16||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Blue Cross PPO Select|BCBS UTHCT|2.16||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.16||||2.16||| 73030|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73030|EAP|0320|SHOULDER, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 73030|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 73030|EAP|0320|SHOULDER, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.16||| 73030|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.28||| 73030|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 73030|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.14||| 73030|EAP|0320|SHOULDER, LEFT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.16||| 73030|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 73030|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 73030|EAP|0320|SHOULDER, RIGHT|Blue Cross PPO|BLUE CROSS POS|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Blue Cross PPO|BCBS WALMART|||||2.16||| 73030|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 73030|EAP|0320|SHOULDER, LEFT|Blue Cross PPO|BLUE CROSS POS|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Blue Cross PPO|BLUE CROSS PPO|2.16||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Blue Cross PPO|BCBS TRANE PPO|||||2.16||| 73030|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 73030|EAP|0320|SHOULDER, LEFT|Blue Cross PPO|BCBS TRANE PPO|||||2.16||| 73030|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73030|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 73030|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 73030|EAP|0320|SHOULDER, LEFT|United Healthcare|UMR|||||0.00||| 73030|EAP|0320|SHOULDER, LEFT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Blue Cross PPO|BCBS WALMART|||||0.00||| 73030|EAP|0320|SHOULDER, RIGHT|Blue Cross PPO|BLUE CROSS PPO|2.16||||2.16||| 73030|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73030|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||213.82||| 73030|EAP|0320|SHOULDER, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|United Healthcare|UMR|||||0.00||| 73030|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 73030|EAP|0320|SHOULDER, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|ChampVA|CHAMPVA OF CO DENVER|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.16||| 73030|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 73030|EAP|0981||Workers Compensation|DO NOT USE----ENABLE COMP|||||0.00||| 73030|EAP|0320|SHOULDER, LEFT|Workers Compensation|WC OTHER|||||2.16||| 73030|EAP|0450||Workers Compensation|WC OTHER|||||181.41||| 73030|EAP|0320|SHOULDER, RIGHT|Workers Compensation|WC OTHER|||||2.16||| 73030|EAP|0450||Workers Compensation|DO NOT USE----ENABLE COMP|||||213.82||| 73030|EAP|0320|SHOULDER, RIGHT|Workers Compensation|DO NOT USE----ENABLE COMP|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.16||| 73030|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 73030|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73030|EAP|0270||Medicare|MEDICARE A & B|||||0.07||| 73030|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 73030|EAP|0320|SHOULDER, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.16||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|Medicaid|MEDICAID|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Medicaid|MEDICAID|||||1.08||| 73030|EAP|0320||NON CONTRACTED|COMMERCIAL OTHER|2.16||||2.04||| 73030|EAP|0320|SHOULDER, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 73030|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73030|EAP|0320|SHOULDER, LEFT|Medicare|MEDICARE A & B|2.16||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|NON CONTRACTED|COMMERCIAL OTHER|2.16||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|NON CONTRACTED|BOONE CHAPMAN|||||2.16||| 73030|EAP|0320|SHOULDER, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|2.16||||0.00||| 73030|EAP|0320|SHOULDER, LEFT|NON CONTRACTED|MRAMVA|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.16||| 73030|EAP|0450||Medicare|MEDICARE A & B|||||669.83||| 73030|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 73030|EAP|0320|SHOULDER, RIGHT|Medicare|MEDICARE RAILROAD|||||0.00||| 73030|EAP|0320|SHOULDER, RIGHT|Medicare|MEDICARE A & B|2.16||||2.16||| 73030|EAP|0320||Medicare|MEDICARE A & B|2.16||||2.04||| 73030|EAP|0320|SHOULDER, RIGHT|NON CONTRACTED|MRAMVA|||||2.16||| 73030|EAP|0320|SHOULDER, LEFT|Medicare|MEDICARE RAILROAD|||||2.16||| 73040|EAP|0322|SHOULDER ARTHROGRAPHY|Blue Cross PPO Select|BCBS UTHCT|||||8.86||| 73060|EAP|0320|HUMERUS, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 73060|EAP|0320|HUMERUS, RIGHT|NON CONTRACTED|MRAMVA|||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|Medicare|MEDICARE A & B|||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||3.48||| 73060|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73060|EAP|0320|HUMERUS, LEFT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.48||| 73060|EAP|0981||Managed Medicaid|OTHER MEDICAID|||||0.00||| 73060|EAP|0320|HUMERUS, LEFT|Medicaid|MEDICAID|||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|Workers Compensation|WC OTHER|||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.48||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.48||||3.48||| 73060|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 73060|EAP|0320|HUMERUS, RIGHT|Blue Cross PPO|BLUE CROSS PPO|3.48||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|Medicare|MEDICARE A & B|||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|Blue Cross PPO|BLUE CROSS PPO|3.48||||3.48||| 73060|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||213.82||| 73060|EAP|0320|HUMERUS, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|Managed Medicaid|OTHER MEDICAID|||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||3.48||| 73060|EAP|0320|HUMERUS, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.48||| 73060|EAP|0320|HUMERUS, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||3.48||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Blue Cross PPO Select|BCBS UTHCT|||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.88||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.61||| 73070|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 73070|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73070|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||0.88||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.61||| 73070|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Managed Medicaid|SUPERIOR STAR MCD|||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Managed Medicaid|SUPERIOR STAR MCD|||||1.61||| 73070|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.61||| 73070|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 73070|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.61||| 73070|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73070|EAP|0271||Managed Medicaid|MOLINA MEDICAID|||||4.90||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.88||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Managed Medicaid|MOLINA MEDICAID|||||1.61||| 73070|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73070|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||0.88||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Blue Cross PPO|BLUE CROSS PPO|||||1.61||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Blue Cross PPO|BLUE CROSS PPO|||||1.61||| 73070|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 73070|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 73070|EAP|0270||Managed Medicaid|MOLINA MEDICAID|||||0.07||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Blue Cross PPO|BCBS WALMART|||||1.61||| 73070|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 73070|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.61||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Blue Cross PPO Select|BCBS UTHCT|||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.61||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.61||||1.61||| 73070|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73070|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Medicaid|MEDICAID|||||1.61||| 73070|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Medicaid|MEDICAID|||||1.61||| 73070|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|NON CONTRACTED|COMMERCIAL OTHER|||||1.61||| 73070|EAP|0320||Medicare|MEDICARE A & B|1.61||||0.88||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|NON CONTRACTED|MRAMVA|||||1.61||| 73070|EAP|0320|ELBOW, 2 VIEWS AP & LATERAL LT|Medicare|MEDICARE A & B|1.61||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|Medicare|MEDICARE A & B|1.61||||1.61||| 73070|EAP|0320|ELBOW; 2 VIEWS AP & LATERAL RT|NON CONTRACTED|COMMERCIAL OTHER|||||0.88||| 73080|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Medicare|MEDICARE A & B|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Blue Cross PPO|BLUE CROSS PPO|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Blue Cross PPO|BLUE CROSS POS|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Blue Cross PPO|BCBS TRANE PPO|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.61||| 73080|EAP|0320|**ELBOW COMPLETE MINIMUM 3V|Blue Cross PPO Select|BCBS UTHCT|||||1.61||| 73080|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 73090|EAP|0320|FOREARM, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73090|EAP|0320|FOREARM, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73090|EAP|0320|FOREARM, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73090|EAP|0320||Managed Medicaid|SUPERIOR STAR MCD|||||5.01||| 73090|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||3.45||| 73090|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73090|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.85||| 73090|EAP|0320|FOREARM, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73090|EAP|0320|FOREARM, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73090|EAP|0320|FOREARM, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73090|EAP|0320|OSSEOUS SURVEY (METASTASES)|Managed Medicaid|SUPERIOR STAR MCD|||||8.92||| 73090|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73090|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73090|EAP|0320|FOREARM, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.88||| 73090|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.51||| 73090|EAP|0250||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||21.30||| 73090|EAP|0320|FOREARM, LEFT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.88||| 73090|EAP|0320|FOREARM, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73090|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.30||| 73090|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73090|EAP|0320|FOREARM, LEFT|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 73090|EAP|0320|FOREARM, RIGHT|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 73090|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||8.58||| 73090|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.51||| 73090|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73090|EAP|0320|FOREARM, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73090|EAP|0320|FOREARM, LEFT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73090|EAP|0636||Managed Medicaid|SUPERIOR STAR MCD|||||27.30||| 73090|EAP|0320|FOREARM, LEFT|Medicaid|MEDICAID|||||2.04||| 73090|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73090|EAP|0320|FOREARM, LEFT|NON CONTRACTED|MRAMVA|||||2.04||| 73090|EAP|0320|FOREARM, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73090|EAP|0510||Medicare|MEDICARE A & B|||||1.50||| 73090|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73090|EAP|0320|FOREARM, RIGHT|Medicare|MEDICARE A & B|2.04||||2.04||| 73090|EAP|0320|FOREARM, LEFT|Medicare|MEDICARE A & B|2.04||||2.04||| 73090|EAP|0320|FOREARM, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73090|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 73110|EAP|0320|WRIST, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||0.88||| 73110|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73110|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 73110|EAP|0450||Medicare|MEDICARE A & B|||||669.83||| 73110|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 73110|EAP|0320|WRIST, RIGHT|NON CONTRACTED|MRAMVA|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Medicare|MEDICARE A & B|2.04||||2.04||| 73110|EAP|0270||Medicare|MEDICARE A & B|||||0.07||| 73110|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73110|EAP|0320|WRIST, RIGHT|Medicaid|MEDICAID|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Medicaid|MEDICAID|||||2.04||| 73110|EAP|0981||Medicaid|MEDICAID|||||0.00||| 73110|EAP|0450||Medicaid|MEDICAID|||||3.45||| 73110|EAP|0450||United Healthcare|UMR|||||2.15||| 73110|EAP|0981||United Healthcare|UMR|||||0.00||| 73110|EAP|0320|WRIST, LEFT|United Healthcare|UMR|||||2.04||| 73110|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73110|EAP|0320|WRIST, RIGHT|United Healthcare|UMR|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73110|EAP|0450||United Healthcare|UMR|||||213.82||| 73110|EAP|0320|WRIST, LEFT|Blue Cross PPO|BCBS TRANE PPO|||||1.46||| 73110|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||197.62||| 73110|EAP|0320|WRIST, LEFT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73110|EAP|0320|WRIST, LEFT|Blue Cross PPO|BCBS WALMART|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Blue Cross PPO|BLUE CROSS POS|||||0.88||| 73110|EAP|0320|WRIST, RIGHT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Blue Cross PPO|BLUE CROSS POS|||||0.88||| 73110|EAP|0320|WRIST, RIGHT|Blue Cross PPO|BCBS TRANE PPO|||||1.46||| 73110|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 73110|EAP|0320|WRIST, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.46||| 73110|EAP|0320|WRIST, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73110|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73110|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 73110|EAP|0320|WRIST, LEFT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73110|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 73110|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73110|EAP|0320|WRIST, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73110|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 73110|EAP|0320|**WRIST COMPLETE MINIMUM 3V|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 73110|EAP|0320|WRIST, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73110|EAP|0320|**WRIST COMPLETE MINIMUM 3V|United Healthcare|UMR|||||2.99||| 73110|EAP|0320|WRIST, LEFT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73110|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73110|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||3.45||| 73110|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 73110|EAP|0320|WRIST, LEFT|Medicare|MEDICARE A & B|2.04||||2.04||| 73110|EAP|0320|WRIST, LEFT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.88||| 73110|EAP|0320|WRIST, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73110|EAP|0270||ChampVA|CHAMPVA OF CO DENVER|||||0.07||| 73110|EAP|0320|WRIST, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73110|EAP|0320|WRIST, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73110|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73110|EAP|0320|WRIST, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73110|EAP|0320|WRIST, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73110|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|||||213.82||| 73110|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 73110|EAP|0320|WRIST, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||1.46||| 73110|EAP|0320|WRIST, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73110|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 73110|EAP|0320|**WRIST COMPLETE MINIMUM 3V|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.99||| 73110|EAP|0320|WRIST, RIGHT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73110|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73110|EAP|0320|WRIST, RIGHT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73130|EAP|0320|HAND, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73130|EAP|0320|HAND, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 73130|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 73130|EAP|0320|HAND, RIGHT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73130|EAP|0320|HAND, LEFT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73130|EAP|0320|HAND, LEFT|Cigna|CIGNA OTHER|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73130|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 73130|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73130|EAP|0320|HAND, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73130|EAP|0270||Managed Medicaid|SUPERIOR STAR MCD|||||0.07||| 73130|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 73130|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||2.15||| 73130|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.12||| 73130|EAP|0320|HAND, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73130|EAP|0320|HAND, LEFT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73130|EAP|0320|HAND, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73130|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||2.15||| 73130|EAP|0270||Managed Medicaid|MOLINA MEDICAID|||||0.07||| 73130|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||5.77||| 73130|EAP|0320|HAND, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73130|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.69||| 73130|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.77||| 73130|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73130|EAP|0320|HAND, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73130|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 73130|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 73130|EAP|0320|HAND, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73130|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 73130|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 73130|EAP|0320|HAND, LEFT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73130|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 73130|EAP|0320|HAND, RIGHT|Blue Cross PPO|BLUE CROSS POS|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73130|EAP|0320|HAND, LEFT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73130|EAP|0320|HAND, LEFT|Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 73130|EAP|0320|HAND, LEFT|Blue Cross PPO|BCBS WALMART|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 73130|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73130|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.25||| 73130|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.77||| 73130|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.12||| 73130|EAP|0450||Workers Compensation|WC OTHER|||||4.12||| 73130|EAP|0450||Workers Compensation|WC OTHER|||||181.41||| 73130|EAP|0320|HAND, LEFT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73130|EAP|0981||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 73130|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 73130|EAP|0771||Workers Compensation|WC OTHER|||||160.36||| 73130|EAP|0320|HAND, RIGHT|Workers Compensation|WC TX MUTUAL INS|||||2.04||| 73130|EAP|0771||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||160.36||| 73130|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 73130|EAP|0320|HAND, LEFT|Workers Compensation|WC OTHER|||||2.04||| 73130|EAP|0320|HAND, LEFT|Workers Compensation|WC TX MUTUAL INS|||||2.04||| 73130|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.08||| 73130|EAP|0320|HAND, RIGHT|Workers Compensation|DO NOT USE----ENABLE COMP|||||2.04||| 73130|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||4.12||| 73130|EAP|0320|HAND, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.04||||2.04||| 73130|EAP|0320|HAND, RIGHT|United Healthcare|UMR|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.04||| 73130|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.21||| 73130|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73130|EAP|0320|HAND, LEFT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 73130|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||197.62||| 73130|EAP|0320|HAND, LEFT|United Healthcare|UMR|||||2.04||| 73130|EAP|0320|HAND, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.04||||2.04||| 73130|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.36||| 73130|EAP|0981||Medicaid|MEDICAID|||||0.00||| 73130|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 73130|EAP|0320|HAND, LEFT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.04||| 73130|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73130|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 73130|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73130|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 73130|EAP|0320|HAND, RIGHT|Medicaid|MEDICAID|||||2.04||| 73130|EAP|0320|HAND, LEFT|Medicaid|MEDICAID|||||2.04||| 73130|EAP|0771||Managed Medicaid|SUPERIOR STAR MCD|||||160.36||| 73130|EAP|0320|HAND, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 73130|EAP|0320|HAND, LEFT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73130|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 73130|EAP|0320|HAND, LEFT|Medicare|MEDICARE A & B|2.04||||2.04||| 73130|EAP|0320||NON CONTRACTED|COMMERCIAL OTHER|||||0.88||| 73130|EAP|0320|HAND, LEFT|NON CONTRACTED|MRAMVA|||||2.04||| 73130|EAP|0320|HAND, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73130|EAP|0450||Medicare|MEDICARE A & B|||||4.36||| 73130|EAP|0450||Medicare|MEDICARE A & B|||||2.15||| 73130|EAP|0320|HAND, RIGHT|Medicare|MEDICARE PART A|2.04||||||| 73130|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73130|EAP|0320|HAND, RIGHT|NON CONTRACTED|MRAMVA|||||2.04||| 73130|EAP|0320|HAND, RIGHT|Medicare|MEDICARE RAILROAD|||||0.00||| 73130|EAP|0320|HAND, RIGHT|Medicare|MEDICARE A & B|2.04||||2.04||| 73130|EAP|0320|HAND, LEFT|Medicare|MEDICARE PART A|2.04||||||| 73130|EAP|0320|HAND, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73140|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER|2.04||||1.02||| 73140|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73140|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Medicaid|MEDICAID|||||0.00||| 73140|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73140|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 73140|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73140|EAP|0450||United Healthcare|UMR|||||181.41||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.04||| 73140|EAP|0981||United Healthcare|UMR|||||0.00||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73140|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|United Healthcare|UMR|||||2.04||| 73140|EAP|0771||United Healthcare|UMR|||||160.36||| 73140|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Workers Compensation|WC OTHER|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Blue Cross PPO|BCBS WALMART|||||0.00||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Blue Cross PPO|BCBS TRANE PPO|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 73140|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73140|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73140|EAP|0450||United Healthcare|UMR|||||4.36||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Aetna|AETNA|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 73140|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73140|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.36||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 73140|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| 73140|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Medicare|MEDICARE A & B|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73140|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||181.41||| 73140|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.36||| 73140|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||6.74||| 73140|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||669.83||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|ChampVA|CHAMPVA OF CO DENVER|||||1.02||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73140|EAP|0320|FINGER(S); MINIMUM 2 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73200|EAP|0352|CT UPPER EXTREMITY WITHOUT CON|Blue Cross PPO|BLUE CROSS PPO|||||19.32||| 73200|EAP|0352|CT UPPER EXTREMITY WITHOUT CON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.32||| 73200|EAP|0352|CT UPPER EXTREMITY WITHOUT CON|NON CONTRACTED|COMMERCIAL OTHER|||||19.32||| 73200|EAP|0352|CT UPPER EXTREMITY WITHOUT CON|Medicare|MEDICARE A & B|||||19.32||| 73201|EAP|0352||Medicare|MEDICARE A & B|21.69||||21.69||| 73201|EAP|0352||NON CONTRACTED|COMMERCIAL OTHER|||||21.69||| 73201|EAP|0352|CT UPPER EXTREMITY; W/ CONTRAS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.69||| 73218|EAP|0610|MRI; UPPER EXTREMITY WITHOUT C|Blue Cross PPO|BLUE CROSS PPO|||||26.57||| 73218|EAP|0610|MRI; UPPER EXTREMITY WITHOUT C|Medicare|MEDICARE A & B|||||26.57||| 73220|EAP|0610||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||36.09||| 73220|EAP|0610|MRI EXTREMITY W/WO CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||36.09||| 73220|EAP|0610|MRI EXTREMITY W/WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|36.09||||||| 73220|EAP|0610||Blue Cross PPO Select|BCBS UTHCT|||||36.09||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Aetna|AETNA EL PASO CLAIMS OFFICE|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Blue Cross PPO|BLUE CROSS PPO|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Blue Cross PPO|BLUE CROSS POS|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|ChampVA|CHAMPVA OF CO DENVER|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Blue Cross PPO Select|BCBS UTHCT|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Medicare|MEDICARE A & B|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|NON CONTRACTED|COMMERCIAL OTHER|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|Workers Compensation|DO NOT USE----ENABLE COMP|||||28.78||| 73221|EAP|0610|MRI; UPPER EXTREMITY JOINT W/O|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||28.78||| 73222|EAP|0610|MRI; SHOULDER W/CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||32.29||| 73223|EAP|0610|MRI JOINT UPPER EXT; W/O CONT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||38.90||| 73223|EAP|0610|MRI JOINT UPPER EXT; W/O CONT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||38.90||| 73502|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73502|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73502|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Aetna|AETNA|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73502|EAP|0981||Aetna|TRS COORDINATED CARE|||||0.00||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Aetna|TRS COORDINATED CARE|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73502|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73502|EAP|0450||Aetna|TRS COORDINATED CARE|||||181.41||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73502|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73502|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||197.62||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Blue Cross PPO Select|BCBS UTHCT|||||1.02||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|NON CONTRACTED|BOONE CHAPMAN|||||2.04||| 73502|EAP|0320||Medicare|MEDICARE A & B|1.63||||2.70||| 73502|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73502|EAP|0450||Medicare|MEDICARE A & B|||||0.00||| 73502|EAP|0450||Medicare|MEDICARE A & B|||||7.27||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73502|EAP|0981||NON CONTRACTED|MRAMVA|||||0.00||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|NON CONTRACTED|MRAMVA|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|NON CONTRACTED|MRAMVA|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73502|EAP|0450||NON CONTRACTED|MRAMVA|||||181.41||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73502|EAP|0320|RAD EXM,HIPS,UNIL,W/PELV;2-3 V|Medicare|MEDICARE A & B|1.63||||1.63||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Medicare|MEDICARE A & B|1.63||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Medicare|MEDICARE A & B|1.63||||2.04||| 73502|EAP|0320||Medicare|MEDICARE A & B|1.63||||4.50||| 73502|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 73502|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Medicare|MEDICARE RAILROAD|||||0.00||| 73502|EAP|0320||Medicare|MEDICARE A & B|2.04||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Blue Cross PPO|BLUE CROSS POS|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.04||| 73502|EAP|0307||Medicare|MEDICARE A & B|||||1.18||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Medicaid|MEDICAID|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|Medicaid|MEDICAID|||||2.04||| 73502|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Workers Compensation|WC OTHER|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|United Healthcare|UMR|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73502|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|United Healthcare|UMR|||||2.04||| 73502|EAP|0320|HIP, LEFT 2-3 VIEWS ONLY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.04||| 73502|EAP|0320|HIP, RIGHT 2-3 VIEWS ONLY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 73502|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 73503|EAP|0320|RAD EXAM,HIPS,UNIL,W/PELV;4 VW|Workers Compensation|WC OTHER|||||2.70||| 73503|EAP|0320|RAD EXAM,HIPS,UNIL,W/PELV;4 VW|Medicare|MEDICARE A & B|2.70||||2.70||| 73503|EAP|0320|RAD EXAM,HIPS,UNIL,W/PELV;4 VW|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.70||| 73521|EAP|0320|RAD EXAM,HIPS,BIL W/PELV;2 VWS|Blue Cross PPO|BLUE CROSS PPO|||||2.70||| 73521|EAP|0320|RAD EXAM,HIPS,BIL W/PELV;2 VWS|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 73521|EAP|0320|RAD EXAM,HIPS,BIL W/PELV;2 VWS|Blue Cross PPO Select|BCBS UTHCT|||||2.70||| 73521|EAP|0320|RAD EXAM,HIPS,BIL W/PELV;2 VWS|Medicaid|MEDICAID|||||2.70||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|5.15||||||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Medicare|MEDICARE A & B|5.15||||5.15||| 73523|EAP|0320||NON CONTRACTED|COMMERCIAL OTHER|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|NON CONTRACTED|COMMERCIAL OTHER|||||5.15||| 73523|EAP|0320||Medicare|MEDICARE A & B|5.15||||5.15||| 73523|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|United Healthcare|UMR|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Blue Cross PPO Select|BCBS UTHCT|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|ChampVA|CHAMPVA OF CO DENVER|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Managed Medicaid|SUPERIOR STAR MCD|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.15||| 73523|EAP|0320||Blue Cross PPO|BLUE CROSS PPO|||||5.15||| 73523|EAP|0320|RAD EXM,HIPS,BIL W/PELV;5V MIN|Blue Cross PPO|BLUE CROSS PPO|||||5.15||| 73523|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73523|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 73552|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73552|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||181.41||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Blue Cross PPO|BLUE CROSS PPO|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Blue Cross PPO|BLUE CROSS PPO|||||3.70||| 73552|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Blue Cross PPO|BLUE CROSS POS|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||3.70||| 73552|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||3.70||| 73552|EAP|0981||Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||0.00||| 73552|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73552|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Medicaid|MEDICAID|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|NON CONTRACTED|BOONE CHAPMAN|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|Medicare|MEDICARE A & B|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Medicare|MEDICARE RAILROAD|||||0.00||| 73552|EAP|0320|FEMUR; 2 VIEW, RIGHT|Medicare|MEDICARE A & B|||||3.70||| 73552|EAP|0320|FEMUR; 2 VIEW, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.70||||3.70||| 73560|EAP|0320|KNEE, LEFT|Workers Compensation|WC OTHER|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.04||||2.04||| 73560|EAP|0320|KNEE, RIGHT|United Healthcare|UMR|||||2.04||| 73560|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 73560|EAP|0320|KNEE, LEFT|United Healthcare|UMR|||||1.02||| 73560|EAP|0320|KNEE, LEFT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 73560|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73560|EAP|0320|KNEE, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.04||||2.04||| 73560|EAP|0320|KNEE, LEFT|Medicare|MEDICARE A & B|2.04||||2.04||| 73560|EAP|0320|KNEE, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73560|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 73560|EAP|0320|KNEE, RIGHT|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.04||| 73560|EAP|0320|KNEE, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||1.02||| 73560|EAP|0450||NON CONTRACTED|MRAMVA|||||181.41||| 73560|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73560|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| 73560|EAP|0761|US PV RESIDUAL URINE|Medicare|MEDICARE A & B|||||0.83||| 73560|EAP|0320|KNEE, RIGHT|NON CONTRACTED|BOONE CHAPMAN|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Multiplan|TML GRP INS|||||2.04||| 73560|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 73560|EAP|0921||Medicare|MEDICARE A & B|||||18.54||| 73560|EAP|0320|KNEE, RIGHT|Medicare|MEDICARE A & B|2.04||||2.04||| 73560|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 73560|EAP|0270||Medicare|MEDICARE A & B|||||0.07||| 73560|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73560|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73560|EAP|0320|KNEE, RIGHT|Medicaid|MEDICAID|||||2.04||| 73560|EAP|0250||Medicare|MEDICARE A & B|||||408.85||| 73560|EAP|0320|KNEE, LEFT|Medicaid|MEDICAID|||||2.04||| 73560|EAP|0981||Medicaid|MEDICAID|||||0.00||| 73560|EAP|0320|KNEE, LEFT|Cigna|CIGNA OTHER|||||0.00||| 73560|EAP|0450|CLSD TX OF MEDIAL MALLEOLUS FR|Blue Cross PPO Select|BCBS UTHCT|||||29.39||| 73560|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73560|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|||||181.41||| 73560|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||2.10||| 73560|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 73560|EAP|0320|KNEE, LEFT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 73560|EAP|0320|KNEE, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 73560|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||669.83||| 73560|EAP|0320|KNEE, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 73560|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||2.64||| 73560|EAP|0320|KNEE, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73560|EAP|0510||Cigna|NALC HLTH BENEFIT|||||2.50||| 73560|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 73560|EAP|0320|KNEE, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73560|EAP|0320|KNEE, RIGHT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73560|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 73560|EAP|0320|KNEE, LEFT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73560|EAP|0320|KNEE, LEFT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.02||| 73560|EAP|0320|KNEE, LEFT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73560|EAP|0949||Medicare|MEDICARE A & B|||||213.82||| 73560|EAP|0320|KNEE, LEFT|Cigna|NALC HLTH BENEFIT|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Cigna|CIGNA OTHER|||||0.00||| 73560|EAP|0320|KNEE, LEFT|NON CONTRACTED|MRAMVA|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 73560|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73560|EAP|0270|SUPPORT,KNEE 10-22 XXL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.50||| 73560|EAP|0320|KNEE, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.04||||2.04||| 73560|EAP|0320|KNEE, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.04||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|NON CONTRACTED|MRAMVA|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73560|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.50||| 73560|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 73560|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 73560|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 73560|EAP|0320|KNEE, LEFT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73560|EAP|0320|KNEE, LEFT|PHCS|TML GRP INS|||||2.04||| 73560|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.51||| 73560|EAP|0320|KNEE, RIGHT|Aetna|AETNA EXXON MOBIL|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Aetna|AETNA EXXON MOBIL|||||2.04||| 73560|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73560|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 73560|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 73560|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||213.82||| 73560|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.15||| 73560|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73560|EAP|0320|KNEE, LEFT|Blue Cross PPO|BLUE CROSS POS|||||1.02||| 73560|EAP|0320|KNEE, LEFT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Blue Cross PPO|BCBS WALMART|||||2.04||| 73560|EAP|0320|KNEE, LEFT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73560|EAP|0320|KNEE, LEFT|Blue Cross PPO|BCBS WALMART|||||2.04||| 73560|EAP|0320|KNEE, RIGHT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73560|EAP|0320|KNEE, LEFT|Blue Cross PPO|BCBS TRANE PPO|||||2.04||| 73562|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73562|EAP|0320|KNEE, XRAY 3 VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 73562|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.07||| 73562|EAP|0320|KNEE, XRAY 3 VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 73562|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||213.82||| 73562|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 73562|EAP|0320|KNEE, XRAY 3 VIEWS|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 73562|EAP|0320|KNEE, XRAY 3 VIEWS|Cigna|CIGNA OPEN ACCESS PLUS|||||2.16||| 73562|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73562|EAP|0320|KNEE, XRAY 3 VIEWS|Medicare|MEDICARE A & B|||||2.16||| 73562|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73564|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73564|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 73564|EAP|0320|KNEE, XRAY COMP 4 OR MORE VWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73565|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 73565|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 73565|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 73565|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73565|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73565|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|PHCS|TML GRP INS|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Medicare|MEDICARE A & B|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|Multiplan|TML GRP INS|||||2.04||| 73565|EAP|0320|KNEE; BOTH KNEES STANDING AP|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 73590|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73590|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73590|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 73590|EAP|0771||Managed Medicaid|SUPERIOR STAR MCD|||||160.36||| 73590|EAP|0320|TIB/FIB, RIGHT|Medicare|MEDICARE A & B|2.04||||2.04||| 73590|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73590|EAP|0320|TIB/FIB, LEFT|Medicare|MEDICARE A & B|2.04||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|NON CONTRACTED|MRAMVA|||||2.04||| 73590|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 73590|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 73590|EAP|0320|TIB/FIB, RIGHT|NON CONTRACTED|BOONE CHAPMAN|||||2.04||| 73590|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 73590|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 73590|EAP|0320|TIB/FIB, RIGHT|Workers Compensation|WC TX MUTUAL INS|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|Workers Compensation|WC OTHER|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|United Healthcare|UMR|2.04||||||| 73590|EAP|0320|TIB/FIB, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|PHCS|TML GRP INS|||||2.04||| 73590|EAP|0450||Workers Compensation|WC OTHER|||||4.36||| 73590|EAP|0320|TIB/FIB, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Multiplan|TML GRP INS|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.04||| 73590|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 73590|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 73590|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||3.37||| 73590|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 73590|EAP|0320|TIB/FIB, RIGHT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.02||| 73590|EAP|0320|TIB/FIB, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73590|EAP|0270|WALKER PRESSURE SM/MD|Medicare|MEDICARE A & B|||||2.21||| 73590|EAP|0320|TIB/FIB, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 73590|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73590|EAP|0320|TIB/FIB, RIGHT|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 73590|EAP|0320|TIB/FIB, LEFT|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 73590|EAP|0320|TIB/FIB, RIGHT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73590|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 73590|EAP|0320|TIB/FIB, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 73610|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 73610|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 73610|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.16||| 73610|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 73610|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 73610|EAP|0320|XRAY ANKLE, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 73610|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 73610|EAP|0320|XRAY ANKLE, LEFT|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Blue Cross PPO|BLUE CROSS POS|||||2.16||| 73610|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 73610|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73610|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.16||| 73610|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 73610|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73610|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73610|EAP|0320|XRAY ANKLE, LEFT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 73610|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 73610|EAP|0320|XRAY ANKLE, LEFT|Managed Medicaid|FAMILY PLANNING GRANT|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Managed Medicaid|MOLINA MEDICAID|||||1.08||| 73610|EAP|0320|XRAY ANKLE, LEFT|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 73610|EAP|0320|XRAY ANKLE, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 73610|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 73610|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.16||| 73610|EAP|0510||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.99||| 73610|EAP|0320|XRAY ANKLE, LEFT|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.16||| 73610|EAP|0270||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.07||| 73610|EAP|0270||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.42||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 73610|EAP|0270||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.57||| 73610|EAP|0320|XRAY ANKLE, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 73610|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 73610|EAP|0320|XRAY ANKLE, RIGHT|United Healthcare|UMR|||||2.16||| 73610|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73610|EAP|0510||United Healthcare|UMR|||||2.50||| 73610|EAP|0320|XRAY ANKLE, RIGHT|United Healthcare|GOLDEN RULE INSURANCE|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|United Healthcare|UMR|||||2.16||| 73610|EAP|0981||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 73610|EAP|0981||Workers Compensation|WC GALLAGHER BASSETT|||||0.00||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Workers Compensation|WC OTHER|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Workers Compensation|WC TX MUTUAL INS|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Workers Compensation|WC TRAVELERS|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Workers Compensation|WC OTHER|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Workers Compensation|WC GALLAGHER BASSETT|||||2.16||| 73610|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.07||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Medicare|MEDICARE A & B|2.16||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Medicare|MEDICARE RAILROAD|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|Medicare|MEDICARE A & B|2.16||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|NON CONTRACTED|BOONE CHAPMAN|||||2.16||| 73610|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73610|EAP|0320|XRAY ANKLE, RIGHT|NON CONTRACTED|MRAMVA|||||2.16||| 73610|EAP|0320|XRAY ANKLE, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|2.16||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.16||| 73610|EAP|0320|XRAY ANKLE, LEFT|NON CONTRACTED|COMMERCIAL OTHER|2.16||||1.08||| 73610|EAP|0270||Medicare|MEDICARE A & B|||||2.32||| 73610|EAP|0320|XRAY ANKLE, RIGHT|Medicaid|MEDICAID|||||2.16||| 73610|EAP|0981||Medicaid|MEDICAID|||||0.00||| 73610|EAP|0636||Managed Medicaid|SUPERIOR STAR MCD|||||27.30||| 73610|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73610|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73610|EAP|0320|XRAY ANKLE, LEFT|Medicaid|MEDICAID|||||2.16||| 73630|EAP|0270||Medicare|MEDICARE A & B|||||0.36||| 73630|EAP|0270||Medicare|MEDICARE A & B|||||131.25||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Medicaid|MEDICAID|2.04||||2.04||| 73630|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Medicaid|MEDICAID|2.04||||2.04||| 73630|EAP|0981||Medicaid|MEDICAID|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.04||| 73630|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Medicare|MEDICARE A & B|2.04||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Medicare|MEDICARE RAILROAD|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|NON CONTRACTED|BOONE CHAPMAN|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Multiplan|WEB TPA|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|NON CONTRACTED|MRAMVA|||||2.04||| 73630|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Medicare|MEDICARE A & B|2.04||||2.04||| 73630|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73630|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 73630|EAP|0510||Medicare|MEDICARE A & B|||||2.51||| 73630|EAP|0981||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Workers Compensation|WC OTHER|||||2.04||| 73630|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 73630|EAP|0771||Workers Compensation|WC TX MUTUAL INS|||||160.36||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Workers Compensation|WC OTHER|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Workers Compensation|WC TRAVELERS|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Workers Compensation|WC TX MUTUAL INS|||||2.04||| 73630|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||4.36||| 73630|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.49||| 73630|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.07||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|United Healthcare|UMR|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73630|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|United Healthcare|GOLDEN RULE INSURANCE|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 73630|EAP|0270|SHOE POST-OP W MED (POD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.37||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|PHCS|WEB TPA|||||2.04||| 73630|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|United Healthcare|GOLDEN RULE INSURANCE|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73630|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.04||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 73630|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 73630|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.04||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|United Healthcare|UMR|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Workers Compensation|WC GALLAGHER BASSETT|||||2.04||| 73630|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Managed Medicaid|MOLINA MEDICAID|||||1.02||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73630|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 73630|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 73630|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 73630|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 73630|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||7.27||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 73630|EAP|0320||Medicare|MEDICARE A & B|2.04||||2.97||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73630|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|ChampVA|CHAMPVA OF CO DENVER|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Blue Cross PPO|BLUE CROSS POS|2.04||||2.04||| 73630|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73630|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 73630|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Blue Cross PPO|BCBS WALMART|||||2.04||| 73630|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 73630|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 73630|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.37||| 73630|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 73630|EAP|0270||Medicare|MEDICARE A & B|||||0.37||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Blue Cross PPO|BLUE CROSS POS|2.04||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Blue Cross PPO|BCBS WALMART|||||2.04||| 73630|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.12||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73630|EAP|0320|HEEL/CALCANEUS, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.88||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, RIGHT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73630|EAP|0320|FOOT; COMPLETE, MIN 3 V, LEFT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.97||| 73650|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Blue Cross PPO|BLUE CROSS PPO|||||192.50||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Blue Cross PPO|BLUE CROSS POS|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|Blue Cross PPO|BLUE CROSS PPO|||||2.97||| 73650|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||0.88||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|Blue Cross PPO Select|BCBS UTHCT|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Blue Cross PPO Select|BCBS UTHCT|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Cigna|CIGNA OF TN CHATTANOOGA|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|ChampVA|CHAMPVA OF CO DENVER|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, LEFT|Medicare|MEDICARE A & B|||||2.97||| 73650|EAP|0320|HEEL/CALCANEUS, RIGHT|Medicare|MEDICARE A & B|||||2.97||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 73660|EAP|0270||Medicare|MEDICARE A & B|||||0.07||| 73660|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 73660|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 73660|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Medicare|MEDICARE A & B|2.04||||2.04||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||0.00||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 73660|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Blue Cross PPO|BLUE CROSS PPO|||||1.02||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 73660|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 73660|EAP|0450|CLSD REDUCTION DISLOC W/O ANES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.38||| 73660|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 73660|EAP|0320|TOE(S); MINIMUM 2 VIEWS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 73700|EAP|0352|CT LOWER EXTREMITY WITHOUT CON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.28||| 73700|EAP|0352|CT LOWER EXTREMITY WITHOUT CON|Blue Cross PPO Select|BCBS UTHCT|||||19.28||| 73700|EAP|0352|CT LOWER EXTREMITY WITHOUT CON|Managed Medicaid|SUPERIOR STAR MCD|||||19.28||| 73700|EAP|0352|CT LOWER EXTREMITY WITHOUT CON|Medicare|MEDICARE A & B|||||19.28||| 73700|EAP|0352|CT LOWER EXTREMITY WITHOUT CON|Workers Compensation|WC GALLAGHER BASSETT|||||19.28||| 73700|EAP|0352|CT LOWER EXTREMITY WITHOUT CON|United Healthcare|GOLDEN RULE INSURANCE|||||19.28||| 73701|EAP|0352|CT LOWER EXTREMITY W/CONTRAST|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||21.41||| 73701|EAP|0352|CT LOWER EXTREMITY W/CONTRAST|Medicare|MEDICARE A & B|21.41||||21.41||| 73701|EAP|0352|CT LOWER EXTREMITY W/CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||21.41||| 73701|EAP|0352|CT LOWER EXTREMITY W/CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||21.41||| 73706|EAP|0350||Medicare|MEDICARE A & B|||||28.27||| 73718|EAP|0610|MRI; LOWER EXT W/O CONT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||30.56||| 73718|EAP|0610|MRI; LOWER EXT W/O CONT|Blue Cross PPO Select|BCBS UTHCT|||||30.56||| 73718|EAP|0610|MRI; LOWER EXT W/O CONT|Medicare|MEDICARE A & B|||||30.56||| 73720|EAP|0610|MRI; LOWER EXTREMITY N/JOINT W|Medicare|MEDICARE PART A|38.90||||||| 73720|EAP|0610|MRI; LOWER EXTREMITY N/JOINT W|Medicare|MEDICARE A & B|38.90||||38.90||| 73720|EAP|0610|MRI; LOWER EXTREMITY N/JOINT W|Blue Cross PPO Select|BCBS UTHCT|||||38.90||| 73720|EAP|0610|MRI; LOWER EXTREMITY N/JOINT W|Blue Cross PPO|BLUE CROSS PPO|38.90||||38.90||| 73720|EAP|0610|MRI; LOWER EXTREMITY N/JOINT W|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||38.90||| 73720|EAP|0610|MRI; LOWER EXTREMITY N/JOINT W|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|38.90||||||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Blue Cross PPO|BLUE CROSS PPO|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Blue Cross PPO|BLUE CROSS POS|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|ChampVA|CHAMPVA OF CO DENVER|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Blue Cross PPO Select|BCBS UTHCT|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Cigna|CIGNA OPEN ACCESS PLUS|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Workers Compensation|DO NOT USE----ENABLE COMP|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||30.10||| 73721|EAP|0610|MRI; LOWER EXTREMITY / JOINT|Medicare|MEDICARE A & B|||||30.10||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|Medicare|MEDICARE A & B|||||41.63||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|Medicaid|MEDICAID|41.63||||||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||41.63||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||41.63||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|Blue Cross PPO Select|BCBS UTHCT|||||41.63||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||41.63||| 73723|EAP|0610|MRI; LOWER EXTREMITY JOINT W/W|Blue Cross PPO|BLUE CROSS PPO|41.63||||||| 73725|EAP|0610|MRA; RT LOW EXTR W/WO CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.67||| 74018|EAP|0450||United Healthcare|UMR|||||181.41||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|United Healthcare|UMR|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Medicaid|MEDICAID|2.04||||2.04||| 74018|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 74018|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Medicare|MEDICARE A & B|||||1.44||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Medicare|MEDICARE PART A|2.04||||||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Optum Behavioral Health|OPTUM|2.04||||||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Medicare|MEDICARE A & B|2.04||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|NON CONTRACTED|COMMERCIAL OTHER|2.04||||1.02||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|NON CONTRACTED|MRAMVA|||||2.04||| 74018|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 74018|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Managed Medicaid|SUPERIOR STAR MCD|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.04||||2.04||| 74018|EAP|0309|AER ORG SUSCEPT (ARUP)|Medicare|MEDICARE A & B|||||0.93||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.04||| 74018|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.25||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Blue Cross PPO Select|BCBS UTHCT|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 74018|EAP|0981||United Healthcare|UMR|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Cigna|CIGNA OTHER|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Cigna|CIGNA OPEN ACCESS PLUS|||||2.04||| 74018|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Blue Cross PPO|BLUE CROSS PPO|2.04||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Blue Cross PPO|BLUE CROSS POS|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Aetna|AETNA EL PASO CLAIMS OFFICE|2.04||||2.04||| 74018|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 74018|EAP|0320|ABDOMEN, 1 VIEW (KUB, FLAT PLA|Aetna|TRS COORDINATED CARE|||||2.04||| 74019|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Aetna|AETNA EXXON MOBIL|||||0.00||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.16||| 74019|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Blue Cross PPO|BLUE CROSS POS|||||1.08||| 74019|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 74019|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.66||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Blue Cross PPO|BLUE CROSS PPO|2.16||||2.16||| 74019|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.32||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Cigna|CIGNA OF TN CHATTANOOGA|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.16||| 74019|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Managed Medicaid|SUPERIOR STAR MCD|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Managed Medicaid|MOLINA MEDICAID|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.16||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.16||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|NON CONTRACTED|COMMERCIAL OTHER|||||2.16||| 74019|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|ChampVA|CHAMPVA OF CO DENVER|2.16||||||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Blue Cross PPO|BCBS TRANE PPO|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Medicare|MEDICARE A & B|2.16||||2.16||| 74019|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 74019|EAP|0981||Medicaid|MEDICAID|||||0.00||| 74019|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 74019|EAP|0450||Medicaid|MEDICAID|||||181.41||| 74019|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Medicaid|MEDICAID|||||2.16||| 74019|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 74019|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.16||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.16||| 74019|EAP|0320|ABDOMEN, 2 VIEWS (FLAT & UPRIG|United Healthcare|UMR|||||2.16||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|Medicare|MEDICARE A & B|||||22.03||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|NON CONTRACTED|MRAMVA|||||22.03||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||22.03||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.03||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||22.03||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||22.03||| 74150|EAP|0352|CT ABDOMEN WITHOUT CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||22.03||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Aetna|AETNA EL PASO CLAIMS OFFICE|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Blue Cross PPO|BLUE CROSS POS|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Blue Cross PPO|BLUE CROSS PPO|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Blue Cross PPO Select|BCBS UTHCT|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.35||| 74160|EAP|0510||United Healthcare|UMR|||||2.50||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|United Healthcare|UMR|||||27.35||| 74160|EAP|0352|CT ABDOMEN WITH CONTRAST MATER|Medicare|MEDICARE A & B|27.35||||27.35||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Medicare|MEDICARE A & B|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Blue Cross PPO Select|BCBS UTHCT|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Blue Cross PPO|BLUE CROSS POS|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Blue Cross PPO|BLUE CROSS PPO|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||30.81||| 74170|EAP|0352|CT ABDOMEN CONTRAST SCAN W/WO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||30.81||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|Blue Cross PPO|BLUE CROSS PPO|||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|ChampVA|CHAMPVA OF CO DENVER|||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|Managed Medicaid|MOLINA MEDICAID|||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.00||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.00||| 74175|EAP|0352|CTA, ABD W/CONTRAST MATERIAL|Medicare|MEDICARE A & B|||||9.00||| 74176|EAP|0981||Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.00||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Medicaid|MEDICAID|19.08||||19.08||| 74176|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Medicare|MEDICARE PART A|19.08||||||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Medicare|MEDICARE A & B|19.08||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|19.08||||19.08||| 74176|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|19.08||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|19.08||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|United Healthcare|UMR|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Managed Medicaid|MEDICAID CSHCN|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Managed Medicaid|SUPERIOR STAR MCD|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||19.08||| 74176|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||19.08||| 74176|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|19.08||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Aetna|AETNA EXXON MOBIL|||||19.08||| 74176|EAP|0352|CT ABD & PELVIS W/O CONTRAST|Aetna|TRS COORDINATED CARE|||||19.08||| 74176|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.39||| 74177|EAP|0307||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.18||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|28.51||||28.51||| 74177|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.44||| 74177|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Aetna|AETNA EL PASO CLAIMS OFFICE|||||28.51||| 74177|EAP|0255||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Aetna|AETNA|||||28.51||| 74177|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross PPO|BCBS TRANE PPO|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross PPO|BCBS WALMART|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross PPO|BLUE CROSS PPO|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Cigna|CIGNA OF TN CHATTANOOGA|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|ChampVA|CHAMPVA OF CO DENVER|||||28.51||| 74177|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Cigna|NALC HLTH BENEFIT|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Managed Medicaid|MOLINA MEDICAID|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Managed Medicaid|SUPERIOR STAR MCD|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|PHCS|WEB TPA|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|PHCS|TML GRP INS|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross PPO Select|BCBS UTHCT|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|PHCS|WEB TPA OF GRAND PRAIRIE|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Blue Cross PPO|BLUE CROSS POS|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|United Healthcare|UMR|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Medicare|MEDICARE RAILROAD|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Multiplan|WEB TPA OF GRAND PRAIRIE|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Multiplan|WEB TPA|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Multiplan|TML GRP INS|||||28.51||| 74177|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.14||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Medicare|MEDICARE A & B|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Medicare|MEDICARE PART A|28.51||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER|||||28.51||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||28.51||| 74177|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 74177|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 74177|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 74177|EAP|0305||Medicaid|MEDICAID|||||1.68||| 74177|EAP|0306||Medicaid|MEDICAID|||||1.36||| 74177|EAP|0301||Medicaid|MEDICAID|||||3.14||| 74177|EAP|0301||Medicaid|MEDICAID|||||0.19||| 74177|EAP|0307||Medicaid|MEDICAID|||||1.18||| 74177|EAP|0352|CT ABDOMEN & PELVIS W/CONTRAST|Medicaid|MEDICAID|||||28.51||| 74177|EAP|0301||Medicaid|MEDICAID|||||1.44||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Medicare|MEDICARE PART B|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Medicare|MEDICARE A & B|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|NON CONTRACTED|COMMERCIAL OTHER|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|United Healthcare|UMR|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.51||| 74178|EAP|0352||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Blue Cross PPO Select|BCBS UTHCT|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Blue Cross PPO|BLUE CROSS PPO|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Blue Cross PPO|BLUE CROSS POS|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||28.51||| 74178|EAP|0352|CT ABD & PELV 1+ SECTION/REGNS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||28.51||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Blue Cross PPO Select|BCBS UTHCT|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|PHCS|WEB TPA|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Multiplan|WEB TPA|||||32.46||| 74181|EAP|0610|MRI; ABDOMEN WITHOUT CONTRAST|Medicare|MEDICARE A & B|32.46||||32.46||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Medicare|MEDICARE A & B|42.62||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|NON CONTRACTED|COMMERCIAL OTHER|||||42.62||| 74183|EAP|0636||Medicare|MEDICARE A & B|||||266.96||| 74183|EAP|0255||Medicare|MEDICARE A & B|||||2.40||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Blue Cross PPO Select|BCBS UTHCT|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Blue Cross PPO|BLUE CROSS PPO|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||42.62||| 74183|EAP|0610|MRI ABDOMEN WITH & WITHOUT CO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||42.62||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Aetna|AETNA|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Blue Cross PPO|BLUE CROSS POS|5.92||||||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Blue Cross PPO|BCBS WALMART|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Blue Cross PPO Select|BCBS UTHCT|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Blue Cross PPO|BLUE CROSS PPO|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.92||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.92||| 74230|EAP|0309||Medicare|MEDICARE A & B|||||2.25||| 74230|EAP|0306||Medicare|MEDICARE A & B|||||2.11||| 74230|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Medicare|MEDICARE A & B|||||3.00||| 74230|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 74230|EAP|0309||Medicare|MEDICARE A & B|||||3.54||| 74230|EAP|0444||Medicare|MEDICARE A & B|||||5.00||| 74230|EAP|0320|ESOPH/PHARYNX-SWALLOW WITH CIN|Medicare|MEDICARE A & B|5.92||||5.92||| 74246|EAP|0320|UPPER GI (UGI)|Medicare|MEDICARE A & B|||||7.82||| 74246|EAP|0320|UPPER GI (UGI)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.82||| 74246|EAP|0320|UPPER GI (UGI)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.82||| 74246|EAP|0320|UPPER GI (UGI)|Blue Cross PPO Select|BCBS UTHCT|||||7.82||| 74246|EAP|0320|UPPER GI (UGI)|Blue Cross PPO|BLUE CROSS PPO|||||7.82||| 74250|EAP|0320|SBFT (SMALL BOWEL FOLLOW THRU)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.09||| 74250|EAP|0320|SBFT (SMALL BOWEL FOLLOW THRU)|Medicare|MEDICARE A & B|||||6.09||| 74280|EAP|0320|BARIUM ENEMA (AIR CONTRAST, A-|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.58||| 74280|EAP|0320|BARIUM ENEMA (AIR CONTRAST, A-|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.58||| 74280|EAP|0320|BARIUM ENEMA (AIR CONTRAST, A-|Medicare|MEDICARE A & B|||||8.58||| 74280|EAP|0320|BARIUM ENEMA (AIR CONTRAST, A-|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||8.58||| 74455|EAP|0320|URETHROCYSTOGRAPHY, VOIDING|Blue Cross PPO|BLUE CROSS PPO|||||6.29||| 74740|EAP|0320|HYSTEROSALPINGOGRAM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.10||| 74740|EAP|0320|HYSTEROSALPINGOGRAM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||7.10||| 74740|EAP|0320|HYSTEROSALPINGOGRAM|Blue Cross PPO Select|BCBS UTHCT|||||7.10||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Blue Cross PPO|BLUE CROSS PPO|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.79||| 75571|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Blue Cross PPO Select|BCBS UTHCT|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|Medicare|MEDICARE A & B|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|NON CONTRACTED|COMMERCIAL OTHER|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.79||| 75571|EAP|0350|CT CARDIAC CALCIUM SCORE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.79||| 75635|EAP|0350|CTA,ABD ARTERIES W/CONTRAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||28.27||| 75635|EAP|0350|CTA,ABD ARTERIES W/CONTRAST|Medicare|MEDICARE A & B|28.27||||28.27||| 75635|EAP|0350|CTA,ABD ARTERIES W/CONTRAST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.27||| 75635|EAP|0350|CTA,ABD ARTERIES W/CONTRAST|Blue Cross PPO|BLUE CROSS PPO|||||28.27||| 75635|EAP|0350|CTA,ABD ARTERIES W/CONTRAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||28.27||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.26||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.26||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Blue Cross PPO|BCBS WALMART|||||4.26||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.26||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.26||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Medicaid|MEDICAID|||||4.26||| 76000|EAP|0320|FLUOROSCOPY; TIME TO 1 HOUR|Medicare|MEDICARE A & B|4.26||||4.26||| 76376|EAP|0350|3D RENDER W/O POSTPROCESS|Medicare|MEDICARE A & B|||||7.87||| 76377|EAP|0610|3D RENDERING W/POSTPROCESS MRI|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.00||||9.00||| 76377|EAP|0610||Blue Cross PPO|BLUE CROSS PPO|||||9.00||| 76377|EAP|0610|3D RENDERING W/POSTPROCESS MRI|Medicare|MEDICARE A & B|9.00||||9.00||| 76377|EAP|0610||Medicare|MEDICARE A & B|9.00||||9.00||| 76499|EAP|0320|UNLISTED DX RADIOLOGIC PROCEDU|Medicare|MEDICARE A & B|||||1.61||| 76499|EAP|0320|UNLISTED DX RADIOLOGIC PROCEDU|Aetna|AETNA|||||1.61||| 76499|EAP|0320|UNLISTED DX RADIOLOGIC PROCEDU|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.61||| 76536|EAP|0403||Cigna|CIGNA OPEN ACCESS PLUS|||||0.82||| 76536|EAP|0403||Cigna|CIGNA OPEN ACCESS PLUS|||||4.83||| 76536|EAP|0402|US THYROID|Cigna|CIGNA OPEN ACCESS PLUS|||||8.48||| 76536|EAP|0402|US THYROID|Cigna|CIGNA OF TN CHATTANOOGA|||||8.48||| 76536|EAP|0402|US THYROID|Managed Medicaid|SUPERIOR STAR MCD|||||8.48||| 76536|EAP|0402|US THYROID|Humana Medicare Advantage|HUMANA MEDICARE PPO|8.48||||8.48||| 76536|EAP|0402|US THYROID|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||8.48||| 76536|EAP|0402|US THYROID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.48||| 76536|EAP|0402|US THYROID|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||8.48||| 76536|EAP|0402|US THYROID|Blue Cross PPO|BCBS WALMART|||||8.48||| 76536|EAP|0402|US THYROID|Blue Cross PPO|BLUE CROSS POS|||||8.48||| 76536|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 76536|EAP|0402|US THYROID|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||8.48||| 76536|EAP|0402|US THYROID|Blue Cross PPO|BLUE CROSS PPO|||||8.48||| 76536|EAP|0402|US THYROID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.48||| 76536|EAP|0402|US THYROID|Aetna|AETNA EXXON MOBIL|||||8.48||| 76536|EAP|0402|US THYROID|Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.48||| 76536|EAP|0402|US THYROID|Aetna|TRS COORDINATED CARE|||||8.48||| 76536|EAP|0402|US THYROID|Aetna|AETNA|||||8.48||| 76536|EAP|0402|US THYROID|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|8.48||||||| 76536|EAP|0402|US THYROID|PHCS|WEB TPA|||||8.48||| 76536|EAP|0402|US THYROID|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||8.48||| 76536|EAP|0402|US THYROID|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||8.48||| 76536|EAP|0402|US THYROID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||8.48||| 76536|EAP|0402|US THYROID|United Healthcare|UMR|||||8.48||| 76536|EAP|0402|US THYROID|Blue Cross PPO Select|BCBS UTHCT|||||8.48||| 76536|EAP|0402|US THYROID|Medicaid|MEDICAID|||||8.48||| 76536|EAP|0402|US THYROID|Multiplan|WEB TPA|||||8.48||| 76536|EAP|0402|US THYROID|NON CONTRACTED|COMMERCIAL OTHER|||||8.48||| 76536|EAP|0636||Medicare|MEDICARE A & B|||||45.15||| 76536|EAP|0402|US THYROID|Medicare|MEDICARE RAILROAD|||||8.48||| 76536|EAP|0402|US THYROID|Medicare|MEDICARE A & B|8.48||||8.48||| 76536|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Medicare|MEDICARE A & B|8.25||||8.25||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Medicare|MEDICARE PART A|8.25||||||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.25||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Blue Cross PPO|BLUE CROSS PPO|8.25||||8.25||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Blue Cross PPO|BLUE CROSS POS|||||8.25||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Humana Medicare Advantage|HUMANA MEDICARE PPO|8.25||||||| 76604|EAP|0402|US CHEST (FLUID LOCALIZATION)|Blue Cross PPO Select|BCBS UTHCT|||||8.25||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Blue Cross PPO Select|BCBS UTHCT|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Cigna|CIGNA OF TN CHATTANOOGA|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Managed Medicaid|FAMILY PLANNING GRANT|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Blue Cross PPO|BLUE CROSS POS|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Blue Cross PPO|BLUE CROSS PPO|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Aetna|AETNA|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Cigna|CIGNA OPEN ACCESS PLUS|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Aetna|TRS COORDINATED CARE|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|United Healthcare|UMR|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|NON CONTRACTED|COMMERCIAL OTHER|||||7.47||| 76641|EAP|0402|US BILATERAL BREAST W/AXILLA C|Medicare|MEDICARE A & B|||||7.47||| 76641|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Medicare|MEDICARE A & B|||||0.56||| 76641|EAP|0401||Medicare|MEDICARE A & B|||||4.38||| 76641|EAP|0401||Medicare|MEDICARE A & B|||||0.82||| 76642|EAP|0403||Medicare|MEDICARE A & B|||||0.82||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Multiplan|TML GRP INS|||||3.74||| 76642|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Medicare|MEDICARE A & B|||||7.47||| 76642|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|NON CONTRACTED|COMMERCIAL OTHER|||||7.47||| 76642|EAP|0401||Medicare|MEDICARE A & B|||||1.35||| 76642|EAP|0401||Medicare|MEDICARE A & B|||||0.82||| 76642|EAP|0403||Medicare|MEDICARE A & B|||||1.15||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.74||| 76642|EAP|0401||Medicare|MEDICARE A & B|||||5.45||| 76642|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 76642|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Medicare|MEDICARE A & B|||||2.50||| 76642|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 76642|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||28.00||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||7.47||| 76642|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Medicaid|MEDICAID|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Managed Medicare|RESERVE NAT INS|||||3.74||| 76642|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 76642|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 76642|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.40||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|PHCS|TML GRP INS|||||3.74||| 76642|EAP|0610|CAD-BREAST MRI|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.72||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|United Healthcare|UMR|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|United Healthcare|GOLDEN RULE INSURANCE|||||3.74||| 76642|EAP|0401||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| 76642|EAP|0401||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Aetna|TRS COORDINATED CARE|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Aetna|TRS COORDINATED CARE|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Medicare|MEDICARE A & B|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.47||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Aetna|AETNA|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Medicare|MEDICARE RAILROAD|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Blue Cross PPO|BLUE CROSS PPO|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Blue Cross PPO|BLUE CROSS POS|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Blue Cross PPO|BLUE CROSS POS|||||7.47||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Blue Cross PPO|BLUE CROSS PPO|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Blue Cross PPO|BCBS WALMART|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Managed Medicaid|FAMILY PLANNING GRANT|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.47||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Managed Medicaid|FAMILY PLANNING GRANT|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|NON CONTRACTED|COMMERCIAL OTHER|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Cigna|CIGNA OF TN CHATTANOOGA|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Cigna|CIGNA BEHAVIORAL HEALTH|||||7.47||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Blue Cross PPO Select|BCBS UTHCT|||||3.74||| 76642|EAP|0402|US BREAST BILATERAL,REAL TIME|Blue Cross PPO Select|BCBS UTHCT|||||7.47||| 76642|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|ChampVA|CHAMPVA OF CO DENVER|||||3.74||| 76642|EAP|0402|US,BRST,UNILAT,RTIME W/ID,AXIL|Cigna|CIGNA OPEN ACCESS PLUS|||||3.74||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|ChampVA|CHAMPVA OF CO DENVER|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Cigna|CIGNA OF TN CHATTANOOGA|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Cigna|CIGNA OTHER|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross PPO Select|BCBS UTHCT|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Managed Medicaid|FAMILY PLANNING GRANT|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Managed Medicaid|MOLINA MEDICAID|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Managed Medicaid|SUPERIOR STAR MCD|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross PPO|BLUE CROSS PPO|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross PPO|BCBS WALMART|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross PPO|BLUE CROSS POS|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross PPO|BCBS TRANE PPO|||||14.97||| 76700|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.79||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||14.97||| 76700|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 76700|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.59||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Aetna|AETNA|||||14.97||| 76700|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.14||| 76700|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.44||| 76700|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.27||| 76700|EAP|0402||Blue Cross PPO|BLUE CROSS POS|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||14.97||| 76700|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 76700|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 76700|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 76700|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.17||| 76700|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 76700|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.17||| 76700|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.22||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|PHCS|WEB TPA|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|United Healthcare|UMR|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Medicaid|MEDICAID|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||14.97||| 76700|EAP|0942||Medicare|MEDICARE A & B|||||0.56||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Cigna|CIGNA OPEN ACCESS PLUS|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Multiplan|WEB TPA|||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|NON CONTRACTED|COMMERCIAL OTHER|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|NON CONTRACTED|PPO OTHER|||||14.97||| 76700|EAP|0402||Medicare|MEDICARE A & B|14.97||||11.18||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Medicare|MEDICARE A & B|14.97||||14.97||| 76700|EAP|0402|US ABDOMEN, COMPLETE, MULTIPLE|Medicare|MEDICARE PART A|14.97||||||| 76705|EAP|0402|US ABDOMEN, LIMITED|NON CONTRACTED|COMMERCIAL OTHER|11.18||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Medicare|MEDICARE A & B|11.18||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Medicaid|MEDICAID|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|United Healthcare|UMR|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||11.18||| 76705|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 76705|EAP|0402|US ABDOMEN, LIMITED|Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.18||||11.18||| 76705|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross PPO|BCBS TRANE PPO|11.18||||||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross PPO|BLUE CROSS PPO|11.18||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross PPO|BCBS WALMART|11.18||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross PPO|BLUE CROSS POS|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Managed Medicaid|SUPERIOR STAR MCD|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Managed Medicaid|FAMILY PLANNING GRANT|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.18||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|ChampVA|CHAMPVA OF CO DENVER|||||11.18||| 76705|EAP|0402|US ABDOMEN, LIMITED|Blue Cross PPO Select|BCBS UTHCT|11.18||||11.18||| 76706|EAP|0402|US,ABDOMINAL AORTA,R/T W/IMAGE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.55||| 76706|EAP|0402|US,ABDOMINAL AORTA,R/T W/IMAGE|Medicare|MEDICARE A & B|||||4.55||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|NON CONTRACTED|COMMERCIAL OTHER|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Multiplan|WEB TPA|||||10.01||| 76775|EAP|0402|AORTA ULTRASOUND LIMITED|Medicare|MEDICARE A & B|10.01||||1.26||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Medicare|MEDICARE A & B|10.01||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Medicare|MEDICARE RAILROAD|||||10.01||| 76775|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|PHCS|WEB TPA|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|United Healthcare|UMR|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|10.01||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Cigna|CIGNA OPEN ACCESS PLUS|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Humana Medicare Advantage|HUMANA MEDICARE PPO|10.01||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||10.01||| 76775|EAP|0402|AORTA ULTRASOUND LIMITED|Blue Cross PPO|BLUE CROSS PPO|10.01||||1.26||| 76775|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Blue Cross PPO Select|BCBS UTHCT|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Blue Cross PPO|BLUE CROSS PPO|10.01||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Cigna|CIGNA OF TN CHATTANOOGA|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||10.01||| 76775|EAP|0402|US EXAM ABDO BACK WALL, LIM|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||10.01||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Medicaid|MEDICAID|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Managed Medicaid|MOLINA MEDICAID|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|NON CONTRACTED|COMMERCIAL OTHER|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Blue Cross PPO|BLUE CROSS PPO|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Blue Cross PPO Select|BCBS UTHCT|||||11.22||| 76801|EAP|0402|US, PREGNANT UTERUS, <14 WKS|Managed Medicaid|SUPERIOR STAR MCD|||||11.22||| 76817|EAP|0402|US TRANSVAGINAL OB|Managed Medicaid|SUPERIOR STAR MCD|||||14.67||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|NON CONTRACTED|COMMERCIAL OTHER|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross PPO|BCBS WALMART|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Managed Medicaid|MOLINA MEDICAID|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|United Healthcare|UMR|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||12.62||| 76830|EAP|0270|IV ADMINISTRATION, ALARIS #226|Blue Cross PPO|BLUE CROSS PPO|||||50.40||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Managed Medicaid|FAMILY PLANNING GRANT|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|ChampVA|CHAMPVA OF CO DENVER|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Medicare|MEDICARE A & B|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross PPO Select|BCBS UTHCT|||||12.62||| 76830|EAP|0402||NON CONTRACTED|COMMERCIAL OTHER|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross PPO|BCBS TRANE PPO|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||12.62||| 76830|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS PPO|||||5.69||| 76830|EAP|0270|ADMINISTRATION SET IV, STANDAR|Blue Cross PPO|BLUE CROSS PPO|||||6.30||| 76830|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|12.62||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Medicaid|MEDICAID|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|12.62||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||12.62||| 76830|EAP|0270|NEEDLE; 22GA X 1 INCH|Blue Cross PPO|BLUE CROSS PPO|||||11.55||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Cigna|CIGNA OF TN CHATTANOOGA|||||12.62||| 76830|EAP|0272|IV START KIT WITHOUT CATHET|Blue Cross PPO|BLUE CROSS PPO|||||12.60||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Aetna|TRS COORDINATED CARE|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||12.62||| 76830|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross PPO|BLUE CROSS POS|||||12.62||| 76830|EAP|0272|SOLUTION IV SOD. CHLORIDE 0.90|Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|Blue Cross PPO|BLUE CROSS PPO|||||12.62||| 76830|EAP|0402|US ECHOGRAPHY TRANSVAGINAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||12.62||| 76856|EAP|0402|US PELVIS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||12.20||| 76856|EAP|0402|US PELVIS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||12.20||| 76856|EAP|0402|US PELVIS|Blue Cross PPO|BLUE CROSS PPO|||||12.20||| 76856|EAP|0402|US PELVIS|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||12.20||| 76856|EAP|0402|US PELVIS|Medicaid|MEDICAID|||||12.20||| 76856|EAP|0402|US PELVIS|NON CONTRACTED|COMMERCIAL OTHER|||||12.20||| 76856|EAP|0402|US PELVIS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||12.20||| 76856|EAP|0402|US PELVIS|Managed Medicaid|FAMILY PLANNING GRANT|||||12.20||| 76856|EAP|0402|US PELVIS|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||12.20||| 76856|EAP|0402|US PELVIS|United Healthcare|UMR|||||12.20||| 76856|EAP|0402|US PELVIS|Managed Medicaid|MOLINA MEDICAID|||||12.20||| 76856|EAP|0402|US PELVIS|Cigna|CIGNA OF TN CHATTANOOGA|||||12.20||| 76856|EAP|0402|US PELVIS|Medicare|MEDICARE A & B|||||12.20||| 76856|EAP|0402|US PELVIS|ChampVA|CHAMPVA OF CO DENVER|||||12.20||| 76856|EAP|0402|US PELVIS|Blue Cross PPO|BLUE CROSS POS|||||12.20||| 76856|EAP|0402|US PELVIS|Managed Medicaid|SUPERIOR STAR MCD|||||12.20||| 76856|EAP|0402|US PELVIS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.20||| 76856|EAP|0402|US PELVIS|Blue Cross PPO Select|BCBS UTHCT|||||12.20||| 76856|EAP|0402|US PELVIS|Aetna|TRS COORDINATED CARE|||||12.20||| 76856|EAP|0402|US PELVIS|Blue Cross PPO|BCBS TRANE PPO|||||12.20||| 76856|EAP|0402|US PELVIS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||12.20||| 76856|EAP|0402|US PELVIS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||12.20||| 76856|EAP|0402|US PELVIS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|12.20||||12.20||| 76856|EAP|0402||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.62||| 76856|EAP|0402|US PELVIS|Blue Cross PPO|BCBS WALMART|||||12.20||| 76856|EAP|0402|US PELVIS|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||12.20||| 76857|EAP|0402|NON OB PELVIC US; LIMITED|Medicare|MEDICARE A & B|||||2.69||| 76857|EAP|0402|NON OB PELVIC US; LIMITED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.69||| 76870|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.97||| 76870|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 76870|EAP|0307||Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 76870|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Cigna|CIGNA OF TN CHATTANOOGA|||||584.50||| 76870|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Aetna|AETNA US HEALTHCARE PA|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Blue Cross PPO|BLUE CROSS PPO|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Blue Cross PPO Select|BCBS UTHCT|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.78||| 76870|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Managed Medicaid|SUPERIOR STAR MCD|||||9.78||| 76870|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 76870|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Blue Cross PPO|BLUE CROSS POS|||||9.78||| 76870|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 76870|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 76870|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.45||| 76870|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Managed Medicaid|MOLINA MEDICAID|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||9.78||| 76870|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.30||| 76870|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||9.78||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||9.78||| 76870|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 76870|EAP|0402|US TESTICULAR (SCROTAL)|Medicare|MEDICARE A & B|||||9.78||| 76872|EAP|0402|US PROSTATE (URO CLINIC)|Medicare|MEDICARE A & B|||||9.86||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Blue Cross PPO|BLUE CROSS PPO|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.23||| 76882|EAP|0301||Medicare|MEDICARE A & B|||||0.27||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Medicare|MEDICARE A & B|4.23||||4.23||| 76882|EAP|0402|RXT RULE OUT MASS|Medicare|MEDICARE A & B|4.23||||1.43||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|NON CONTRACTED|COMMERCIAL OTHER|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Blue Cross PPO Select|BCBS UTHCT|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.23||| 76882|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 76882|EAP|0771|ADM OF INFLUENZA VACC (GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.23||| 76882|EAP|0401||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Cigna|CIGNA OPEN ACCESS PLUS|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.23||| 76882|EAP|0402|RXT RULE OUT MASS|Cigna|CIGNA OF TN CHATTANOOGA|||||1.43||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Cigna|CIGNA OF TN CHATTANOOGA|||||4.23||| 76882|EAP|0402|US EXTREMITY NONVASE LIMITED|Aetna|AETNA|||||4.23||| 76882|EAP|0402|RXT RULE OUT MASS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.43||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Aetna|AETNA|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Medicare|MEDICARE A & B|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Blue Cross PPO|BLUE CROSS POS|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Aetna|TRS COORDINATED CARE|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Blue Cross PPO|BLUE CROSS PPO|||||9.62||| 76942|EAP|0402||Medicare|MEDICARE A & B|||||3.77||| 76942|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.77||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Blue Cross PPO Select|BCBS UTHCT|||||9.62||| 76942|EAP|0402||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.77||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Managed Medicaid|FAMILY PLANNING GRANT|||||9.62||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.62||| 76942|EAP|0402||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.77||| 76942|EAP|0402|US GUIDANCE NEEDLE BIOPSY|Cigna|CIGNA OF TN CHATTANOOGA|||||9.62||| 77003|EAP|0320|FLUORO GUIDE LOCAL - SPINE DIA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.49||| 77003|EAP|0320||Medicare|MEDICARE A & B|||||4.49||| 77003|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.49||| 77012|EAP|0350|CT SCAN NEEDLE BIOPSY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||25.07||| 77012|EAP|0350|CT SCAN NEEDLE BIOPSY|Medicare|MEDICARE A & B|||||25.07||| 77014|EAP|0333|CT GUIDING PLAC RADIA THERAPY|Medicare|MEDICARE A & B|||||9.63||| 77014|EAP|0333|CT GUIDING PLAC RADIA THERAPY|Blue Cross PPO|BLUE CROSS PPO|||||9.63||| 77048|EAP|0610||Blue Cross PPO Select|BCBS UTHCT|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.72||| 77048|EAP|0610||United Healthcare|UMR|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.72||| 77048|EAP|0610||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|Blue Cross PPO|BLUE CROSS PPO|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.72||| 77048|EAP|0610||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.72||| 77048|EAP|0610||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|Blue Cross PPO Select|BCBS UTHCT|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.72||| 77048|EAP|0610|CAD-BREAST MRI|Medicare|MEDICARE A & B|||||0.72||| 77048|EAP|0610||Medicare|MEDICARE A & B|||||0.72||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|United Healthcare|UMR|||||28.00||| 77049|EAP|0610||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.72||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Blue Cross PPO|BLUE CROSS PPO|||||28.00||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.00||| 77049|EAP|0610||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.72||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||28.00||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Cigna|CIGNA OF TN CHATTANOOGA|||||28.00||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Blue Cross PPO Select|BCBS UTHCT|||||28.00||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Medicare|MEDICARE A & B|||||28.00||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.00||| 77049|EAP|0610|MRI BREAST, BILAT W/WO CONTR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||28.00||| 77053|EAP|0320|MAMMARY DUCTOGRAM|Blue Cross PPO|BLUE CROSS PPO|||||8.48||| 77053|EAP|0320|MAMMARY DUCTOGRAM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.48||| 77053|EAP|0320|MAMMARY DUCTOGRAM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.48||| 77053|EAP|0320|MAMMARY DUCTOGRAM|Medicare|MEDICARE A & B|||||8.48||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|United Healthcare|GOLDEN RULE INSURANCE|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Medicare|MEDICARE A & B|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|United Healthcare|UMR|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Blue Cross PPO|BLUE CROSS POS|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Managed Medicaid|FAMILY PLANNING GRANT|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Cigna|CIGNA OF TN CHATTANOOGA|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.82||| 77061|EAP|0401|DIAG DIG BREAST TOMOSYNTH UNL|Aetna|AETNA|||||0.82||| 77063|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO|BCBS WALMART|||||0.82||| 77063|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 77063|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 77063|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.82||| 77063|EAP|0942||Medicare|MEDICARE A & B|||||0.48||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Multiplan|TML GRP INS|||||0.82||| 77063|EAP|0403||Blue Cross PPO|BLUE CROSS PPO|||||4.83||| 77063|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 77063|EAP|0636|MEOPOLIZUMAB(NUCALA 100MG) VL|Medicare|MEDICARE A & B|||||8,157.30||| 77063|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.60||| 77063|EAP|0403||Medicare|MEDICARE A & B|||||4.83||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.82||| 77063|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 77063|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 77063|EAP|0306||Medicare|MEDICARE A & B|||||1.16||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|United Healthcare|GOLDEN RULE INSURANCE|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|NON CONTRACTED|BOONE CHAPMAN|||||0.82||| 77063|EAP|0510||PHCS|TML GRP INS|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|United Healthcare|UMR|||||0.82||| 77063|EAP|0940||Blue Cross PPO|BLUE CROSS PPO|||||1.02||| 77063|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|||||0.57||| 77063|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Managed Medicare|RESERVE NAT INS|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.82||| 77063|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|NON CONTRACTED|COMMERCIAL OTHER|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.82||| 77063|EAP|0510||Multiplan|TML GRP INS|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Medicare|MEDICARE RAILROAD|||||0.82||| 77063|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO|BLUE CROSS POS|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Medicaid|MEDICAID|||||0.82||| 77063|EAP|0320||Medicare|MEDICARE A & B|||||5.06||| 77063|EAP|0403||Medicare|MEDICARE A & B|||||0.82||| 77063|EAP|0260|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|||||213.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Medicare|MEDICARE A & B|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|PHCS|TML GRP INS|||||0.82||| 77063|EAP|0480|PACER, DUAL W/PROGRAMMING|Medicare|MEDICARE A & B|||||3.22||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO|BCBS TRANE PPO|||||0.82||| 77063|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 77063|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Aetna|AETNA EXXON MOBIL|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.82||| 77063|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 77063|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 77063|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 77063|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 77063|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 77063|EAP|0403||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.83||| 77063|EAP|0403||Managed Medicaid|FAMILY PLANNING GRANT|||||4.83||| 77063|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 77063|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.99||| 77063|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.83||| 77063|EAP|0251|ARIPIPRAZOLE 2MG TABLET PO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||113.60||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Cigna|NALC HLTH BENEFIT|||||0.82||| 77063|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Managed Medicaid|MEDICAID CSHCN|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|ChampVA|CHAMPVA OF CO DENVER|||||0.82||| 77063|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.14||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Cigna|CIGNA OTHER|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 77063|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||1.15||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO Select|BCBS UTHCT|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Cigna|CIGNA OF TN CHATTANOOGA|||||0.82||| 77063|EAP|0482||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.03||| 77063|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 77063|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.28||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Cigna|CIGNA OPEN ACCESS PLUS|||||0.82||| 77063|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Aetna|AETNA|||||0.82||| 77063|EAP|0307||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.69||| 77063|EAP|0311||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.60||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Managed Medicaid|FAMILY PLANNING GRANT|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.82||| 77063|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.36||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Aetna|TRS COORDINATED CARE|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| 77063|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.82||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.38||| 77065|EAP|0401|MAMMO; UNILATERAL SYMPTOMATIC|Medicare|MEDICARE A & B|||||2.13||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 77065|EAP|0401|MAMMO; UNILATERAL SYMPTOMATIC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.13||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|United Healthcare|UMR|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|United Healthcare|GOLDEN RULE INSURANCE|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.38||| 77065|EAP|0401|MAMMO; UNILATERAL SYMPTOMATIC|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.13||| 77065|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 77065|EAP|0401|MAMMO; UNILATERAL SYMPTOMATIC|Blue Cross PPO|BLUE CROSS PPO|||||2.13||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Blue Cross PPO|BLUE CROSS POS|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.38||| 77065|EAP|0401|MAMMO; UNILATERAL SYMPTOMATIC|Blue Cross PPO Select|BCBS UTHCT|||||2.13||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|NON CONTRACTED|COMMERCIAL OTHER|||||4.38||| 77065|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Cigna|CIGNA OPEN ACCESS PLUS|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Blue Cross PPO Select|BCBS UTHCT|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Managed Medicaid|FAMILY PLANNING GRANT|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Medicare|MEDICARE A & B|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.38||| 77065|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||45.15||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 77065|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Aetna|AETNA|||||4.38||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Cigna|CIGNA OPEN ACCESS PLUS|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Blue Cross PPO Select|BCBS UTHCT|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|ChampVA|CHAMPVA OF CO DENVER|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Managed Medicaid|FAMILY PLANNING GRANT|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Aetna|AETNA|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Blue Cross PPO|BCBS WALMART|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Blue Cross PPO|BLUE CROSS PPO|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Cigna|CIGNA OF TN CHATTANOOGA|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Blue Cross PPO|BLUE CROSS POS|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Cigna|CIGNA BEHAVIORAL HEALTH|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.45||| 77066|EAP|0401||Medicare|MEDICARE A & B|||||0.82||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Managed Medicare|RESERVE NAT INS|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|NON CONTRACTED|COMMERCIAL OTHER|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Aetna|AETNA EXXON MOBIL|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Medicaid|MEDICAID|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|United Healthcare|UMR|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Medicare|MEDICARE RAILROAD|||||5.45||| 77066|EAP|0401|MAMMO DIAG,INCL CAD,BILATERAL|Medicare|MEDICARE A & B|||||5.45||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|United Healthcare|UMR|||||4.83||| 77067|EAP|0403||Medicare|MEDICARE A & B|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|United Healthcare|GOLDEN RULE INSURANCE|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Managed Medicare|RESERVE NAT INS|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Medicare|MEDICARE A & B|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|PHCS|TML GRP INS|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Cigna|CIGNA OPEN ACCESS PLUS|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Cigna|CIGNA OTHER|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Blue Cross PPO|BLUE CROSS POS|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Aetna|AETNA|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|NON CONTRACTED|COMMERCIAL OTHER|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Aetna|TRS COORDINATED CARE|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO|BCBS WALMART|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|NON CONTRACTED|BOONE CHAPMAN|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO|BLUE CROSS POS|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO|BCBS TRANE PPO|||||4.83||| 77067|EAP|0403||Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Blue Cross PPO|BLUE CROSS PPO|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Aetna|AETNA EXXON MOBIL|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Medicare|MEDICARE A & B|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Medicare|MEDICARE RAILROAD|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|ChampVA|CHAMPVA OF CO DENVER|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Cigna|CIGNA OF TN CHATTANOOGA|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO Select|BCBS UTHCT|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Multiplan|TML GRP INS|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Medicaid|MEDICAID|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Blue Cross PPO Select|BCBS UTHCT|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO|BLUE CROSS PPO|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Managed Medicaid|FAMILY PLANNING GRANT|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.83||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Cigna|NALC HLTH BENEFIT|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 77067|EAP|0403||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Managed Medicaid|MEDICAID CSHCN|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Managed Medicaid|FAMILY PLANNING GRANT|||||1.15||| 77067|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.83||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.15||| 77067|EAP|0403|MAMMO SCR DIGITAL BIL REDUCE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.15||| 77073|EAP|0320|XRAYS BONE LENGTH STUDIES|Cigna|CIGNA OF TN CHATTANOOGA|||||1.07||| 77073|EAP|0320|XRAYS BONE LENGTH STUDIES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.07||| 77075|EAP|0320|OSSEOUS SURVEY (METASTASES)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.92||| 77076|EAP|0320|OSSEOUS SURVEY (INFANT)|Managed Medicaid|SUPERIOR STAR MCD|||||5.01||| 77080|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Managed Medicaid|FAMILY PLANNING GRANT|||||5.06||| 77080|EAP|0771||Blue Cross PPO|BLUE CROSS POS|||||160.36||| 77080|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 77080|EAP|0510|CLIN VISIT;MIN,EST (IMC)|Medicare|MEDICARE A & B|||||2.09||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|United Healthcare|UMR|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Medicare|MEDICARE A & B|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Medicare|MEDICARE RAILROAD|||||5.06||| 77080|EAP|0510||United Healthcare|GOLDEN RULE INSURANCE|||||2.50||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross PPO|BCBS WALMART|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|United Healthcare|GOLDEN RULE INSURANCE|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross PPO|BLUE CROSS POS|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross PPO|BCBS TRANE PPO|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Aetna|TRS COORDINATED CARE|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross PPO|BLUE CROSS PPO|||||5.06||| 77080|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Cigna|CIGNA OPEN ACCESS PLUS|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross PPO Select|BCBS UTHCT|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Cigna|CIGNA OTHER|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|NON CONTRACTED|BOONE CHAPMAN|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Cigna|CIGNA OF TN CHATTANOOGA|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Managed Medicaid|MOLINA MEDICAID|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|NON CONTRACTED|COMMERCIAL OTHER|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Managed Medicaid|MEDICAID CSHCN|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Medicaid|MEDICAID|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|ChampVA|CHAMPVA OF CO DENVER|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Aetna|AETNA EXXON MOBIL|||||5.06||| 77080|EAP|0320|BONE DENSITY STUDY (DEXA)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.06||| 77080|EAP|0320||Medicare|MEDICARE A & B|||||5.06||| 77280|EAP|0333||Medicare|MEDICARE A & B|||||5.25||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Medicaid|MEDICAID|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Blue Cross PPO|BLUE CROSS PPO|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Blue Cross PPO|BLUE CROSS POS|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Medicare|MEDICARE A & B|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.08||| 77280|EAP|0333||Medicare|MEDICARE A & B|||||3.25||| 77280|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.08||| 77280|EAP|0333|THERAP RADIO SIMULAT; SIMPLE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.08||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||12.42||| 77290|EAP|0333||Blue Cross PPO|BLUE CROSS PPO|||||12.42||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Blue Cross PPO|BLUE CROSS PPO|||||12.42||| 77290|EAP|0333||Blue Cross PPO|BLUE CROSS POS|||||12.42||| 77290|EAP|0333||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||12.42||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Blue Cross PPO|BLUE CROSS POS|||||12.42||| 77290|EAP|0333||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||12.42||| 77290|EAP|0333||Medicare|MEDICARE A & B|||||9.76||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Medicare|MEDICARE A & B|||||12.42||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||12.42||| 77290|EAP|0333||Medicare|MEDICARE A & B|||||12.42||| 77290|EAP|0333||Aetna|AETNA EL PASO CLAIMS OFFICE|||||12.42||| 77290|EAP|0333||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.42||| 77290|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||12.42||| 77290|EAP|0333|THERAP RADIO SIMUL; COMPLEX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.42||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.57||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.57||| 77293|EAP|0333||Medicare|MEDICARE A & B|||||9.76||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Blue Cross PPO|BLUE CROSS POS|||||4.57||| 77293|EAP|0333||Medicare|MEDICARE A & B|||||3.08||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.57||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.57||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.57||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.57||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|Medicare|MEDICARE A & B|||||4.57||| 77293|EAP|0333|RESPIRATORY MOTION MGMT SIMULA|United Healthcare|UMR|||||4.57||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Medicare|MEDICARE A & B|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Cigna|CIGNA OF TN CHATTANOOGA|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Medicaid|MEDICAID|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|NON CONTRACTED|COMMERCIAL OTHER|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Blue Cross PPO|BLUE CROSS PPO|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Blue Cross PPO|BLUE CROSS POS|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.22||| 77295|EAP|0333|THERAP RADIO SIMUL;3-DEIMENSIO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.22||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Medicare|MEDICARE A & B|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Medicaid|MEDICAID|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.08||| 77300|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|NON CONTRACTED|COMMERCIAL OTHER|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|United Healthcare|UMR|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Cigna|NALC HLTH BENEFIT|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Cigna|CIGNA OF TN CHATTANOOGA|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Blue Cross PPO|BLUE CROSS POS|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Blue Cross PPO|BLUE CROSS PPO|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.08||| 77300|EAP|0333|BASIC RADIA DOSM CALCU TREATME|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.08||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|NON CONTRACTED|COMMERCIAL OTHER|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|United Healthcare|UMR|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Blue Cross PPO|BLUE CROSS PPO|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Cigna|NALC HLTH BENEFIT|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||28.22||| 77301|EAP|0333|INTENSITY MOD RADIOTHER PLAN|Medicare|MEDICARE A & B|||||28.22||| 77307|EAP|0333|TELETHERAPY ISODOSE PLAN COMPL|Blue Cross PPO|BLUE CROSS POS|||||7.28||| 77307|EAP|0333|TELETHERAPY ISODOSE PLAN COMPL|Cigna|CIGNA OF TN CHATTANOOGA|||||7.28||| 77307|EAP|0333|TELETHERAPY ISODOSE PLAN COMPL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.28||| 77307|EAP|0333|TELETHERAPY ISODOSE PLAN COMPL|Blue Cross PPO|BLUE CROSS PPO|||||7.28||| 77307|EAP|0333|TELETHERAPY ISODOSE PLAN COMPL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.28||| 77307|EAP|0333|TELETHERAPY ISODOSE PLAN COMPL|Medicare|MEDICARE A & B|||||7.28||| 77332|EAP|0333|TREATMENT DEVICES; SIMPLE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.86||| 77332|EAP|0333|TREATMENT DEVICES; SIMPLE|Medicare|MEDICARE A & B|||||5.86||| 77332|EAP|0333|TREATMENT DEVICES; SIMPLE|Blue Cross PPO|BLUE CROSS PPO|||||5.86||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Blue Cross PPO|BLUE CROSS PPO|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Medicaid|MEDICAID|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Medicare|MEDICARE A & B|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|NON CONTRACTED|COMMERCIAL OTHER|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Blue Cross PPO|BLUE CROSS POS|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|United Healthcare|UMR|||||7.81||| 77333|EAP|0333|TREATMENT DEVICES; INTERMEDIAT|Cigna|CIGNA OF TN CHATTANOOGA|||||7.81||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Medicaid|MEDICAID|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Cigna|CIGNA OF TN CHATTANOOGA|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|NON CONTRACTED|COMMERCIAL OTHER|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Cigna|NALC HLTH BENEFIT|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Blue Cross PPO|BLUE CROSS POS|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Blue Cross PPO|BLUE CROSS PPO|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Medicare|MEDICARE A & B|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|United Healthcare|UMR|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.76||| 77334|EAP|0333|TREATMENT DEVICES; COMPLEX|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||9.76||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Cigna|NALC HLTH BENEFIT|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Cigna|CIGNA OF TN CHATTANOOGA|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Blue Cross PPO|BLUE CROSS POS|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Blue Cross PPO|BLUE CROSS PPO|||||3.25||| 77336|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 77336|EAP|0270||Medicare|MEDICARE A & B|||||17.85||| 77336|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 77336|EAP|0333||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||20.70||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|United Healthcare|UMR|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.25||| 77336|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.36||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Medicare|MEDICARE A & B|||||3.25||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|Medicaid|MEDICAID|||||3.25||| 77336|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 77336|EAP|0333|CONT MEDICAL PHYSICS CONSULT|NON CONTRACTED|COMMERCIAL OTHER|||||3.25||| 77336|EAP|0270||Medicare|MEDICARE A & B|||||11.55||| 77336|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 77336|EAP|0260||Medicare|MEDICARE A & B|||||200.04||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|NON CONTRACTED|COMMERCIAL OTHER|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Cigna|NALC HLTH BENEFIT|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Blue Cross PPO|BLUE CROSS PPO|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Medicare|MEDICARE A & B|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||26.57||| 77338|EAP|0333|MULTI-LEAF COLLIMATOR FOR IMRT|United Healthcare|UMR|||||26.57||| 77373|EAP|0333|SRS MAXI 5 SESSION PER CRS TRT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||51.70||| 77373|EAP|0333|SRS MAXI 5 SESSION PER CRS TRT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||51.70||| 77373|EAP|0333|SRS MAXI 5 SESSION PER CRS TRT|Medicare|MEDICARE A & B|||||51.70||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|Blue Cross PPO|BLUE CROSS PPO|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|NON CONTRACTED|COMMERCIAL OTHER|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|Cigna|NALC HLTH BENEFIT|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||13.80||| 77385|EAP|0333|IMRT W/GUIDANCE&TRACKING:SIMPL|Medicare|MEDICARE A & B|||||13.80||| 77386|EAP|0333||NON CONTRACTED|COMMERCIAL OTHER|||||13.80||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Blue Cross PPO|BLUE CROSS PPO|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Cigna|NALC HLTH BENEFIT|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|NON CONTRACTED|COMMERCIAL OTHER|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|United Healthcare|UMR|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|Medicare|MEDICARE A & B|20.70||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.70||| 77386|EAP|0333|IMRT W/GUIDANCE&TRACK:COMPLEX|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||20.70||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|Blue Cross PPO|BLUE CROSS PPO|||||8.00||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|Blue Cross PPO|BLUE CROSS POS|||||8.00||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.00||| 77387|EAP|0333||Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.00||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.00||| 77387|EAP|0333||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.25||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.00||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||8.00||| 77387|EAP|0333||Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.25||| 77387|EAP|0333|GUIDANCE LOC TARGET VOL DELIV|Medicare|MEDICARE A & B|||||8.00||| 77412|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Cigna|CIGNA OF TN CHATTANOOGA|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Blue Cross PPO|BLUE CROSS POS|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Medicaid|MEDICAID|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|NON CONTRACTED|COMMERCIAL OTHER|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.25||| 77412|EAP|0333|RADIA TRMT DEL,=MEV;COMPLEX|Medicare|MEDICARE A & B|||||5.25||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|NON CONTRACTED|COMMERCIAL OTHER|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Medicare|MEDICARE A & B|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Blue Cross PPO|BLUE CROSS POS|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Cigna|CIGNA OF TN CHATTANOOGA|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.00||| 77417|EAP|0333|THERAPEUTIC RADIO PORT FILM(S)|Blue Cross PPO|BLUE CROSS PPO|||||8.00||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13.80||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||13.80||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.80||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|Blue Cross PPO|BLUE CROSS PPO|||||13.80||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|NON CONTRACTED|COMMERCIAL OTHER|||||13.80||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|Medicare|MEDICARE A & B|||||13.80||| 77470|EAP|0333|SPECIAL TREATMENT PROCEDURE|United Healthcare|UMR|||||13.80||| 78014|EAP|0341|NM THYROID SCAN WITH UPTAKE, M|Blue Cross PPO|BLUE CROSS POS|||||20.90||| 78014|EAP|0341|NM THYROID SCAN WITH UPTAKE, M|Blue Cross PPO|BLUE CROSS PPO|||||20.90||| 78014|EAP|0341|NM THYROID SCAN WITH UPTAKE, M|Blue Cross PPO|BCBS WALMART|||||20.90||| 78014|EAP|0341|NM THYROID SCAN WITH UPTAKE, M|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.90||| 78014|EAP|0341|NM THYROID SCAN WITH UPTAKE, M|Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.90||| 78014|EAP|0341|NM THYROID SCAN WITH UPTAKE, M|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.90||| 78018|EAP|0341|NM THYROID CARCINOMA MET IMAGE|Blue Cross PPO|BLUE CROSS PPO|||||22.11||| 78018|EAP|0341|NM THYROID CARCINOMA MET IMAGE|Medicare|MEDICARE A & B|||||22.11||| 78018|EAP|0341|NM THYROID CARCINOMA MET IMAGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||22.11||| 78018|EAP|0341|NM THYROID CARCINOMA MET IMAGE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.11||| 78070|EAP|0340|NM PARATHYROID IMAGING|Blue Cross PPO|BLUE CROSS PPO|||||14.55||| 78070|EAP|0340|NM PARATHYROID IMAGING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||14.55||| 78070|EAP|0340|NM PARATHYROID IMAGING|Cigna|CIGNA OF TN CHATTANOOGA|||||14.55||| 78070|EAP|0340|NM PARATHYROID IMAGING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||14.55||| 78070|EAP|0340|NM PARATHYROID IMAGING|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||14.55||| 78070|EAP|0340|NM PARATHYROID IMAGING|Medicare|MEDICARE A & B|||||14.55||| 78195|EAP|0341|LYMPHATIC AND LYMPH NODE IMAGE|Medicare|MEDICARE A & B|||||19.53||| 78195|EAP|0341|LYMPHATIC AND LYMPH NODE IMAGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.53||| 78195|EAP|0341|LYMPHATIC AND LYMPH NODE IMAGE|Blue Cross PPO Select|BCBS UTHCT|||||19.53||| 78227|EAP|0341|NM HEPATOBILIARY W/PHARM INTVE|Blue Cross PPO|BLUE CROSS PPO|||||19.91||| 78227|EAP|0341|NM HEPATOBILIARY W/PHARM INTVE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.91||| 78227|EAP|0341|NM HEPATOBILIARY W/PHARM INTVE|Blue Cross PPO Select|BCBS UTHCT|||||19.91||| 78227|EAP|0341|NM HEPATOBILIARY W/PHARM INTVE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.91||| 78227|EAP|0341|NM HEPATOBILIARY W/PHARM INTVE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||19.91||| 78227|EAP|0341|NM HEPATOBILIARY W/PHARM INTVE|Medicare|MEDICARE A & B|||||19.91||| 78264|EAP|0341|NM GASTRIC EMPTYING|Blue Cross PPO Select|BCBS UTHCT|||||19.16||| 78264|EAP|0341|NM GASTRIC EMPTYING|Medicare|MEDICARE A & B|||||19.16||| 78264|EAP|0341|NM GASTRIC EMPTYING|ChampVA|CHAMPVA OF CO DENVER|||||19.16||| 78264|EAP|0341|NM GASTRIC EMPTYING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|19.16||||19.16||| 78264|EAP|0341|NM GASTRIC EMPTYING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.16||| 78264|EAP|0341|NM GASTRIC EMPTYING|Blue Cross PPO|BLUE CROSS PPO|||||19.16||| 78264|EAP|0341|NM GASTRIC EMPTYING|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.16||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Blue Cross PPO|BLUE CROSS POS|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Blue Cross PPO|BLUE CROSS PPO|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Medicare|MEDICARE A & B|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Blue Cross PPO Select|BCBS UTHCT|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|ChampVA|CHAMPVA OF CO DENVER|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Medicaid|MEDICAID|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|Medicare|MEDICARE PART B|||||23.45||| 78306|EAP|0341|NM BONE SCAN; WHOLE BODY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||23.45||| 78315|EAP|0341|NM BONE SCAN III PHASE STUDY|Medicare|MEDICARE A & B|||||32.58||| 78315|EAP|0341|NM BONE SCAN III PHASE STUDY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||32.58||| 78315|EAP|0341|NM BONE SCAN III PHASE STUDY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||32.58||| 78451|EAP|0341|NM MYOCARDIAL SPECT, SINGLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||34.47||| 78451|EAP|0341|NM MYOCARDIAL SPECT, SINGLE|NON CONTRACTED|COMMERCIAL OTHER|||||34.47||| 78451|EAP|0341|NM MYOCARDIAL SPECT, SINGLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||34.47||| 78451|EAP|0341|NM MYOCARDIAL SPECT, SINGLE|Medicare|MEDICARE A & B|||||34.47||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Blue Cross PPO|BLUE CROSS POS|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|NON CONTRACTED|COMMERCIAL OTHER|58.13||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Medicaid|MEDICAID|||||58.13||| 78452|EAP|0636||Medicare|MEDICARE A & B|||||1,047.25||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Medicare|MEDICARE A & B|58.13||||58.13||| 78452|EAP|0483||Medicare|MEDICARE A & B|||||14.21||| 78452|EAP|0482||Medicare|MEDICARE A & B|||||13.03||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||58.13||| 78452|EAP|0343||Medicare|MEDICARE A & B|||||9.08||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|United Healthcare|UMR|||||58.13||| 78452|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Blue Cross PPO|BLUE CROSS PPO|58.13||||58.13||| 78452|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Veterans Affairs|VETERANS CHOICE - TRI WEST|58.13||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Blue Cross PPO|BCBS WALMART|58.13||||||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||58.13||| 78452|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Aetna|AETNA EL PASO CLAIMS OFFICE|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Cigna|CIGNA OF TN CHATTANOOGA|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Blue Cross PPO Select|BCBS UTHCT|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|ChampVA|CHAMPVA OF CO DENVER|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Humana Medicare Advantage|HUMANA MEDICARE PPO|58.13||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||58.13||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||58.13||| 78452|EAP|0949||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 78452|EAP|0341|NM MYOCARDIAL SPECT MULTIPLE S|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|58.13||||58.13||| 78579|EAP|0341|NM LUNG VENTILATION (V/Q PART|Medicaid|MEDICAID|11.48||||||| 78580|EAP|0341|NM LUNCG PERFUSION (V/Q PART 1|Humana Medicare Advantage|HUMANA MEDICARE PPO|19.11||||||| 78580|EAP|0341|NM LUNCG PERFUSION (V/Q PART 1|United Healthcare|UMR|||||19.11||| 78580|EAP|0341|NM LUNCG PERFUSION (V/Q PART 1|Medicare|MEDICARE A & B|19.11||||19.11||| 78582|EAP|0341|LUNG PERFUSION/VENT STUDY|Blue Cross PPO Select|BCBS UTHCT|||||22.16||| 78582|EAP|0341|LUNG PERFUSION/VENT STUDY|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||22.16||| 78582|EAP|0341|LUNG PERFUSION/VENT STUDY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.16||| 78582|EAP|0341|LUNG PERFUSION/VENT STUDY|Blue Cross PPO|BLUE CROSS PPO|||||22.16||| 78582|EAP|0341|LUNG PERFUSION/VENT STUDY|Medicare|MEDICARE A & B|22.16||||22.16||| 78598|EAP|0341|NM QUANT DIFF PULM PERF/VENTIL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||21.47||| 78700|EAP|0341|RENAL SCAN|Medicare|MEDICARE A & B|||||15.36||| 78708|EAP|0341|NM RENAL SCAN W/CAPTOPRIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||24.21||| 78708|EAP|0341|NM RENAL SCAN W/CAPTOPRIL|Blue Cross PPO|BLUE CROSS POS|||||24.21||| 78708|EAP|0341|NM RENAL SCAN W/CAPTOPRIL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||24.21||| 78708|EAP|0341|NM RENAL SCAN W/CAPTOPRIL|Blue Cross PPO|BLUE CROSS PPO|||||24.21||| 78708|EAP|0341|NM RENAL SCAN W/CAPTOPRIL|Medicare|MEDICARE A & B|||||24.21||| 78803|EAP|0341|NM SPECT - WHOLE BODY|Medicare|MEDICARE A & B|||||25.56||| 78803|EAP|0341|NM SPECT - WHOLE BODY|Blue Cross PPO Select|BCBS UTHCT|||||25.56||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Blue Cross PPO|BLUE CROSS POS|||||64.02||| 78815|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||266.96||| 78815|EAP|0306||Medicare|MEDICARE A & B|||||1.38||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Aetna|TRS COORDINATED CARE|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|ChampVA|CHAMPVA OF CO DENVER|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||64.02||| 78815|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.07||| 78815|EAP|0343||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||16.41||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||64.02||| 78815|EAP|0636||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7,341.40||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|United Healthcare|UMR|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||64.02||| 78815|EAP|0301||Medicare|MEDICARE A & B|||||1.07||| 78815|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 78815|EAP|0343||Medicare|MEDICARE A & B|||||16.41||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Medicaid|MEDICAID|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Blue Cross PPO|BLUE CROSS PPO|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Medicare|MEDICARE A & B|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|Medicare|MEDICARE RAILROAD|||||64.02||| 78815|EAP|0404|PET IMAGE W/CT, SKULL-THIGH|NON CONTRACTED|COMMERCIAL OTHER|||||64.02||| 78815|EAP|0636||Medicare|MEDICARE A & B|||||266.96||| 78815|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 78816|EAP|0404|PET IMAGE W/CT, FULL BODY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||64.02||| 78816|EAP|0404|PET IMAGE W/CT, FULL BODY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||64.02||| 78816|EAP|0404|PET IMAGE W/CT, FULL BODY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||64.02||| 78816|EAP|0404|PET IMAGE W/CT, FULL BODY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||64.02||| 78816|EAP|0404|PET IMAGE W/CT, FULL BODY|Medicare|MEDICARE A & B|||||64.02||| 79005|EAP|0342|RADIOPHARM THERAPY, ORAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.37||| 79005|EAP|0342|RADIOPHARM THERAPY, ORAL|Blue Cross PPO|BLUE CROSS PPO|||||9.37||| 79005|EAP|0341||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.11||| 79005|EAP|0342|RADIOPHARM THERAPY, ORAL|Medicare|MEDICARE A & B|||||9.37||| 79005|EAP|0342|RADIOPHARM THERAPY, ORAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.37||| 79101|EAP|0636||Medicare|MEDICARE A & B|||||2.94||| 79101|EAP|0258||Medicare|MEDICARE A & B|||||42.85||| 79101|EAP|0340|RADIOPHARMC THERAPY BY IV ADM|Medicare|MEDICARE A & B|||||9.56||| 79101|EAP|0340|RADIOPHARMC THERAPY BY IV ADM|Blue Cross PPO|BLUE CROSS PPO|||||9.56||| 79101|EAP|0340|RADIOPHARMC THERAPY BY IV ADM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.56||| 80048|EAP|0301|BASIC METABOLIC PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.33||||2.33||| 80048|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO|BLUE CROSS POS|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID CSHCN|||||2.33||| 80048|EAP|0360||Blue Cross PPO|BLUE CROSS PPO|||||7.43||| 80048|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.99||| 80048|EAP|0301|BASIC METABOLIC PANEL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|ChampVA|CHAMPVA OF CO DENVER|2.33||||2.33||| 80048|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.33||||2.33||| 80048|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.33||||0.19||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|FAMILY PLANNING GRANT|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|SUPERIOR STAR MCD|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|MOLINA MEDICAID|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.33||| 80048|EAP|0360||Blue Cross PPO|BLUE CROSS PPO|||||35.10||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO Select|BCBS UTHCT|2.33||||2.33||| 80048|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||1.55||| 80048|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.20||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aetna|AETNA|||||2.33||| 80048|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.16||| 80048|EAP|0272|THYROID DRAPE|Blue Cross PPO|BLUE CROSS PPO|||||17.50||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aetna|AETNA EXXON MOBIL|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aetna|TRS COORDINATED CARE|||||1.29||| 80048|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.33||||2.33||| 80048|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||14.50||| 80048|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.33||| 80048|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.33||||0.00||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO|BLUE CROSS PPO|2.33||||2.33||| 80048|EAP|0258||Blue Cross PPO|BLUE CROSS PPO|||||0.05||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO|BCBS TRANE PPO|||||2.33||| 80048|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 80048|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 80048|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||2.70||| 80048|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.06||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO|BCBS WALMART|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|PHCS|TML GRP INS|2.33||||||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Workers Compensation|WC TX MUTUAL INS|||||0.25||| 80048|EAP|0301|BASIC METABOLIC PANEL|Multiplan|TML GRP INS|2.33||||||| 80048|EAP|0258||Medicare|MEDICARE A & B|||||0.05||| 80048|EAP|0270||Medicare|MEDICARE A & B|||||23.08||| 80048|EAP|0270||Medicare|MEDICARE A & B|||||0.20||| 80048|EAP|0270||Medicare|MEDICARE A & B|||||14.50||| 80048|EAP|0272||Medicare|MEDICARE A & B|||||0.20||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|2.33||||2.33||| 80048|EAP|0301||Medicare|MEDICARE A & B|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicare|MEDICARE RAILROAD|2.33||||2.33||| 80048|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicare|MEDICARE A & B|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.29||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicaid|MEDICAID|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicare|MEDICARE PART A|2.33||||2.33||| 80048|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 80048|EAP|0301|BASIC METABOLIC PANEL|Cigna|NALC HLTH BENEFIT|2.33||||||| 80048|EAP|0301|BASIC METABOLIC PANEL|Cigna|CIGNA OPEN ACCESS PLUS|||||2.33||| 80048|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.33||||2.33||| 80048|EAP|0272||Medicare|MEDICARE A & B|||||1.55||| 80048|EAP|0272||Medicare|MEDICARE A & B|||||2.70||| 80048|EAP|0270||Medicare|MEDICARE A & B|||||0.21||| 80048|EAP|0272||Medicare|MEDICARE A & B|||||3.50||| 80048|EAP|0272||Medicare|MEDICARE A & B|||||0.16||| 80048|EAP|0270||Medicare|MEDICARE A & B|||||4.90||| 80048|EAP|0360||Medicare|MEDICARE A & B|||||7.43||| 80048|EAP|0360||Medicare|MEDICARE A & B|||||35.10||| 80048|EAP|0301|BASIC METABOLIC PANEL|NON CONTRACTED|COMMERCIAL OTHER|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|GOLDEN RULE INSURANCE|||||2.33||| 80048|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.33||||0.19||| 80048|EAP|0301|BASIC METABOLIC PANEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|UMR|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.33||||2.33||| 80048|EAP|0301|BASIC METABOLIC PANEL|Optum Behavioral Health|OPTUM|2.33||||||| 80048|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|2.33||||0.19||| 80048|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||23.08||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.28||| 80050|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 80050|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.72||| 80050|EAP|0301||Blue Cross PPO|BCBS WALMART|||||0.86||| 80050|EAP|0301||Blue Cross PPO|BLUE CROSS POS|||||0.86||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO Select|BCBS UTHCT|||||0.86||| 80050|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.30||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||108.50||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||153.50||| 80050|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.47||| 80050|EAP|0311||Blue Cross PPO Select|BCBS UTHCT|||||0.57||| 80050|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BCBS WALMART|||||0.86||| 80050|EAP|0301|GENERAL HEALTH PANEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.86||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||134.50||| 80050|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||96.50||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.37||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.86||| 80050|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.86||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.04||| 80050|EAP|0612||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BCBS TRANE PPO|||||0.86||| 80050|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.86||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 80050|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 80050|EAP|0301||Blue Cross PPO|BCBS WALMART|||||0.00||| 80050|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 80050|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||137.50||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.14||| 80050|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BLUE CROSS POS|||||0.86||| 80050|EAP|0301|GENERAL HEALTH PANEL|NON CONTRACTED|COMMERCIAL OTHER|||||0.86||| 80050|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 80050|EAP|0301|GENERAL HEALTH PANEL|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.86||| 80050|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 80051|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||0.58||| 80051|EAP|0300|ELECTROLYTE PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.01||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.01||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Managed Medicaid|OTHER MEDICAID|||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Managed Medicaid|SUPERIOR STAR MCD|9.01||||9.01||| 80051|EAP|0750||Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 80051|EAP|0300|ELECTROLYTE PANEL|Blue Cross PPO Select|BCBS UTHCT|||||9.01||| 80051|EAP|0999||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 80051|EAP|0370||Blue Cross PPO|BLUE CROSS PPO|||||7.02||| 80051|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 80051|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||21.30||| 80051|EAP|0300|ELECTROLYTE PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.01||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Blue Cross PPO|BCBS WALMART|9.01||||9.01||| 80051|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||20.10||| 80051|EAP|0300|ELECTROLYTE PANEL|Blue Cross PPO|BLUE CROSS PPO|9.01||||9.01||| 80051|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 80051|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 80051|EAP|0300|ELECTROLYTE PANEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|9.01||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|PHCS|TML GRP INS|9.01||||||| 80051|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 80051|EAP|0301|LYTE PANEL (ELECTROLYTES)|Optum Behavioral Health|OPTUM|2.31||||||| 80051|EAP|0300|ELECTROLYTE PANEL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||9.01||| 80051|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 80051|EAP|0750||Medicare|MEDICARE A & B|||||20.18||| 80051|EAP|0300|ELECTROLYTE PANEL|Medicare|MEDICARE PART A|9.01||||||| 80051|EAP|0305||Medicare|MEDICARE A & B|||||0.58||| 80051|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| 80051|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 80051|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 80051|EAP|0300|ELECTROLYTE PANEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|9.01||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|NON CONTRACTED|COMMERCIAL OTHER 2|9.01||||||| 80051|EAP|0300|ELECTROLYTE PANEL|Medicaid|MEDICAID|||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|9.01||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Cigna|CIGNA OF TN CHATTANOOGA|||||9.01||| 80051|EAP|0300|ELECTROLYTE PANEL|Multiplan|TML GRP INS|9.01||||||| 80051|EAP|0300|ELECTROLYTE PANEL|Medicare|MEDICARE A & B|9.01||||9.01||| 80051|EAP|0272||Medicare|MEDICARE A & B|||||11.55||| 80051|EAP|0300|ELECTROLYTE PANEL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||9.01||| 80051|EAP|0370||Medicare|MEDICARE A & B|||||7.02||| 80051|EAP|0252||Blue Cross PPO|BLUE CROSS PPO|||||61.80||| 80051|EAP|0300|ELECTROLYTE PANEL|Medicare|MEDICARE RAILROAD|||||9.01||| 80051|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.06||| 80051|EAP|0300|ELECTROLYTE PANEL|NON CONTRACTED|COMMERCIAL OTHER|||||9.01||| 80051|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||11.55||| 80051|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 80051|EAP|0300|ELECTROLYTE PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|9.01||||9.01||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|FAMILY PLANNING GRANT|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|MOLINA MEDICAID|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|OTHER MEDICAID|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|MEDICAID CSHCN|||||3.14||| 80053|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|||||1.68||| 80053|EAP|0301||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 80053|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||2.23||| 80053|EAP|0360||Blue Cross PPO Select|BCBS UTHCT|||||7.43||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|ChampVA|CHAMPVA OF CO DENVER|3.14||||3.14||| 80053|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||2.10||| 80053|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.32||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|CIGNA OTHER|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.72||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|CIGNA OF TN CHATTANOOGA|3.14||||3.14||| 80053|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|3.14||||4.14||| 80053|EAP|0360||Blue Cross PPO Select|BCBS UTHCT|||||35.10||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||3.14||| 80053|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||0.19||| 80053|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||0.00||| 80053|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||1.22||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.14||||3.14||| 80053|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||1.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|CIGNA OPEN ACCESS PLUS|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|SUPERIOR STAR MCD|3.14||||3.14||| 80053|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.36||| 80053|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|3.14||||0.00||| 80053|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.14||||1.88||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|NALC HLTH BENEFIT|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|CIGNA BEHAVIORAL HEALTH|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.14||| 80053|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Multiplan|PHCS OF AZ PHEONIX|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Multiplan|WEB TPA|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Multiplan|TML GRP INS|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Multiplan|GILSBAR INC|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|COMMERCIAL OTHER|3.14||||3.14||| 80053|EAP|0301|ANTI-DOUBLE STRANDED DNA|NON CONTRACTED|COMMERCIAL OTHER|3.14||||4.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Multiplan|WEB TPA OF GRAND PRAIRIE|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|BOONE CHAPMAN|||||3.14||| 80053|EAP|0301||NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.10||| 80053|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|3.14||||0.19||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|COMMERCIAL OTHER 2|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|PPO OTHER|||||1.72||| 80053|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 80053|EAP|0272|LAP SPONGE|Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.06||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|SIERRA HEALTH & LIFE|||||3.14||| 80053|EAP|0311||Medicaid|MEDICAID|||||1.68||| 80053|EAP|0311||Medicaid|MEDICAID|||||0.99||| 80053|EAP|0272|SUCTION CANISTER|Medicaid|**DO NOT USE**MEDICAID PCCM|||||6.50||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Medicare|MEDICARE A & B|3.14||||3.14||| 80053|EAP|0360||Medicaid|**DO NOT USE**MEDICAID PCCM|||||35.10||| 80053|EAP|0360||Medicaid|**DO NOT USE**MEDICAID PCCM|||||7.43||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||1.63||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||0.73||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||0.00||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||182.99||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Medicare|MEDICARE PART A|3.14||||3.14||| 80053|EAP|0730||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 80053|EAP|0270|SPONGE 4X4 RAY DETECTABLE#7317|Medicaid|**DO NOT USE**MEDICAID PCCM|||||4.90||| 80053|EAP|0258|0.9%NORMAL SALINE 3,000 ML BAG|Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.15||| 80053|EAP|0270|SANITARY NAPKINS|Medicaid|**DO NOT USE**MEDICAID PCCM|||||3.50||| 80053|EAP|0272||Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.20||| 80053|EAP|0272||Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.16||| 80053|EAP|0272||Medicaid|**DO NOT USE**MEDICAID PCCM|||||3.50||| 80053|EAP|0272||Medicaid|**DO NOT USE**MEDICAID PCCM|||||1.55||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.14||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||1.97||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Medicaid|MEDICAID|3.14||||3.14||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||0.19||| 80053|EAP|0301||Medicare|MEDICARE A & B|3.14||||1.46||| 80053|EAP|0301||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.19||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Medicare|MEDICARE RAILROAD|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Workers Compensation|WC RISK MANAGEMENT|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Workers Compensation|WC GALLAGHER BASSETT|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Workers Compensation|WC OTHER|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Healthcare|GOLDEN RULE INSURANCE|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Healthcare|AARP OF GA ATLANTA|||||1.72||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|PHCS|WEB TPA OF GRAND PRAIRIE|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|PHCS|TML GRP INS|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|PHCS|WEB TPA|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|PHCS|PHCS OF AZ PHEONIX|||||3.14||| 80053|EAP|0302||United Healthcare|UMR|||||7.35||| 80053|EAP|0302||Medicare|MEDICARE A & B|||||2.23||| 80053|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.26||| 80053|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|3.14||||3.14||| 80053|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.14||||3.14||| 80053|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.52||| 80053|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|3.14||||2.28||| 80053|EAP|0272|SUCTION TUBING 10 FT|Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 80053|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.20||| 80053|EAP|0258|0.9%NORMAL SALINE 3,000 ML BAG|Blue Cross PPO|BLUE CROSS PPO|||||0.15||| 80053|EAP|0272|CATHETER; URETHRAL 16FR RED RU|Blue Cross PPO|BLUE CROSS PPO|||||0.31||| 80053|EAP|0272|LAP SPONGE|Blue Cross PPO|BLUE CROSS PPO|||||0.06||| 80053|EAP|0272|SUCTION CANISTER|Blue Cross PPO|BLUE CROSS PPO|||||6.50||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Healthcare|UMR|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Access Direct Platinum|ACCESS DIRECT|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.14||||3.14||| 80053|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.14||||0.19||| 80053|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.14||||0.86||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.14||||3.14||| 80053|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||1.55||| 80053|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|3.14||||1.88||| 80053|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.14||||0.19||| 80053|EAP|0270|UNDERBUTTOCK DRAPE W/POUCH|Blue Cross PPO|BLUE CROSS PPO|||||0.10||| 80053|EAP|0270|SPONGE 4X4 RAY DETECTABLE#7317|Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 80053|EAP|0301||United Healthcare|UMR|3.14||||0.19||| 80053|EAP|0272|DRESSING TELFA 8 X 3|Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 80053|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|3.14||||2.28||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross PPO|BLUE CROSS POS|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Workers Compensation|WC TX MUTUAL INS|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross PPO|BLUE CROSS PPO|3.14||||3.14||| 80053|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|3.14||||0.86||| 80053|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|3.14||||2.10||| 80053|EAP|0301||Blue Cross PPO|BCBS WALMART|3.14||||0.86||| 80053|EAP|0301||Aetna|TRS COORDINATED CARE|||||1.88||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Aetna|AETNA EXXON MOBIL|||||3.14||| 80053|EAP|0301||Aetna|TRS COORDINATED CARE|||||2.10||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Aetna|AETNA US HEALTHCARE PA|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicare|RESERVE NAT INS|||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Aetna|AETNA|||||3.14||| 80053|EAP|0612||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 80053|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|3.14||||2.28||| 80053|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 80053|EAP|0270|SANITARY NAPKINS|Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 80053|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|3.14||||0.19||| 80053|EAP|0272|CATHETER; URETHRAL 16FR RED RU|Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.31||| 80053|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|3.14||||0.86||| 80053|EAP|0301||Blue Cross PPO|BCBS WALMART|3.14||||0.47||| 80053|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.16||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Aetna|AETNA EL PASO CLAIMS OFFICE|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Aetna|TRS COORDINATED CARE|||||3.14||| 80053|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.35||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Medicare|MEDICARE PART B|||||3.14||| 80053|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|3.14||||0.86||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross PPO|BCBS TRANE PPO|3.14||||3.14||| 80053|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||3.50||| 80053|EAP|0305||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|MRAMVA|||||3.14||| 80053|EAP|0270||Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.21||| 80053|EAP|0305||Blue Cross PPO|BCBS TRANE PPO|||||1.68||| 80053|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.21||| 80053|EAP|0270|UNDERBUTTOCK DRAPE W/POUCH|Medicaid|**DO NOT USE**MEDICAID PCCM|||||0.10||| 80053|EAP|0311||Blue Cross PPO|BCBS WALMART|||||0.57||| 80053|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||3.50||| 80053|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.14||||2.28||| 80053|EAP|0360||Blue Cross PPO|BLUE CROSS PPO|||||7.43||| 80053|EAP|0360||Blue Cross PPO|BLUE CROSS PPO|||||35.10||| 80053|EAP|0258|0.9%NORMAL SALINE 3,000 ML BAG|Blue Cross PPO Select|BCBS UTHCT|||||0.15||| 80053|EAP|0270|HYSTER FLOW TUBING|Blue Cross PPO Select|BCBS UTHCT|||||1.26||| 80053|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.09||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross PPO|BCBS WALMART|3.14||||3.14||| 80053|EAP|0270|SPONGE 4X4 RAY DETECTABLE#7317|Blue Cross PPO Select|BCBS UTHCT|||||4.90||| 80053|EAP|0272|SUCTION TUBING 10 FT|Blue Cross PPO Select|BCBS UTHCT|||||3.50||| 80053|EAP|0272|DRESSING TELFA 8 X 3|Blue Cross PPO Select|BCBS UTHCT|||||3.50||| 80053|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||1.55||| 80053|EAP|0272|CATHETER; URETHRAL 16FR RED RU|Blue Cross PPO Select|BCBS UTHCT|||||0.31||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|NON CONTRACTED|COMMUNITY CARE|||||0.30||| 80053|EAP|0301||NON CONTRACTED|SIERRA HEALTH & LIFE|||||1.88||| 80053|EAP|0272|SUCTION CANISTER|Blue Cross PPO Select|BCBS UTHCT|||||6.50||| 80053|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.20||| 80053|EAP|0306||Blue Cross PPO|BCBS WALMART|||||1.82||| 80053|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|3.14||||2.28||| 80053|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|3.14||||0.86||| 80053|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 80053|EAP|0272|LAP SPONGE|Blue Cross PPO Select|BCBS UTHCT|||||0.06||| 80053|EAP|0270|UNDERBUTTOCK DRAPE W/POUCH|Blue Cross PPO Select|BCBS UTHCT|||||0.10||| 80053|EAP|0270|SANITARY NAPKINS|Blue Cross PPO Select|BCBS UTHCT|||||3.50||| 80053|EAP|0305||Blue Cross PPO|BCBS WALMART|||||0.25||| 80053|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.16||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Blue Cross PPO Select|BCBS UTHCT|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|3.14||||3.14||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.14||| 80053|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.14||||0.19||| 80053|EAP|0301|COMPREHENSIVE METABOLIC (CMP)|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||3.14||| 80061|EAP|0301|LIPID PANEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.36||| 80061|EAP|0301|LIPID PANEL|Cigna|CIGNA OTHER|||||2.36||| 80061|EAP|0301|LIPID PANEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.36||| 80061|EAP|0301|LIPID PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Cigna|CIGNA OF TN CHATTANOOGA|||||0.38||| 80061|EAP|0301|LIPID PANEL (6010)|Cigna|CIGNA OF TN CHATTANOOGA|2.36||||0.64||| 80061|EAP|0301|LIPID PANEL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.36||| 80061|EAP|0301|LIPID PANEL|Cigna|CIGNA OF TN CHATTANOOGA|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Cigna|CIGNA BEHAVIORAL HEALTH|2.36||||||| 80061|EAP|0301|LIPID PANEL|ChampVA|CHAMPVA OF CO DENVER|||||2.36||| 80061|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|||||1.68||| 80061|EAP|0301|LIPID PANEL|Cigna|CIGNA OPEN ACCESS PLUS|||||2.36||| 80061|EAP|0301|LIPID (TDH)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 80061|EAP|0301|LIPID PANEL|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.36||| 80061|EAP|0301|LIPID PANEL|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Managed Medicaid|SUPERIOR STAR MCD|2.36||||2.36||| 80061|EAP|0301||Managed Medicaid|SUPERIOR STAR MCD|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Managed Medicaid|MEDICAID CSHCN|||||2.36||| 80061|EAP|0301|LIPID PANEL|Managed Medicaid|FAMILY PLANNING GRANT|||||2.36||| 80061|EAP|0301||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.36||| 80061|EAP|0301|LIPID PANEL|Blue Cross PPO Select|BCBS UTHCT|2.36||||2.36||| 80061|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|2.36||||0.19||| 80061|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|2.36||||3.14||| 80061|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL (6010)|Blue Cross PPO Select|BCBS UTHCT|2.36||||0.64||| 80061|EAP|0301|LIPID PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Blue Cross PPO|BLUE CROSS POS|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Aetna|AETNA EXXON MOBIL|||||2.36||| 80061|EAP|0301|LIPID PANEL|Aetna|AETNA|||||2.36||| 80061|EAP|0301||Blue Cross PPO|BLUE CROSS POS|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Blue Cross PPO|BCBS TRANE PPO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Blue Cross PPO|BCBS WALMART|2.36||||2.36||| 80061|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Blue Cross PPO|BLUE CROSS PPO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.36||| 80061|EAP|0301|LIPID PANEL|PHCS|TML GRP INS|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.36||| 80061|EAP|0301|LIPID PANEL|PHCS|WEB TPA|||||2.36||| 80061|EAP|0301|LIPID PANEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.36||||||| 80061|EAP|0301|LIPID PANEL|PHCS|PHCS OF AZ PHEONIX|||||2.36||| 80061|EAP|0301|LIPID PANEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.36||||2.36||| 80061|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|2.36||||0.86||| 80061|EAP|0301|LIPID PANEL|United Healthcare|GOLDEN RULE INSURANCE|||||2.36||| 80061|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|2.36||||2.28||| 80061|EAP|0301|LIPID PANEL (6010)|PHCS|TML GRP INS|2.36||||0.64||| 80061|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.36||| 80061|EAP|0301|LIPID PANEL|Workers Compensation|WC TX MUTUAL INS|||||2.36||| 80061|EAP|0301|LIPID PANEL (6010)|Medicare|MEDICARE A & B|2.36||||0.64||| 80061|EAP|0301|LIPID PANEL|Medicare|MEDICARE PART A|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|United Healthcare|UMR|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Medicare|MEDICARE RAILROAD|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Managed Medicaid|MOLINA MEDICAID|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Aetna|TRS COORDINATED CARE|||||0.38||| 80061|EAP|0301|LIPID PANEL|Medicare|MEDICARE PART B|||||2.36||| 80061|EAP|0301|LIPID PANEL|Medicaid|MEDICAID|2.36||||2.36||| 80061|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.36||||0.38||| 80061|EAP|0301|LIPID PANEL|Medicare|MEDICARE A & B|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Access Direct Platinum|ACCESS DIRECT|||||2.36||| 80061|EAP|0301|LIPID PANEL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.36||| 80061|EAP|0301|LIPID PANEL|Managed Medicare|RESERVE NAT INS|||||2.36||| 80061|EAP|0301|LIPID PANEL (6010)|Medicare|MEDICARE PART A|2.36||||0.64||| 80061|EAP|0301||Medicare|MEDICARE A & B|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|NON CONTRACTED|COMMERCIAL OTHER 2|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.36||||0.38||| 80061|EAP|0301|LIPID PANEL (6010)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.36||||0.64||| 80061|EAP|0301|LIPID PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|Multiplan|PHCS OF AZ PHEONIX|||||2.36||| 80061|EAP|0301|LIPID PANEL|Multiplan|GILSBAR INC|||||2.36||| 80061|EAP|0301|LIPID PANEL|Multiplan|TML GRP INS|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL (6010)|NON CONTRACTED|COMMERCIAL OTHER|2.36||||0.64||| 80061|EAP|0301|LIPID PANEL|Multiplan|WEB TPA|||||2.36||| 80061|EAP|0301|LIPID PANEL (6010)|Multiplan|TML GRP INS|2.36||||0.64||| 80061|EAP|0301|LIPID PANEL|Optum Behavioral Health|OPTUM|2.36||||||| 80061|EAP|0301|LIPID PANEL|NON CONTRACTED|PPO OTHER|||||0.38||| 80061|EAP|0301|LIPID PANEL|NON CONTRACTED|BOONE CHAPMAN|||||2.36||| 80061|EAP|0301|LIPID PANEL|NON CONTRACTED|COMMERCIAL OTHER|2.36||||2.36||| 80061|EAP|0301|LIPID PANEL|NON CONTRACTED|COMMUNITY CARE|||||0.38||| 80061|EAP|0301|LIPID PANEL|NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.36||| 80069|EAP|0301||Medicare|MEDICARE A & B|||||0.25||| 80069|EAP|0301|RENAL FUNCTION PANEL|United Healthcare|UMR|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Blue Cross PPO Select|BCBS UTHCT|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.90||| 80069|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Access Direct Platinum|ACCESS DIRECT|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Medicare|MEDICARE A & B|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|NON CONTRACTED|COMMERCIAL OTHER|||||2.90||| 80069|EAP|0301|RENAL FUNCTION PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||157.50||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Cigna|CIGNA OF TN CHATTANOOGA|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|7.35||||||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|ChampVA|CHAMPVA OF CO DENVER|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross PPO|BLUE CROSS PPO|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross PPO|BLUE CROSS POS|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Managed Medicaid|SUPERIOR STAR MCD|7.35||||||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross PPO|BCBS WALMART|7.35||||1.34||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross PPO|BCBS TRANE PPO|7.35||||||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.34||| 80074|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross PPO Select|BCBS UTHCT|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Aetna|TRS COORDINATED CARE|||||7.35||| 80074|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Aetna|AETNA EL PASO CLAIMS OFFICE|7.35||||1.34||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Managed Medicaid|FAMILY PLANNING GRANT|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Managed Medicaid|MOLINA MEDICAID|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|United Healthcare|GOLDEN RULE INSURANCE|||||1.34||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Medicare|MEDICARE RAILROAD|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|NON CONTRACTED|COMMERCIAL OTHER 2|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Medicare|MEDICARE A & B|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Medicare|MEDICARE PART A|7.35||||||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|Medicaid|MEDICAID|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|NON CONTRACTED|COMMERCIAL OTHER|7.35||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||7.35||| 80074|EAP|0302|ACUTE HEPATITIS PANEL (INHOUSE|United Healthcare|UMR|7.35||||7.35||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|NON CONTRACTED|COMMERCIAL OTHER|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Medicare|MEDICARE A & B|2.46||||2.46||| 80076|EAP|0301||Medicare|MEDICARE A & B|2.46||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Medicare|MEDICARE PART A|2.46||||||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|United Healthcare|UMR|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.46||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross PPO|BLUE CROSS SECONDARY|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Medicaid|MEDICAID|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross PPO|BLUE CROSS PPO|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.46||| 80076|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross PPO|BLUE CROSS POS|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.46||| 80076|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross PPO|BCBS TRANE PPO|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Blue Cross PPO Select|BCBS UTHCT|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Managed Medicaid|MOLINA MEDICAID|||||2.46||| 80076|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.46||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|ChampVA|CHAMPVA OF CO DENVER|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Cigna|CIGNA OPEN ACCESS PLUS|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.46||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.46||||2.46||| 80076|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.46||||2.46||| 80076|EAP|0301|HEPATIC FUNCTION PANEL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.46||| 80076|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.46||| 80150|EAP|0301|AMIKACIN, PEAK (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.31||| 80150|EAP|0301|AMIKACIN, PEAK (REF)|ChampVA|CHAMPVA OF CO DENVER|||||0.31||| 80150|EAP|0301|AMIKACIN, PEAK (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.31||||||| 80150|EAP|0301|AMIKACIN, PEAK (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.31||| 80150|EAP|0301|AMIKACIN,TROUGH (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.31||||||| 80150|EAP|0301|AMIKACIN, PEAK (REF)|Medicare|MEDICARE A & B|||||0.31||| 80156|EAP|0301|CARBAMAZEPINE; TOTAL|NON CONTRACTED|COMMERCIAL OTHER|2.21||||0.41||| 80156|EAP|0301|CARBAMAZEPINE; TOTAL|Medicare|MEDICARE A & B|2.21||||2.21||| 80156|EAP|0301|CARBAMAZEPINE; TOTAL|Blue Cross PPO|BLUE CROSS PPO|||||1.31||| 80156|EAP|0301|CARBAMAZEPINE; TOTAL|Managed Medicaid|SUPERIOR STAR MCD|||||2.21||| 80156|EAP|0301|CARBAMAZEPINE; TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.41||| 80158|EAP|0301|CYCLOSPORIN A, WHOLE BLOOD (RE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.35||| 80162|EAP|0301|DIGOXIN|United Healthcare|UMR|2.04||||2.04||| 80162|EAP|0301|DIGOXIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.04||| 80162|EAP|0301|DIGOXIN|Medicare|MEDICARE A & B|2.04||||2.04||| 80162|EAP|0301||Medicare|MEDICARE A & B|2.04||||2.04||| 80162|EAP|0301|DIGOXIN|Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 80162|EAP|0301|DIGOXIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.04||||120.50||| 80162|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.04||| 80162|EAP|0301|DIGOXIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||2.04||| 80162|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.04||||0.37||| 80162|EAP|0301|DIGOXIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.04||| 80162|EAP|0301|DIGOXIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 80162|EAP|0301|DIGOXIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.37||| 80162|EAP|0301|DIGOXIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.04||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Managed Medicaid|MOLINA MEDICAID|2.11||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.11||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Managed Medicaid|SUPERIOR STAR MCD|2.11||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Blue Cross PPO Select|BCBS UTHCT|2.11||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Blue Cross PPO|BLUE CROSS POS|2.11||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.11||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Blue Cross PPO|BLUE CROSS PPO|2.11||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|NON CONTRACTED|COMMERCIAL OTHER|2.11||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Optum Behavioral Health|OPTUM|2.11||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Medicare|MEDICARE A & B|2.11||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Medicare|MEDICARE PART A|2.11||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.38||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Medicaid|MEDICAID|||||0.38||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Workers Compensation|WC TX MUTUAL INS|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|United Healthcare|UMR|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.11||||||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.11||| 80164|EAP|0301|DEPAKENE (VALPROIC ACID)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.11||||2.11||| 80175|EAP|0301|LAMOTRIGINE (REF)|Medicare|MEDICARE A & B|||||2.58||| 80175|EAP|0301|LAMOTRIGINE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||98.05||| 80175|EAP|0301|LAMOTRIGINE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.58||| 80175|EAP|0301|LAMOTRIGINE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.58||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.73||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.73||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|Blue Cross PPO Select|BCBS UTHCT|||||1.73||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|Blue Cross PPO|BLUE CROSS POS|1.73||||||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.73||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|Medicare|MEDICARE A & B|||||1.73||| 80177|EAP|0301|KEPPRA (LEVETIRACETAM) ARUP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.73||| 80178|EAP|0301|LITHIUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.76||| 80178|EAP|0301|LITHIUM|NON CONTRACTED|COMMERCIAL OTHER|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Medicare|MEDICARE A & B|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Medicaid|MEDICAID|||||1.76||| 80178|EAP|0301|LITHIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.76||| 80178|EAP|0301|LITHIUM|Blue Cross PPO|BLUE CROSS PPO|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.76||| 80178|EAP|0301|LITHIUM|Cigna|CIGNA OF TN CHATTANOOGA|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Managed Medicaid|FAMILY PLANNING GRANT|||||1.76||| 80178|EAP|0301|LITHIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.76||||1.76||| 80178|EAP|0301|LITHIUM|Blue Cross PPO Select|BCBS UTHCT|||||1.76||| 80178|EAP|0301|LITHIUM|Blue Cross PPO|BCBS WALMART|||||1.76||| 80178|EAP|0301|LITHIUM|Managed Medicaid|MOLINA MEDICAID|||||1.76||| 80178|EAP|0301|LITHIUM|Aetna|AETNA|||||1.76||| 80180|EAP|0301|MYCOPHENOLIC ACID,SERUM REF|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.58||| 80180|EAP|0301|MYCOPHENOLIC ACID,SERUM REF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.58||| 80183|EAP|0301|OXCARBAZEPINE (REF)|Blue Cross PPO|BLUE CROSS PPO|2.58||||98.05||| 80183|EAP|0301|OXCARBAZEPINE (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||98.05||| 80184|EAP|0301|PHENOBARBITAL|Medicare|MEDICARE A & B|||||2.39||| 80184|EAP|0301|PHENOBARBIIAL (REF)|Medicare|MEDICARE A & B|||||2.39||| 80184|EAP|0301|PHENOBARBITAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.39||| 80184|EAP|0301|PHENOBARBITAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.32||| 80184|EAP|0301|PHENOBARBITAL|Blue Cross PPO Select|BCBS UTHCT|||||2.39||| 80184|EAP|0301|PHENOBARBITAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.39||||2.39||| 80185|EAP|0301|DILANTIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.46||||||| 80185|EAP|0301|DILANTIN|Blue Cross PPO|BLUE CROSS PPO|||||2.46||| 80185|EAP|0301|DILANTIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.46||| 80185|EAP|0301|DILANTIN|Blue Cross PPO|BLUE CROSS POS|||||2.46||| 80185|EAP|0301|DILANTIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.46||| 80185|EAP|0301|DILANTIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.46||| 80185|EAP|0301|DILANTIN|NON CONTRACTED|COMMERCIAL OTHER|||||2.46||| 80185|EAP|0301|DILANTIN|Medicare|MEDICARE A & B|2.46||||2.46||| 80188|EAP|0301|PRIMIDONE (MYSOLINE) (REF)|Medicare|MEDICARE A & B|||||0.36||| 80197|EAP|0301|PROGRAF (TACROLIMUS) (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.00||| 80197|EAP|0301|PROGRAF (TACROLIMUS) (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| 80197|EAP|0301|PROGRAF (TACROLIMUS) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.00||| 80197|EAP|0301|PROGRAF (TACROLIMUS) (REF)|Medicare|MEDICARE A & B|||||98.30||| 80198|EAP|0301|THEOPHYLLINE|Medicare|MEDICARE A & B|||||1.95||| 80198|EAP|0301|THEOPHYLLINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.95||||1.95||| 80198|EAP|0301|THEOPHYLLINE|Blue Cross PPO Select|BCBS UTHCT|||||1.95||| 80198|EAP|0301|THEOPHYLLINE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.95||| 80198|EAP|0301|THEOPHYLLINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.95||| 80200|EAP|0301|TOBRAMYCIN, RANDOM|Aetna|AETNA EL PASO CLAIMS OFFICE|3.33||||||| 80200|EAP|0301|TOBRAMYCIN, RANDOM|Medicaid|MEDICAID|3.33||||3.33||| 80200|EAP|0301|TOBRAMYCIN, RANDOM|Medicare|MEDICARE PART A|3.33||||||| 80200|EAP|0301|TOBRAMYCIN, RANDOM|Managed Medicaid|MEDICAID CSHCN|||||3.33||| 80200|EAP|0301|TOBRAMYCIN, RANDOM|Medicare|MEDICARE A & B|3.33||||3.33||| 80201|EAP|0301|TOPAMAX (TOPIRAMATE) (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.34||| 80201|EAP|0301|TOPAMAX (TOPIRAMATE) (REF)|Medicare|MEDICARE A & B|||||0.34||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Cigna|NALC HLTH BENEFIT|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Blue Cross PPO|BLUE CROSS PPO|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Blue Cross PPO|BLUE CROSS POS|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Aetna|AETNA EL PASO CLAIMS OFFICE|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|United Healthcare|UMR|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Medicaid|MEDICAID|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Medicare|MEDICARE A & B|2.59||||||| 80202|EAP|0301|VANCOMYCIN, TROUGH|Medicare|MEDICARE PART A|2.59||||||| 80203|EAP|0301|ZONISAMIDE|Blue Cross PPO|BLUE CROSS PPO|||||2.58||| 80230|EAP|0300|DRUG ASSAY INFLIXIMAB (8889)|United Healthcare|UMR|||||3.56||| 80230|EAP|0300|DRUG ASSAY INFLIXIMAB (8889)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.56||| 80299|EAP|0300|ADALIMUMAB ACT W REFLEX (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.87||| 80299|EAP|0301|QUANT OF DRUG (ARUP) (REF)|Medicare|MEDICARE A & B|||||2.58||| 80299|EAP|0301|QUANT OF DRUG (ARUP) (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.58||| 80299|EAP|0301|MEXILETINE/MEXITIL (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.58||| 80299|EAP|0301|QUANT OF DRUG (ARUP) (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.58||| 80299|EAP|0301|QUANT OF DRUG (ARUP) (REF)|Medicare|MEDICARE PART A|2.58||||||| 80299|EAP|0300|ADALIMUMAB ACT W REFLEX (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.87||| 80299|EAP|0300|ADALIMUMAB ACT W REFLEX (REF)|Blue Cross PPO|BCBS TRANE PPO|||||3.87||| 80299|EAP|0301|QUANTITATION OF DRUG,NOT ELSE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.58||| 80299|EAP|0300|ADALIMUMAB ACT W REFLEX (REF)|Blue Cross PPO Select|BCBS UTHCT|||||3.87||| 80307|EAP|0301|DAU, URINE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.02||| 80307|EAP|0301|DAU, URINE|United Healthcare|UMR|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|United Healthcare|GOLDEN RULE INSURANCE|||||1.02||| 80307|EAP|0301|DAU, URINE|PHCS|WEB TPA OF GRAND PRAIRIE|||||1.02||| 80307|EAP|0307||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.18||| 80307|EAP|0510||PHCS|WEB TPA|||||2.50||| 80307|EAP|0301|DAU, URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.02||| 80307|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 80307|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.15||| 80307|EAP|0301|DAU, URINE|PHCS|TML GRP INS|||||1.02||| 80307|EAP|0301|DAU, URINE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.02||||1.02||| 80307|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||63.90||| 80307|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 80307|EAP|0301|DAU, URINE|PHCS|WEB TPA|||||1.02||| 80307|EAP|0301|DAU, URINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.02||| 80307|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 80307|EAP|0301|DAU, URINE|Medicaid|MEDICAID|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.02||| 80307|EAP|0301|DAU, URINE|Medicare|MEDICARE PART B|||||1.02||| 80307|EAP|0301|DAU, URINE|Medicare|MEDICARE RAILROAD|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Medicare|MEDICARE PART A|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Medicare|MEDICARE A & B|1.02||||1.02||| 80307|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 80307|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 80307|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.02||||1.44||| 80307|EAP|0301|DAU, URINE|Multiplan|WEB TPA OF GRAND PRAIRIE|||||1.02||| 80307|EAP|0301|DAU, URINE|Multiplan|WEB TPA|||||1.02||| 80307|EAP|0510||United Healthcare|UMR|||||2.50||| 80307|EAP|0510||Multiplan|WEB TPA|||||2.50||| 80307|EAP|0636||Medicare|MEDICARE A & B|||||69.31||| 80307|EAP|0301|DAU, URINE|NON CONTRACTED|MRAMVA|||||1.02||| 80307|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||181.41||| 80307|EAP|0301|DAU, URINE|NON CONTRACTED|COMMERCIAL OTHER|1.02||||1.02||| 80307|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 80307|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 80307|EAP|0301|DAU, URINE|Managed Medicaid|MOLINA MEDICAID|||||1.02||| 80307|EAP|0301|DAU, URINE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.02||| 80307|EAP|0301|DAU, URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.02||||1.02||| 80307|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 80307|EAP|0301|DAU, URINE|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.02||| 80307|EAP|0301|DRUG SCREEN 9 PANEL SER (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.02||||1.73||| 80307|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||27.30||| 80307|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 80307|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 80307|EAP|0301|DAU, URINE|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.02||| 80307|EAP|0949||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 80307|EAP|0301|DAU, URINE|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Managed Medicaid|FAMILY PLANNING GRANT|||||1.02||| 80307|EAP|0301|DAU, URINE|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.02||| 80307|EAP|0301|DAU, URINE|Managed Medicaid|SUPERIOR STAR MCD|||||1.02||| 80307|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 80307|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 80307|EAP|0513||Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| 80307|EAP|0301|DAU, URINE|Cigna|CIGNA OF TN CHATTANOOGA|1.02||||1.02||| 80307|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 80307|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 80307|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 80307|EAP|0301|DAU, URINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.02||||1.02||| 80307|EAP|0301|DRUG SCREEN 9 PANEL SER (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.02||||1.73||| 80307|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 80307|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 80307|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||2.64||| 80307|EAP|0513||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 80307|EAP|0301|DAU, URINE|ChampVA|CHAMPVA OF CO DENVER|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.02||| 80307|EAP|0301|DAU, URINE|Cigna|CIGNA OTHER|||||0.40||| 80307|EAP|0301|DAU, URINE|Multiplan|TML GRP INS|||||1.02||| 80307|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 80307|EAP|0301|DAU, URINE|Cigna|CIGNA BEHAVIORAL HEALTH|||||1.02||| 80307|EAP|0301|DAU, URINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.02||| 80307|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 80307|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 80307|EAP|0301|DRUG SCREEN 9 PANEL SER (ARUP)|Medicare|MEDICARE A & B|1.02||||1.73||| 80307|EAP|0510||Aetna|AETNA|||||2.50||| 80307|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 80307|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.02||||1.02||| 80307|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 80307|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 80307|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 80307|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 80307|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 80307|EAP|0301|DAU, URINE|Aetna|AETNA EL PASO CLAIMS OFFICE|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Aetna|TRS COORDINATED CARE|||||0.40||| 80307|EAP|0301|DAU, URINE|Aetna|AETNA|||||1.02||| 80307|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||128.10||| 80307|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 80307|EAP|0300||Blue Cross PPO|BLUE CROSS PPO|||||0.72||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO|BCBS WALMART|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO|BLUE CROSS SECONDARY|||||1.02||| 80307|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO|BLUE CROSS POS|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO|BLUE CROSS PPO|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO|BCBS TRANE PPO|1.02||||1.02||| 80307|EAP|0301|DAU, URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.02||||1.02||| 80307|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.64||| 80307|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 80307|EAP|0949||Blue Cross PPO|BLUE CROSS POS|||||213.82||| 80307|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 80307|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 80307|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 80307|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 80307|EAP|0513||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 80307|EAP|0771||Blue Cross PPO|BCBS TRANE PPO|||||160.36||| 80307|EAP|0513||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 80307|EAP|0301|DAU, URINE|Blue Cross PPO Select|BCBS UTHCT|1.02||||1.02||| 80307|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 80307|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 80339|EAP|0301|LACOSAMIDE SERUM/PLASMA (ARUP)|Medicare|MEDICARE A & B|||||1.71||| 80346|EAP|0300|BENZODIAZEPINES CON/QUANT (ARU|Blue Cross PPO|BLUE CROSS PPO|||||0.87||| 80346|EAP|0301|DAU CONF BENZODIAZ URINE (ARUP|Blue Cross PPO|BLUE CROSS PPO|||||1.27||| 80346|EAP|0301|DAU CONF BENZODIAZ URINE (ARUP|Cigna|CIGNA OF TN CHATTANOOGA|||||1.27||| 80346|EAP|0301|DAU CONF BENZODIAZ URINE (ARUP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.27||| 80346|EAP|0301|DAU CONF BENZODIAZ URINE (ARUP|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||1.27||| 80346|EAP|0301|DAU CONF BENZODIAZ URINE (ARUP|United Healthcare|UMR|||||1.27||| 80348|EAP|0301|BUPRENORPHINE AND METAB (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||1.38||| 80348|EAP|0301|BUPRENORPHINE AND METAB (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.38||| 80348|EAP|0301|BUPRENORPHINE AND METAB (ARUP)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||1.38||| 80348|EAP|0301|BUPRENORPHINE AND METAB (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||1.38||| 80348|EAP|0301|BUPRENORPHINE AND METAB (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||1.38||| 80373|EAP|0301|TRAMADOL/METAB UR QUANT (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.66||| 80373|EAP|0301|TRAMADOL/METAB UR QUANT (ARUP)|Medicare|MEDICARE A & B|||||1.66||| 80400|EAP|0301|CORTISOL STIM PANEL|Blue Cross PPO|BLUE CROSS PPO|||||0.91||| 80400|EAP|0301|CORTISOL STIM PANEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.91||||||| 80400|EAP|0301|CORTISOL STIM PANEL|Medicare|MEDICARE A & B|0.91||||0.91||| 80400|EAP|0301|CORTISOL STIM PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.91||| 80400|EAP|0301|CORTISOL STIM PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.91||||0.91||| 80400|EAP|0301|CORTISOL STIM PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.91||| 80500|EAP|0310|LAB PATHOLOGY CONSULT|Medicare|MEDICARE A & B|1.68||||1.68||| 80500|EAP|0310|LAB PATHOLOGY CONSULT|Blue Cross PPO Select|BCBS UTHCT|||||1.68||| 80500|EAP|0310|LAB PATHOLOGY CONSULT|Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|Medicare|MEDICARE A & B|36,623.60|8892.95|8892.95|8892.95|||| 810|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC|Medicare|MEDICARE A & B|25,922.40|8689.96|8689.96|8689.96|||| 81000|EAP|0301|N-AUTOM URINE DIP W MICRO|Blue Cross PPO|BLUE CROSS POS|||||0.60||| 81000|EAP|0301|N-AUTOM URINE DIP W MICRO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.60||| 81000|EAP|0301|N-AUTOM URINE DIP W MICRO|Medicare|MEDICARE A & B|||||0.60||| 81000|EAP|0301|N-AUTOM URINE DIP W MICRO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.60||| 81000|EAP|0301|N-AUTOM URINE DIP W MICRO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.60||| 81000|EAP|0301|N-AUTOM URINE DIP W MICRO|Blue Cross PPO|BLUE CROSS PPO|||||0.60||| 81001|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Workers Compensation|WC TX MUTUAL INS|||||1.18||| 81001|EAP|0510||United Healthcare|UMR|||||2.64||| 81001|EAP|0510||United Healthcare|UMR|||||2.50||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.18||| 81001|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 81001|EAP|0981||United Healthcare|UMR|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Healthcare|UMR|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|PHCS|WEB TPA OF GRAND PRAIRIE|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|PHCS|TML GRP INS|1.18||||||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Healthcare|AARP OF GA ATLANTA|||||0.25||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|United Healthcare|GOLDEN RULE INSURANCE|||||1.18||| 81001|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 81001|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Multiplan|WEB TPA OF GRAND PRAIRIE|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Multiplan|WEB TPA|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|NON CONTRACTED|COMMERCIAL OTHER 2|1.18||||1.18||| 81001|EAP|0450||Medicare|MEDICARE A & B|||||7.27||| 81001|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 81001|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 81001|EAP|0459||Medicare|MEDICARE A & B|||||5.42||| 81001|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||181.41||| 81001|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Medicare|MEDICARE A & B|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|NON CONTRACTED|MRAMVA|||||1.18||| 81001|EAP|0981||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 81001|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 81001|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Medicaid|MEDICAID|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.18||| 81001|EAP|0309||Medicare|MEDICARE A & B|||||1.44||| 81001|EAP|0309||Medicare|MEDICARE A & B|||||0.93||| 81001|EAP|0306||Medicare|MEDICARE A & B|||||1.36||| 81001|EAP|0306||Medicare|MEDICARE A & B|||||95.50||| 81001|EAP|0306||Medicare|MEDICARE A & B|||||78.50||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.18||||1.18||| 81001|EAP|0510||Cigna|NALC HLTH BENEFIT|||||2.50||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross PPO Select|BCBS UTHCT|1.18||||1.18||| 81001|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 81001|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.36||| 81001|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.66||| 81001|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 81001|EAP|0981||Medicaid|MEDICAID|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|ChampVA|CHAMPVA OF CO DENVER|||||1.18||| 81001|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.10||| 81001|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.15||| 81001|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Cigna|CIGNA OF TN CHATTANOOGA|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.18||| 81001|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.36||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Cigna|CIGNA OPEN ACCESS PLUS|||||1.18||| 81001|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Cigna|NALC HLTH BENEFIT|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Medicare|MEDICARE RAILROAD|1.18||||1.18||| 81001|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Medicare|MEDICARE PART A|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|OTHER MEDICAID|||||1.18||| 81001|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|MEDICAID CSHCN|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|SUPERIOR STAR MCD|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|FAMILY PLANNING GRANT|||||1.18||| 81001|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||17.75||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|MOLINA MEDICAID|||||1.18||| 81001|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|NON CONTRACTED|COMMERCIAL OTHER|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Multiplan|TML GRP INS|1.18||||||| 81001|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross PPO|BLUE CROSS PPO|1.18||||1.18||| 81001|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 81001|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 81001|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 81001|EAP|0307||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.18||||1.18||| 81001|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|PHCS|WEB TPA|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross PPO|BLUE CROSS POS|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross PPO|BCBS WALMART|1.18||||1.18||| 81001|EAP|0307||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.18||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.18||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross PPO|BCBS TRANE PPO|1.18||||1.18||| 81001|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 81001|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 81001|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.18||||1.18||| 81001|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Access Direct Platinum|ACCESS DIRECT|||||1.18||| 81001|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Aetna|AETNA EL PASO CLAIMS OFFICE|1.18||||1.18||| 81001|EAP|0949||Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 81001|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 81001|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 81001|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 81001|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 81001|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 81001|EAP|0307|URINALYSIS, ROUTINE WITH MICRO|Aetna|AETNA EXXON MOBIL|||||0.25||| 81003|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.25||| 81003|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 81003|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.25||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.69||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO|BCBS TRANE PPO|||||0.60||| 81003|EAP|0420||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.81||| 81003|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 81003|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| 81003|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 81003|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 81003|EAP|0307|URINALYSIS, ROUTINE|Aetna|TRS COORDINATED CARE|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Aetna|AETNA|||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Aetna|AETNA US HEALTHCARE PA|||||0.60||| 81003|EAP|0301||Blue Cross PPO|BCBS WALMART|||||0.60||| 81003|EAP|0761||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.83||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO|BLUE CROSS PPO|0.60||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.60||||0.60||| 81003|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO|BLUE CROSS POS|||||0.60||| 81003|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.60||| 81003|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.60||||1.14||| 81003|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 81003|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.50||| 81003|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 81003|EAP|0402||Blue Cross PPO|BLUE CROSS POS|||||9.78||| 81003|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 81003|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross PPO|BLUE CROSS PPO|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross PPO|BCBS TRANE PPO|0.69||||0.69||| 81003|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|||||0.60||| 81003|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 81003|EAP|0761||Blue Cross PPO|BLUE CROSS PPO|||||0.83||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.69||| 81003|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Managed Medicaid|SUPERIOR STAR MCD|||||0.60||| 81003|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 81003|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.09||| 81003|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||1.32||| 81003|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||1.66||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|SUPERIOR STAR MCD|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO Select|BCBS UTHCT|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|0.69||||||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||0.60||| 81003|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross PPO|BLUE CROSS POS|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|FAMILY PLANNING GRANT|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||0.69||| 81003|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 81003|EAP|0510||Managed Medicaid|FAMILY PLANNING GRANT|||||2.50||| 81003|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 81003|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 81003|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 81003|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||669.83||| 81003|EAP|0270|BANDAGE, ELASTIC 6 (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 81003|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.66||| 81003|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.98||| 81003|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Cigna|CIGNA OF TN CHATTANOOGA|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|ChampVA|CHAMPVA OF CO DENVER|0.69||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.60||| 81003|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.69||||0.69||| 81003|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.49||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|ChampVA|CHAMPVA OF CO DENVER|||||0.60||| 81003|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 81003|EAP|0307|URINALYSIS, ROUTINE|Cigna|NALC HLTH BENEFIT|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Cigna|CIGNA BEHAVIORAL HEALTH|0.69||||||| 81003|EAP|0307|URINALYSIS, ROUTINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.47||| 81003|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 81003|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.82||| 81003|EAP|0307|URINALYSIS, ROUTINE|Cigna|CIGNA OTHER|||||0.25||| 81003|EAP|0307|URINALYSIS, ROUTINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.69||||0.69||| 81003|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.64||| 81003|EAP|0307|URINALYSIS, ROUTINE|Medicare|MEDICARE PART B|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross PPO Select|BCBS UTHCT|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Medicaid|MEDICAID|0.69||||0.69||| 81003|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 81003|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|OTHER MEDICAID|||||0.69||| 81003|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.32||| 81003|EAP|0307|URINALYSIS, ROUTINE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Medicaid|MEDICAID|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.60||| 81003|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 81003|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 81003|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.69||||0.69||| 81003|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 81003|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||27.30||| 81003|EAP|0307|URINALYSIS, ROUTINE|Managed Medicaid|MOLINA MEDICAID|||||0.69||| 81003|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 81003|EAP|0981||Medicaid|MEDICAID|||||0.00||| 81003|EAP|0301||Medicare|MEDICARE A & B|0.60||||0.19||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Managed Medicaid|MOLINA MEDICAID|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Managed Medicaid|FAMILY PLANNING GRANT|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Medicare|MEDICARE PART B|||||0.60||| 81003|EAP|0306||Medicare|MEDICARE A & B|||||1.66||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Medicare|MEDICARE A & B|0.60||||0.60||| 81003|EAP|0301||Medicare|MEDICARE A & B|0.60||||1.61||| 81003|EAP|0307|URINALYSIS, ROUTINE|Medicare|MEDICARE A & B|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Medicare|MEDICARE RAILROAD|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Medicare|MEDICARE PART A|0.69||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Medicare|MEDICARE RAILROAD|||||0.60||| 81003|EAP|0301||Medicare|MEDICARE A & B|0.60||||3.14||| 81003|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Medicare|MEDICARE A & B|||||2.64||| 81003|EAP|0510||Medicare|MEDICARE A & B|||||37.63||| 81003|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 81003|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 81003|EAP|0307|URINALYSIS, ROUTINE|Blue Cross PPO|BCBS WALMART|0.69||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Multiplan|WEB TPA|||||0.60||| 81003|EAP|0306||Medicare|MEDICARE A & B|||||1.32||| 81003|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Multiplan|TML GRP INS|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|Multiplan|WEB TPA|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Multiplan|WEB TPA OF GRAND PRAIRIE|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|NON CONTRACTED|MRAMVA|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|NON CONTRACTED|COMMERCIAL OTHER|||||0.60||| 81003|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|NON CONTRACTED|PPO OTHER|||||0.60||| 81003|EAP|0920|SIMPLE UROFLOWMETRY (URO)|Medicare|MEDICARE A & B|||||2.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Multiplan|TML GRP INS|||||0.69||| 81003|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| 81003|EAP|0761|US PV RESIDUAL URINE|Medicare|MEDICARE A & B|||||0.83||| 81003|EAP|0307|URINALYSIS, ROUTINE|NON CONTRACTED|COMMERCIAL OTHER|0.69||||0.69||| 81003|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Aetna|AETNA|||||0.60||| 81003|EAP|0761||Medicare|MEDICARE A & B|||||0.83||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|United Healthcare|UMR|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|United Healthcare|GOLDEN RULE INSURANCE|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|United Healthcare|UMR|0.69||||0.69||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.60||| 81003|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.50||| 81003|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.60||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|Aetna|AETNA EL PASO CLAIMS OFFICE|0.69||||0.69||| 81003|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|PHCS|TML GRP INS|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.69||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|PHCS|TML GRP INS|||||0.69||| 81003|EAP|0981||United Healthcare|UMR|||||0.00||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Blue Cross PPO|BCBS WALMART|||||0.60||| 81003|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 81003|EAP|0450||United Healthcare|UMR|||||181.41||| 81003|EAP|0307|URINALYSIS, ROUTINE|PHCS|WEB TPA OF GRAND PRAIRIE|||||0.69||| 81003|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.66||| 81003|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 81003|EAP|0307|URINALYSIS, ROUTINE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.69||||0.69||| 81003|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.60||| 81003|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|Tricare|TRICARE WEST UNITED HEALTH|||||0.60||| 81003|EAP|0301|URINE DIP AUTOM W/O MICRO|PHCS|WEB TPA|||||0.60||| 81003|EAP|0307|URINALYSIS, ROUTINE|PHCS|WEB TPA|||||0.69||| 81003|EAP|0307|URINALYSIS, ROUTINE|United Healthcare|GOLDEN RULE INSURANCE|||||0.69||| 81003|EAP|0510||United Healthcare|UMR|||||2.25||| 81025|EAP|0510||United Healthcare|UMR|||||2.50||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|United Healthcare|GOLDEN RULE INSURANCE|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|United Healthcare|UMR|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|United Healthcare|UMR|||||0.27||| 81025|EAP|0510||PHCS|TML GRP INS|||||2.82||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|PHCS|TML GRP INS|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 81025|EAP|0510||Multiplan|TML GRP INS|||||2.82||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|NON CONTRACTED|COMMERCIAL OTHER|||||0.27||| 81025|EAP|0301||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.19||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Medicaid|MEDICAID|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Medicare|MEDICARE A & B|||||1.14||| 81025|EAP|0510|INSERT INTRAUTERINE DEVICE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.79||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Medicare|MEDICARE A & B|||||0.27||| 81025|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.64||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|ChampVA|CHAMPVA OF CO DENVER|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Managed Medicaid|MOLINA MEDICAID|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.14||| 81025|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Medicaid|MEDICAID|||||1.14||| 81025|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Blue Cross PPO Select|BCBS UTHCT|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.27||| 81025|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 81025|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Blue Cross PPO|BCBS WALMART|||||0.27||| 81025|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 81025|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 81025|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 81025|EAP|0949||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Aetna|AETNA|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Multiplan|TML GRP INS|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Blue Cross PPO Select|BCBS UTHCT|||||0.27||| 81025|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.16||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Blue Cross PPO|BLUE CROSS POS|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Managed Medicaid|FAMILY PLANNING GRANT|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Blue Cross PPO|BLUE CROSS PPO|||||0.27||| 81025|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 81025|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Blue Cross PPO|BLUE CROSS POS|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Managed Medicaid|FAMILY PLANNING GRANT|||||0.27||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TEST|Cigna|CIGNA OF TN CHATTANOOGA|||||1.14||| 81025|EAP|0301|PREGNANCY QUICKVIEW URINE TE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.27||| 81025|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 81025|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 81050|EAP|0300||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Blue Cross PPO|BLUE CROSS PPO|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Blue Cross PPO Select|BCBS UTHCT|||||0.31||| 81050|EAP|0300||Blue Cross PPO Select|BCBS UTHCT|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.31||| 81050|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Medicare|MEDICARE A & B|0.31||||0.31||| 81050|EAP|0300||Medicare|MEDICARE A & B|0.31||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Medicare|MEDICARE PART A|0.31||||||| 81050|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.31||| 81050|EAP|0300|VOLUME MEASUREMENT TIMED COLLE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.31||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|Medicare|MEDICARE A & B|19,946.28|11226.15|11226.15|11226.15|||| 81170|EAP|0310|BCR-ABL1 NEXT GEN SEQ (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||15.70||| 81170|EAP|0310|BCR-ABL1 NEXT GEN SEQ (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.70||| 81170|EAP|0310|BCR-ABL1 NEXT GEN SEQ (ARUP)|Medicare|MEDICARE A & B|||||15.70||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Veterans Affairs|VETERANS CHOICE - TRI WEST|50,330.38|7913.15|8425.02|3115.4|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Medicare|MEDICARE A & B|37,514.70|8425.02|8425.02|3115.4|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|18,838.24|7745.83|8425.02|3115.4|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|30,734.38|3115.4|8425.02|3115.4|||| 81206|EAP|0310|BCR/ALB1 MAJOR BREAKPT (6502)|Blue Cross PPO|BLUE CROSS PPO|||||0.93||| 81206|EAP|0310|BCR/ALB1 MAJOR BREAKPT (6502)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 81206|EAP|0301|BCR-ABL1, MAJOR QUANT (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.81||| 81206|EAP|0301|BCR-ABL1, MAJOR QUANT (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.81||| 81206|EAP|0301|BCR-ABL1, MAJOR QUANT (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||5.81||| 81206|EAP|0301|BCR-ABL1, MAJOR QUANT (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.81||| 81206|EAP|0310|BCR/ALB1 MAJOR BREAKPT (6502)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.93||| 81206|EAP|0310|BCR/ALB1 MAJOR BREAKPT (6502)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.32||| 81206|EAP|0301|BCR-ABL1, MAJOR QUANT (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||5.81||| 81206|EAP|0310|BCR/ALB1 MAJOR BREAKPT (6502)|Medicare|MEDICARE A & B|||||0.93||| 81206|EAP|0301|BCR-ABL1, MAJOR QUANT (ARUP)|Medicare|MEDICARE A & B|||||5.81||| 81206|EAP|0310|BCR/ALB1 MAJOR BREAKPT (6502)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.93||| 81207|EAP|0310|BCR/ALB1 MINOR BREAKPT (6502)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.93||| 81207|EAP|0310|BCR/ALB1 MINOR BREAKPT (6502)|Medicare|MEDICARE A & B|||||0.93||| 81207|EAP|0310|BCR/ALB1 MINOR BREAKPT (6502)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.32||| 81207|EAP|0310|BCR/ALB1 MINOR BREAKPT (6502)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.93||| 81207|EAP|0310|BCR/ALB1 MINOR BREAKPT (6502)|Blue Cross PPO|BLUE CROSS PPO|||||0.93||| 81207|EAP|0310|BCR/ALB1 MINOR BREAKPT (6502)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 81208|EAP|0300|BCR/ABL1 GENE OTHER BP(6502)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.94||| 81208|EAP|0300|BCR/ABL1 GENE OTHER BP(6502)|Blue Cross PPO|BLUE CROSS PPO|||||0.94||| 81208|EAP|0300|BCR/ABL1 GENE OTHER BP(6502)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.94||| 81208|EAP|0300|BCR/ABL1 GENE OTHER BP(6502)|Medicare|MEDICARE A & B|||||0.94||| 81208|EAP|0300|BCR/ABL1 GENE OTHER BP(6502)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.94||| 81211|EAP|0310|BRCA1 AND BRCA2 SEQ (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||65.86||| 81219|EAP|0310|CALR EXON 9 MUTATION PCR (ARUP|Medicare|MEDICARE A & B|||||5.80||| 81235|EAP|0310|EGFR T790M MUTATION PCR (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||10.60||| 81235|EAP|0310|EGFR T790M MUTATION PCR (ARUP)|Medicare|MEDICARE A & B|||||10.60||| 81240|EAP|0301|PROTHROMBIN GENE MUTATION (REF|Medicare|MEDICARE A & B|||||4.50||| 81240|EAP|0301|PROTHROMBIN GENE MUTATION (REF|Blue Cross PPO Select|BCBS UTHCT|||||4.50||| 81240|EAP|0301|PROTHROMBIN GENE MUTATION (REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.50||| 81240|EAP|0301|PROTHROMBIN GENE MUTATION (REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|4.50||||4.50||| 81240|EAP|0301|PROTHROMBIN GENE MUTATION (REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.50||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.55||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.55||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.55||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Medicare|MEDICARE A & B|2.55||||2.55||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.55||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.55||||||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.55||| 81241|EAP|0301|FACTOR V LEIDEN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.55||||2.55||| 81256|EAP|0310|HEMOCHROMATOSIS MUTATION DETEC|United Healthcare|UMR|||||2.42||| 81256|EAP|0310|HEMOCHROMATOSIS MUTATION DETEC|Medicare|MEDICARE A & B|2.42||||2.42||| 81256|EAP|0310|HEMOCHROMATOSIS MUTATION DETEC|Blue Cross PPO|BLUE CROSS PPO|||||2.42||| 81256|EAP|0310|HEMOCHROMATOSIS MUTATION DETEC|Blue Cross PPO|BLUE CROSS POS|||||2.42||| 81256|EAP|0310|HEMOCHROMATOSIS MUTATION DETEC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.42||| 81256|EAP|0310|HEMOCHROMATOSIS MUTATION DETEC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.42||| 81257|EAP|0310|ALPHA THALESSEMIA HBA1/2 (ARUP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||7.90||| 81257|EAP|0310|ALPHA THALESSEMIA HBA1/2 (ARUP|Medicare|MEDICARE A & B|||||7.90||| 81270|EAP|0301|JAK2 (V617F) MUTATION BY PCR|NON CONTRACTED|COMMERCIAL OTHER|||||6.49||| 81270|EAP|0301|JAK2 (V617F) MUTATION BY PCR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||6.49||| 81270|EAP|0301|JAK2 (V617F) MUTATION BY PCR|Medicare|MEDICARE A & B|||||6.49||| 81270|EAP|0301|JAK2 (V617F) MUTATION BY PCR|Blue Cross PPO Select|BCBS UTHCT|||||6.49||| 81270|EAP|0301|JAK2 (V617F) MUTATION BY PCR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.49||| 81273|EAP|0310|KIT (D816V) MUTATION by PCR|Medicare|MEDICARE A & B|||||237.38||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Medicare|MEDICARE A & B|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|Multiplan|TML GRP INS|||||1.92||| 81291|EAP|0310|MTHFR 2 MUTATIONS (ARUP)|PHCS|TML GRP INS|||||1.92||| 813|DRG||COAGULATION DISORDERS|Humana Medicare Advantage|HUMANA MEDICARE PPO|17,134.18|11817.83|11817.83|11817.83|||| 81331|EAP|0301|SNRPN/UBE3A (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||5.86||| 81383|EAP|0301|NARCOLEPSY GENOTYPING|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.94||| 81402|EAP|0310|MPL 515 MUTATION QUANT (ARUP)|Medicare|MEDICARE A & B|7.90||||7.90||| 81403|EAP|0310|MOLEC PHENOTYPING REF (CARTER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|6.71||||||| 81403|EAP|0310|JAK2 EXON12 MUTATIONA ANALYSIS|Medicare|MEDICARE A & B|||||504.24||| 81479|EAP|0301|MOLECULAR DIAG; INTERP/RPT-REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.75||| 81539|EAP|0301|PROSTATE SPECIFIC KALLIKRIEN|Medicare|MEDICARE A & B|||||15.40||| 816|DRG||RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC|Medicare|MEDICARE A & B|27,167.98|7314.16|7314.16|7314.16|||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Blue Cross PPO|BLUE CROSS POS|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Managed Medicaid|SUPERIOR STAR MCD|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.58||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.58||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|NON CONTRACTED|COMMERCIAL OTHER|0.58||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Medicare|MEDICARE A & B|0.58||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Medicaid|MEDICAID|0.58||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Blue Cross PPO|BCBS WALMART|||||0.58||| 82009|EAP|0301|ACETONE, SERUM QUALITATIVE|Blue Cross PPO|BLUE CROSS PPO|0.58||||0.58||| 82016|EAP|0300|ACYLCARNITINES QUAL REF (7028)|Managed Medicaid|SUPERIOR STAR MCD|||||0.54||| 82016|EAP|0300|ACYLCARNITINES QUAL REF (7028)|Blue Cross PPO|BLUE CROSS PPO|||||0.54||| 82016|EAP|0300|ACYLCARNITINES QUAL REF (7028)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.54||| 82024|EAP|0301|ACTH (REF)|Medicare|MEDICARE A & B|||||4.38||| 82024|EAP|0301|ACTH (REF)|United Healthcare|GOLDEN RULE INSURANCE|||||4.38||| 82024|EAP|0301|ACTH (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.38||| 82024|EAP|0301|ACTH (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.38||| 82024|EAP|0301|ACTH (REF)|Blue Cross PPO Select|BCBS UTHCT|||||4.38||| 82024|EAP|0301|ACTH (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| 82024|EAP|0301|ACTH (REF)|Blue Cross PPO|BCBS TRANE PPO|||||4.38||| 82024|EAP|0301|ACTH (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.38||| 82024|EAP|0301|ACTH (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 82024|EAP|0301|ACTH (REF)|Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 82024|EAP|0301|ACTH (REF)|Blue Cross PPO|BLUE CROSS POS|||||4.38||| 82024|EAP|0301|ACTH (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.38||||4.38||| 82024|EAP|0301|ACTH (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| 82024|EAP|0301|ACTH (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.38||| 82040|EAP|0301|ALBUMIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.64||| 82040|EAP|0301|ALBUMIN|Blue Cross PPO|BLUE CROSS PPO|||||0.64||| 82040|EAP|0301|ALBUMIN|Medicare|MEDICARE A & B|0.64||||0.64||| 82042|EAP|0301|ALBUMIN, BODY FLUID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.28||| 82042|EAP|0301|ALBUMIN, BODY FLUID|NON CONTRACTED|COMMERCIAL OTHER|||||1.28||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Medicare|MEDICARE A & B|1.28||||1.28||| 82042|EAP|0301|ALBUMIN, CSF (REF)|Medicare|MEDICARE A & B|1.28||||1.28||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Blue Cross PPO|BLUE CROSS POS|1.28||||||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.28||||||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Blue Cross PPO|BLUE CROSS PPO|||||1.28||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.28||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.28||||||| 82042|EAP|0301|ALBUMIN, BODY FLUID|Cigna|NALC HLTH BENEFIT|||||1.28||| 82043|EAP|0301|MICROALBUMIN, URINE|ChampVA|CHAMPVA OF CO DENVER|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.75||| 82043|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.75||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Cigna|NALC HLTH BENEFIT|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 82043|EAP|0301|MICROALBUMIN, URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.75||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Cigna|CIGNA OTHER|||||1.75||| 82043|EAP|0301||Managed Medicaid|FAMILY PLANNING GRANT|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Managed Medicaid|SUPERIOR STAR MCD|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.75||| 82043|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.75||| 82043|EAP|0301||Managed Medicaid|MOLINA MEDICAID|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Managed Medicaid|FAMILY PLANNING GRANT|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Access Direct Platinum|ACCESS DIRECT|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Aetna|TRS COORDINATED CARE|||||0.25||| 82043|EAP|0301|MICROALBUMIN, URINE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Aetna|AETNA EXXON MOBIL|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.75||| 82043|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross PPO|BCBS TRANE PPO|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross PPO|BLUE CROSS POS|||||1.75||| 82043|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross PPO|BLUE CROSS PPO|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross PPO|BCBS WALMART|||||1.75||| 82043|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 82043|EAP|0301|MICROALBUMIN, URINE|Managed Medicaid|MEDICAID CSHCN|||||1.75||| 82043|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross PPO Select|BCBS UTHCT|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.75||| 82043|EAP|0301||Medicare|MEDICARE A & B|1.75||||0.25||| 82043|EAP|0301|MICROALBUMIN, URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Medicare|MEDICARE A & B|1.75||||1.75||| 82043|EAP|0301||Medicare|MEDICARE A & B|1.75||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Medicare|MEDICARE PART A|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Medicare|MEDICARE PART B|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Medicaid|MEDICAID|||||1.75||| 82043|EAP|0301||Medicaid|MEDICAID|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Medicare|MEDICARE RAILROAD|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|NON CONTRACTED|COMMERCIAL OTHER|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|NON CONTRACTED|BOONE CHAPMAN|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|NON CONTRACTED|SIERRA HEALTH & LIFE|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Multiplan|TML GRP INS|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|United Healthcare|UMR|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|PHCS|TML GRP INS|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.75||| 82043|EAP|0301|MICROALBUMIN, URINE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.00||| 82043|EAP|0301|MICROALBUMIN, URINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.75||| 82085|EAP|0301|ALDOLASE (REF)|Medicare|MEDICARE RAILROAD|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Medicare|MEDICARE A & B|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Aetna|AETNA EXXON MOBIL|||||69.50||| 82085|EAP|0301|ALDOLASE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.83||| 82085|EAP|0301|ALDOLASE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.83||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|Cigna|CIGNA OF TN CHATTANOOGA|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.19||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.19||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|Blue Cross PPO|BLUE CROSS PPO|||||5.19||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|Blue Cross PPO|BLUE CROSS POS|||||5.19||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|Blue Cross PPO Select|BCBS UTHCT|||||291.85||| 82088|EAP|0301|ALDOSTERONE ARUP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.19||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|NON CONTRACTED|COMMERCIAL OTHER|||||5.19||| 82088|EAP|0301|ALDOSTERONE,RECUMBENT (REF)|Medicare|MEDICARE A & B|||||5.19||| 82088|EAP|0301|ALDOSTERONE ARUP|Medicare|MEDICARE A & B|||||5.19||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Medicare|MEDICARE A & B|2.40||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Medicaid|MEDICAID|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Medicaid|MEDICAID|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|United Healthcare|AARP OF GA ATLANTA|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|United Healthcare|UMR|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Blue Cross PPO|BLUE CROSS PPO|2.40||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|United Healthcare|UMR|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Blue Cross PPO|BLUE CROSS PPO|2.40||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Medicare|MEDICARE A & B|2.40||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.40||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.40||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.40||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.40||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.40||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.40||| 82103|EAP|0301|ALPHA-1, TOTAL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.40||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Blue Cross PPO|BLUE CROSS PPO|1.17||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|United Healthcare|UMR|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Medicare|MEDICARE A & B|||||1.17||| 82104|EAP|0301|ALPHA-1, PHENOTYPE (REF)|Medicaid|MEDICAID|||||1.17||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|United Healthcare|AARP OF GA ATLANTA|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Medicare|MEDICARE A & B|2.45||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Aetna|AETNA|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.45||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.45||| 82105|EAP|0301|AFP,TUMOR MARKER (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.45||| 82128|EAP|0300|AMINO ACIDS MULT QUAL REF 7028|Managed Medicaid|SUPERIOR STAR MCD|||||0.54||| 82128|EAP|0300|AMINO ACIDS MULT QUAL REF 7028|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.54||| 82128|EAP|0300|AMINO ACIDS MULT QUAL REF 7028|Blue Cross PPO|BLUE CROSS PPO|||||0.54||| 82140|EAP|0301|AMMONIA|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.73||||0.41||| 82140|EAP|0301|AMMONIA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.73||| 82140|EAP|0301|AMMONIA|Medicare|MEDICARE PART A|1.73||||||| 82140|EAP|0301|AMMONIA|Medicare|MEDICARE A & B|1.73||||1.73||| 82140|EAP|0301|AMMONIA|Medicaid|MEDICAID|1.73||||||| 82140|EAP|0301|AMMONIA|Blue Cross PPO|BLUE CROSS PPO|||||1.73||| 82140|EAP|0301|AMMONIA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.73||||1.73||| 82140|EAP|0301|AMMONIA|Cigna|CIGNA OTHER|||||1.73||| 82140|EAP|0301|AMMONIA|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.73||||1.73||| 82140|EAP|0301|AMMONIA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.73||||1.73||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|SUPERIOR STAR MCD|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.75||| 82150|EAP|0301|BODY FLUID, AMYLASE|Cigna|NALC HLTH BENEFIT|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.75||||||| 82150|EAP|0301|AMYLASE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Cigna|NALC HLTH BENEFIT|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|ChampVA|CHAMPVA OF CO DENVER|1.75||||||| 82150|EAP|0301|BODY FLUID, AMYLASE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO|BLUE CROSS POS|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO|BLUE CROSS PPO|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO|BCBS WALMART|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO Select|BCBS UTHCT|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Multiplan|WEB TPA|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|NON CONTRACTED|COMMERCIAL OTHER|||||1.75||| 82150|EAP|0301|BODY FLUID, AMYLASE|Medicare|MEDICARE A & B|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Medicare|MEDICARE A & B|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Medicaid|MEDICAID|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|MOLINA MEDICAID|||||1.75||| 82150|EAP|0301||Medicare|MEDICARE A & B|1.75||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|UMR|||||1.00||| 82150|EAP|0301|AMYLASE, SERUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.75||||||| 82150|EAP|0301|AMYLASE, SERUM|PHCS|WEB TPA|||||1.75||| 82150|EAP|0301|AMYLASE, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.75||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.53||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.53||| 82164|EAP|0301||Medicare|MEDICARE A & B|||||104.55||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Medicare|MEDICARE A & B|||||2.53||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.53||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.53||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.53||| 82164|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||104.55||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.53||| 82164|EAP|0301|ANGIOTENSIN CONV ENZYME-(REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.53||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 82172|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 82172|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Medicare|MEDICARE A & B|||||0.65||| 82172|EAP|0301||Medicare|MEDICARE A & B|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|Medicaid|MEDICAID|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|United Healthcare|UMR|||||0.65||| 82172|EAP|0301|APOLIPOPROTEIN, EA (6678)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 82175|EAP|0301|ARSENIC, WHOLE BLOOD (REF)|Medicare|MEDICARE A & B|||||4.41||| 82175|EAP|0301|ARSENIC, (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.41||| 82175|EAP|0301|ARSENIC, WHOLE BLOOD (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||135.85||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.15||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.15||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.15||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.15||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.15||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.15||| 82232|EAP|0301|BETA-2- MICROGLOBULINS (REF)|Medicare|MEDICARE A & B|||||2.15||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 82247|EAP|0301|BILIRUBIN; TOTAL|Medicare|MEDICARE A & B|||||0.89||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Medicare|MEDICARE A & B|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Medicaid|MEDICAID|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|United Healthcare|UMR|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 82247|EAP|0301||Medicare|MEDICARE A & B|||||0.65||| 82247|EAP|0301|BILIRUBIN; TOTAL|Aetna|AETNA|||||0.89||| 82247|EAP|0301|BILIRUBIN; TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.89||| 82247|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 82247|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 82247|EAP|0301|BILIRUBIN; TOTAL|Blue Cross PPO|BLUE CROSS PPO|||||0.89||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.89||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| 82247|EAP|0301|BILIRUBIN; TOTAL|Managed Medicaid|SUPERIOR STAR MCD|||||0.25||| 82247|EAP|0301|BILIRUBIN TOTAL (6678)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.65||| 82248|EAP|0301|BILIRUBIN; DIRECT|Managed Medicaid|SUPERIOR STAR MCD|||||0.25||| 82248|EAP|0301|BILIRUBIN; DIRECT|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.35||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Blue Cross PPO|BLUE CROSS PPO|1.35||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Blue Cross PPO|BLUE CROSS POS|1.35||||||| 82248|EAP|0301|BILIRUBIN; DIRECT|Blue Cross PPO Select|BCBS UTHCT|1.35||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.35||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Aetna|AETNA|||||1.35||| 82248|EAP|0301||Medicare|MEDICARE A & B|1.35||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Medicare|MEDICARE A & B|1.35||||1.35||| 82248|EAP|0301|BILIRUBIN; DIRECT|Medicare|MEDICARE PART A|||||1.35||| 82248|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||1.35||| 82270|EAP|0301|OCCULT BLOOD (*SCREENING); LAB|Medicare|MEDICARE A & B|||||0.81||| 82271|EAP|0301|OCCULT BLOOD, GASTRIC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.63||| 82271|EAP|0301|OCCULT BLOOD, GASTRIC|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.63||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|United Healthcare|UMR|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 82272|EAP|0300|BLOOD OCCULT, SNGL SPEC DRE|Medicare|MEDICARE A & B|||||0.72||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Medicare|MEDICARE A & B|0.65||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.65||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.65||||||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.65||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Blue Cross PPO|BCBS TRANE PPO|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 82272|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Blue Cross PPO|BLUE CROSS POS|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Blue Cross PPO Select|BCBS UTHCT|||||0.65||| 82272|EAP|0300|BLOOD OCCULT, SNGL SPEC DRE|Blue Cross PPO|BCBS WALMART|||||0.65||| 82272|EAP|0301|BLOOD OCCULT PEROX FECES 1-3|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Medicaid|MEDICAID|0.65||||||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Medicare|MEDICARE PART A|0.65||||||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Medicare|MEDICARE A & B|0.65||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|United Healthcare|UMR|||||0.65||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.65||||||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.65||||||| 82274|EAP|0301|FIT, COLORECTAL DIAGNOSTIC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 82300|EAP|0301|CADMIUM (REF)|Medicare|MEDICARE A & B|||||0.69||| 82300|EAP|0301|CADMIUM (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||165.70||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross PPO|BCBS TRANE PPO|||||1.48||| 82306|EAP|0301||Blue Cross PPO|BLUE CROSS POS|2.15||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross PPO|BCBS WALMART|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross PPO|BLUE CROSS PPO|2.15||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross PPO Select|BCBS UTHCT|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Blue Cross PPO Select|BCBS UTHCT|||||1.10||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.15||||2.15||| 82306|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Aetna|AETNA EXXON MOBIL|||||2.15||| 82306|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Aetna|AETNA|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.10||| 82306|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.15||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.15||||2.15||| 82306|EAP|0301||Aetna|AETNA|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.10||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Blue Cross PPO|BLUE CROSS POS|||||1.10||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||91.50||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Managed Medicaid|OTHER MEDICAID|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Managed Medicaid|MOLINA MEDICAID|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Managed Medicaid|MEDICAID CSHCN|||||2.15||| 82306|EAP|0301||Managed Medicaid|MOLINA MEDICAID|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.10||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|ChampVA|CHAMPVA OF CO DENVER|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.10||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Cigna|NALC HLTH BENEFIT|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Cigna|CIGNA OTHER|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Cigna|CIGNA OPEN ACCESS PLUS|||||2.15||| 82306|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||1.48||| 82306|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||0.81||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.10||| 82306|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.15||| 82306|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.48||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Managed Medicaid|FAMILY PLANNING GRANT|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Cigna|CIGNA OF TN CHATTANOOGA|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|United Healthcare|UMR|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|United Healthcare|GOLDEN RULE INSURANCE|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Blue Cross PPO|BLUE CROSS PPO|||||1.10||| 82306|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.10||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|PHCS|TML GRP INS|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Aetna|TRS COORDINATED CARE|||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|PHCS|WEB TPA|||||2.15||| 82306|EAP|0301||PHCS|TML GRP INS|||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Blue Cross PPO|BLUE CROSS POS|2.15||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.15||| 82306|EAP|0301||Multiplan|TML GRP INS|||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Multiplan|TML GRP INS|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Multiplan|WEB TPA|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|NON CONTRACTED|COMMERCIAL OTHER|||||1.10||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|NON CONTRACTED|PPO OTHER|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|NON CONTRACTED|COMMUNITY CARE|||||0.81||| 82306|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||2.15||| 82306|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|2.15||||0.81||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|NON CONTRACTED|BOONE CHAPMAN|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|NON CONTRACTED|COMMERCIAL OTHER|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.15||| 82306|EAP|0300|25-HYDROVITAMIN D2 D3 BY TANDE|Medicare|MEDICARE A & B|1.10||||1.10||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Medicare|MEDICARE RAILROAD|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Medicare|MEDICARE A & B|2.15||||2.15||| 82306|EAP|0301||Medicare|MEDICARE A & B|2.15||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Medicaid|MEDICAID|||||2.15||| 82306|EAP|0301|VITAMIN D, 25 HYDROXY|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.15||| 82308|EAP|0301||Medicare|MEDICARE A & B|||||2.60||| 82308|EAP|0301|CALCITONIN (REF)|Medicare|MEDICARE A & B|||||2.60||| 82308|EAP|0301|CALCITONIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.60||| 82310|EAP|0301|CALCIUM, TOTAL SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.90||| 82310|EAP|0301|CALCIUM, TOTAL SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Blue Cross PPO|BLUE CROSS PPO|||||0.90||| 82310|EAP|0301|CALCIUM, TOTAL SERUM|Blue Cross PPO|BLUE CROSS PPO|||||0.90||| 82310|EAP|0301|CALCIUM, TOTAL SERUM|Blue Cross PPO Select|BCBS UTHCT|||||57.50||| 82310|EAP|0301|CALCIUM, URINE|Blue Cross PPO|BLUE CROSS POS|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Blue Cross PPO Select|BCBS UTHCT|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.90||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.90||| 82310|EAP|0301|CALCIUM, TOTAL SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Medicare|MEDICARE RAILROAD|||||0.90||| 82310|EAP|0301|CALCIUM, TOTAL SERUM|Medicare|MEDICARE A & B|||||0.90||| 82310|EAP|0301|CALCIUM, URINE|Medicare|MEDICARE A & B|||||0.90||| 82330|EAP|0300|ASSAY OF CALCIUM|Multiplan|TML GRP INS|17.58||||||| 82330|EAP|0301|CALCIUM, IONIZED|Multiplan|WEB TPA|||||2.42||| 82330|EAP|0750||Medicare|MEDICARE A & B|||||20.18||| 82330|EAP|0300|ASSAY OF CALCIUM|NON CONTRACTED|COMMERCIAL OTHER|||||17.58||| 82330|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 82330|EAP|0370||Medicare|MEDICARE A & B|||||7.02||| 82330|EAP|0301|CALCIUM, IONIZED|NON CONTRACTED|COMMERCIAL OTHER|||||2.42||| 82330|EAP|0750||Medicare|MEDICARE A & B|||||29.16||| 82330|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|NON CONTRACTED|COMMERCIAL OTHER|||||2.42||| 82330|EAP|0750||Medicare|MEDICARE A & B|||||19.98||| 82330|EAP|0370||Medicare|MEDICARE A & B|||||1.76||| 82330|EAP|0270||Medicare|MEDICARE A & B|||||0.18||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||25.20||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||450.45||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||0.38||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||0.62||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||0.49||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||32.55||| 82330|EAP|0300|ASSAY OF CALCIUM|Medicare|MEDICARE A & B|17.58||||17.58||| 82330|EAP|0300|ASSAY OF CALCIUM|Medicare|MEDICARE PART A|17.58||||||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Medicare|MEDICARE A & B|2.42||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Medicare|MEDICARE RAILROAD|||||2.42||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||11.55||| 82330|EAP|0300|ASSAY OF CALCIUM|Medicaid|MEDICAID|||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|Medicare|MEDICARE A & B|2.42||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|United Healthcare|UMR|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|17.58||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.38||| 82330|EAP|0300|ASSAY OF CALCIUM|PHCS|TML GRP INS|17.58||||||| 82330|EAP|0300|ASSAY OF CALCIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|17.58||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|PHCS|WEB TPA|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|17.58||||17.58||| 82330|EAP|0300|ASSAY OF CALCIUM|Blue Cross PPO|BLUE CROSS PPO|17.58||||17.58||| 82330|EAP|0300|ASSAY OF CALCIUM|Blue Cross PPO|BCBS WALMART|17.58||||17.58||| 82330|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.86||| 82330|EAP|0301|CALCIUM, IONIZED|Aetna|AETNA EXXON MOBIL|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Aetna|AETNA|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.42||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.42||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Aetna|AETNA|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|17.58||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross PPO|BCBS WALMART|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|United Healthcare|UMR|||||2.42||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 82330|EAP|0300|ASSAY OF CALCIUM|Blue Cross PPO Select|BCBS UTHCT|||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Blue Cross PPO|BLUE CROSS PPO|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross PPO|BCBS TRANE PPO|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Medicare|MEDICARE RAILROAD|||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross PPO|BLUE CROSS PPO|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Blue Cross PPO|BLUE CROSS POS|2.42||||1.40||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross PPO|BLUE CROSS POS|2.42||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Blue Cross PPO Select|BCBS UTHCT|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Blue Cross PPO Select|BCBS UTHCT|||||0.38||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.42||| 82330|EAP|0272||Medicare|MEDICARE A & B|||||108.15||| 82330|EAP|0750||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 82330|EAP|0999||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 82330|EAP|0301|CALCIUM, IONIZED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Managed Medicaid|OTHER MEDICAID|||||17.58||| 82330|EAP|0370||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.02||| 82330|EAP|0300|ASSAY OF CALCIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|17.58||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Medicaid|MEDICAID|2.42||||||| 82330|EAP|0301|CALCIUM, IONIZED|NON CONTRACTED|BOONE CHAPMAN|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Managed Medicaid|SUPERIOR STAR MCD|17.58||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.42||| 82330|EAP|0300|ASSAY OF CALCIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|17.58||||17.58||| 82330|EAP|0301|CALCIUM, IONIZED|ChampVA|CHAMPVA OF CO DENVER|||||2.42||| 82330|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.06||| 82330|EAP|0300|ASSAY OF CALCIUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||17.58||| 82330|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| 82330|EAP|0300|ASSAY OF CALCIUM|NON CONTRACTED|COMMERCIAL OTHER 2|17.58||||||| 82330|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.55||| 82330|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.38||| 82330|EAP|0999||Medicare|MEDICARE A & B|||||0.00||| 82330|EAP|0301|CALCIUM, IONIZED|Cigna|CIGNA OF TN CHATTANOOGA|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.42||| 82330|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 82330|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.07||| 82330|EAP|0300|ASSAY OF CALCIUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|17.58||||||| 82330|EAP|0301|CALCIUM, IONIZED|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Cigna|NALC HLTH BENEFIT|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Cigna|CIGNA OTHER|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED (SERUM)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.42||| 82330|EAP|0301|CALCIUM, IONIZED|Cigna|CIGNA OPEN ACCESS PLUS|||||2.42||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.26||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.26||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.26||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Blue Cross PPO|BLUE CROSS PPO|||||1.26||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Blue Cross PPO Select|BCBS UTHCT|||||1.26||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||75.50||| 82340|EAP|0301|CALCIUM, 24-HR (URINE)|Medicare|MEDICARE A & B|||||1.26||| 82340|EAP|0301||Medicare|MEDICARE A & B|||||1.26||| 82365|EAP|0301|KIDNEY STONE ANALYSIS (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.78||| 82365|EAP|0301|KIDNEY STONE ANALYSIS (REF)|Medicare|MEDICARE A & B|||||1.78||| 82365|EAP|0301|KIDNEY STONE ANALYSIS (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.78||| 82374|EAP|0301||Medicare|MEDICARE A & B|||||0.90||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Aetna|AETNA|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Blue Cross PPO|BCBS TRANE PPO|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Blue Cross PPO|BLUE CROSS POS|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Blue Cross PPO|BLUE CROSS PPO|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Cigna|CIGNA OF TN CHATTANOOGA|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Blue Cross PPO Select|BCBS UTHCT|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN FLUID|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.35||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Managed Medicaid|SUPERIOR STAR MCD|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|United Healthcare|UMR|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.45||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|PHCS|TML GRP INS|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Multiplan|TML GRP INS|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|NON CONTRACTED|COMMERCIAL OTHER|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Medicaid|MEDICAID|2.45||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN FLUID|Medicare|MEDICARE A & B|||||0.35||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Medicare|MEDICARE A & B|||||2.45||| 82378|EAP|0301|CARCINOEMBRYONIC ANTIGEN|Medicare|MEDICARE PART A|||||2.45||| 82379|EAP|0301|CARNITINE, FREE & TOTAL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||71.40||| 82384|EAP|0301|CATHECHOLAMINES, PLASMA (REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 82384|EAP|0301|CATHECHOLAMINES,24-HR URINE-RF|Medicare|MEDICARE A & B|2.23||||2.23||| 82384|EAP|0301|CATHECHOLAMINES,24-HR URINE-RF|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 82384|EAP|0301|CATHECHOLAMINES,24-HR URINE-RF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 82384|EAP|0301|CATHECHOLAMINES, PLASMA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 82384|EAP|0301|CATHECHOLAMINES, PLASMA (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.23||| 82384|EAP|0301|CATHECHOLAMINES,24-HR URINE-RF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 82384|EAP|0301|CATHECHOLAMINES, PLASMA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 82390|EAP|0301|CERULOPLASMIN (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.13||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|United Healthcare|UMR|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|United Healthcare|AARP OF GA ATLANTA|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Medicare|MEDICARE A & B|||||2.13||| 82390|EAP|0301|CERULOPLASMIN (REF)|Medicaid|MEDICAID|||||2.13||| 82397|EAP|0300|CHEMILUMINESCENT ASSAY (8889)|United Healthcare|UMR|||||3.55||| 82397|EAP|0301|IGF BINDING PROTEIN-3 ARUP|Blue Cross PPO Select|BCBS UTHCT|||||3.07||| 82397|EAP|0300|CHEMILUMINESCENT ASSAY (8889)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.55||| 82435|EAP|0301||Medicare|MEDICARE A & B|||||0.75||| 82436|EAP|0301|CHLORIDE, URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.65||||||| 82436|EAP|0301|CHLORIDE, URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.65||||||| 82436|EAP|0301|CHLORIDE, URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.65||||||| 82436|EAP|0301|CHLORIDE, URINE|Blue Cross PPO|BLUE CROSS PPO|1.65||||||| 82436|EAP|0301|CHLORIDE, URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.65||||1.65||| 82436|EAP|0301|CHLORIDE, URINE|Medicare|MEDICARE A & B|1.65||||1.65||| 82438|EAP|0301|CHLORIDE, SWEAT|NON CONTRACTED|COMMERCIAL OTHER|||||1.89||| 82438|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| 82438|EAP|0301|CHLORIDE, SWEAT|Medicaid|MEDICAID|||||1.89||| 82438|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.60||| 82438|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.00||| 82438|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.11||| 82438|EAP|0309||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.54||| 82438|EAP|0301|CHLORIDE, SWEAT|United Healthcare|UMR|||||1.89||| 82438|EAP|0309||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.25||| 82438|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.64||| 82438|EAP|0301|CHLORIDE, SWEAT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.89||| 82438|EAP|0410||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.20||| 82438|EAP|0301|CHLORIDE, SWEAT|Blue Cross PPO|BLUE CROSS PPO|||||1.89||| 82438|EAP|0301|CHLORIDE, SWEAT|Blue Cross PPO|BLUE CROSS POS|||||1.89||| 82438|EAP|0301|CHLORIDE, SWEAT|Medicare|MEDICARE A & B|||||1.89||| 82438|EAP|0301|CHLORIDE, SWEAT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.89||| 82438|EAP|0301|CHLORIDE, SWEAT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.89||| 82438|EAP|0301|CHLORIDE, SWEAT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.89||| 82438|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.96||| 82438|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.32||| 82438|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.66||| 82438|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||0.19||| 82438|EAP|0301|CHLORIDE, SWEAT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.89||| 82438|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.09||| 82438|EAP|0301|CHLORIDE, SWEAT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.89||| 82438|EAP|0309||Cigna|CIGNA OF TN CHATTANOOGA|||||0.98||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Cigna|CIGNA OF TN CHATTANOOGA|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Blue Cross PPO|BLUE CROSS POS|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Blue Cross PPO|BCBS WALMART|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Blue Cross PPO|BLUE CROSS PPO|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Blue Cross PPO Select|BCBS UTHCT|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|PHCS|WEB TPA|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Medicare|MEDICARE A & B|||||0.64||| 82465|EAP|0301|CHOLESTEROL,SERUM OR WHOLE BLO|Multiplan|WEB TPA|||||0.64||| 82482|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||2.46||| 82523|EAP|0301|N-TELOPEPTIDE SERUM (ARUP)|Medicare|MEDICARE A & B|||||3.44||| 82523|EAP|0301|OSTEOPOROSIS MONITOR, URINE (R|Medicare|MEDICARE A & B|||||1.49||| 82523|EAP|0301|C-TELOPEPTIDE, BETA CROS SERUM|Medicare|MEDICARE A & B|||||1.96||| 82525|EAP|0301|COPPER (SERUM) (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.27||| 82525|EAP|0301|COPPER (SERUM) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.27||| 82525|EAP|0301|COPPER, 24 HR URINE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.27||| 82525|EAP|0301|COPPER (SERUM) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.27||| 82525|EAP|0301|COPPER (SERUM) (REF)|United Healthcare|UMR|||||88.85||| 82525|EAP|0301|COPPER (SERUM) (REF)|Medicare|MEDICARE A & B|||||2.27||| 82525|EAP|0301|COPPER, 24 HR URINE (REF)|Medicare|MEDICARE A & B|||||2.27||| 82530|EAP|0301||Medicare|MEDICARE A & B|||||1.28||| 82530|EAP|0301|CORTISOL, FREE 24-HR URINE (RE|Medicare|MEDICARE A & B|||||1.28||| 82530|EAP|0301|CORTISOL, FREE 24-HR URINE (RE|Blue Cross PPO|BLUE CROSS PPO|||||1.28||| 82530|EAP|0301|CORTISOL, SERUM FREE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.28||| 82530|EAP|0301|CORTISOL, FREE 24-HR URINE (RE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.28||| 82530|EAP|0301|CORTISOL, FREE 24-HR URINE (RE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.28||| 82530|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.28||| 82530|EAP|0301|CORTISOL, FREE 24-HR URINE (RE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.28||| 82530|EAP|0301|CORTISOL, SERUM FREE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.28||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|ChampVA|CHAMPVA OF CO DENVER|||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.46||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.79||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Managed Medicaid|MOLINA MEDICAID|||||0.46||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.79||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Blue Cross PPO|BLUE CROSS PPO|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Blue Cross PPO|BLUE CROSS POS|||||0.46||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Blue Cross PPO|BLUE CROSS PPO|||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Blue Cross PPO|BCBS TRANE PPO|||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Blue Cross PPO|BLUE CROSS POS|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Blue Cross PPO Select|BCBS UTHCT|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|United Healthcare|GOLDEN RULE INSURANCE|||||2.79||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|PHCS|TML GRP INS|||||0.46||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Multiplan|TML GRP INS|||||0.46||| 82533|EAP|0301|CORTISOL, PM (AFTER 1600)|Medicare|MEDICARE A & B|2.79||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.79||| 82533|EAP|0301|CORTISOL, AM (BEFORE 0800)|Medicare|MEDICARE A & B|2.79||||2.79||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|Medicare|MEDICARE A & B|2.07||||2.07||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||96.75||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.07||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|Blue Cross PPO|BLUE CROSS PPO|||||2.07||| 82542|EAP|0301|5-HIAA PLASMA (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||7.10||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.07||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.07||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|Cigna|CIGNA OF TN CHATTANOOGA|||||2.07||| 82542|EAP|0301|IMMUNOASSAY ANALYTE QUANT-REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.07||| 82550|EAP|0301|CK, TOTAL (CPK)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Managed Medicaid|MOLINA MEDICAID|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Managed Medicaid|SUPERIOR STAR MCD|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Aetna|AETNA EXXON MOBIL|||||0.25||| 82550|EAP|0301|CK, TOTAL (CPK)|Aetna|AETNA US HEALTHCARE PA|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross PPO|BCBS WALMART|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross PPO|BCBS TRANE PPO|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross PPO|BLUE CROSS PPO|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross PPO|BLUE CROSS POS|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Blue Cross PPO Select|BCBS UTHCT|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|United Healthcare|GOLDEN RULE INSURANCE|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|United Healthcare|UMR|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|PHCS|WEB TPA|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|PHCS|TML GRP INS|1.68||||||| 82550|EAP|0301|CK, TOTAL (CPK)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|NON CONTRACTED|COMMERCIAL OTHER 2|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|ChampVA|CHAMPVA OF CO DENVER|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Multiplan|WEB TPA|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Multiplan|TML GRP INS|1.68||||||| 82550|EAP|0301|CK, TOTAL (CPK)|NON CONTRACTED|COMMERCIAL OTHER|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|NON CONTRACTED|MRAMVA|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|NON CONTRACTED|PPO OTHER|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Medicare|MEDICARE PART A|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Medicaid|MEDICAID|1.68||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Medicare|MEDICARE RAILROAD|||||1.68||| 82550|EAP|0301|CK, TOTAL (CPK)|Medicare|MEDICARE A & B|1.68||||1.68||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Medicare|MEDICARE A & B|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Medicaid|MEDICAID|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|NON CONTRACTED|COMMERCIAL OTHER|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|NON CONTRACTED|PPO OTHER|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|United Healthcare|UMR|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|United Healthcare|GOLDEN RULE INSURANCE|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|PHCS|WEB TPA|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross PPO|BCBS WALMART|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross PPO Select|BCBS UTHCT|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Multiplan|WEB TPA|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross PPO|BLUE CROSS POS|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross PPO|BLUE CROSS PPO|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross PPO|BCBS TRANE PPO|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Medicare|MEDICARE PART A|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Managed Medicaid|SUPERIOR STAR MCD|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Managed Medicaid|MOLINA MEDICAID|||||0.33||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|ChampVA|CHAMPVA OF CO DENVER|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.74||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.74||| 82553|EAP|0301|CK-MB (QUANTITATIVE)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.74||||||| 82565|EAP|0301|CREATININE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.92||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Managed Medicaid|SUPERIOR STAR MCD|0.92||||||| 82565|EAP|0301|CREATININE, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross PPO|BLUE CROSS PPO|0.92||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross PPO|BLUE CROSS POS|0.92||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross PPO Select|BCBS UTHCT|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Blue Cross PPO|BCBS WALMART|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|United Healthcare|UMR|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.92||||0.92||| 82565|EAP|0301|CREATININE, SERUM|PHCS|TML GRP INS|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Multiplan|TML GRP INS|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|NON CONTRACTED|COMMERCIAL OTHER|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|NON CONTRACTED|MRAMVA|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Medicare|MEDICARE A & B|0.92||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Medicare|MEDICARE RAILROAD|||||0.92||| 82565|EAP|0301|CREATININE, SERUM|Medicare|MEDICARE PART B|||||0.92||| 82570|EAP|0301|CREATININE, RANDOM URINE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.22||| 82570|EAP|0301||Medicaid|MEDICAID|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Medicare|MEDICARE A & B|1.22||||1.22||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Medicare|MEDICARE A & B|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Medicare|MEDICARE RAILROAD|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Medicare|MEDICARE PART B|||||1.22||| 82570|EAP|0301||Medicare|MEDICARE A & B|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Multiplan|TML GRP INS|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|NON CONTRACTED|SIERRA HEALTH & LIFE|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|NON CONTRACTED|COMMERCIAL OTHER|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|NON CONTRACTED|BOONE CHAPMAN|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|United Healthcare|UMR|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|PHCS|TML GRP INS|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||73.50||| 82570|EAP|0301|CREATININE, RANDOM URINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross PPO|BLUE CROSS POS|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross PPO|BCBS TRANE PPO|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross PPO|BLUE CROSS PPO|1.22||||1.22||| 82570|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross PPO|BCBS WALMART|||||1.22||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Blue Cross PPO|BLUE CROSS PPO|1.22||||1.22||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Blue Cross PPO Select|BCBS UTHCT|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross PPO Select|BCBS UTHCT|1.22||||1.22||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.22||||1.22||| 82570|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Access Direct Platinum|ACCESS DIRECT|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.22||||1.22||| 82570|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Aetna|TRS COORDINATED CARE|||||0.25||| 82570|EAP|0301|CREATININE, RANDOM URINE|Aetna|AETNA EXXON MOBIL|||||1.22||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Aetna|AETNA EL PASO CLAIMS OFFICE|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Managed Medicaid|MEDICAID CSHCN|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Managed Medicaid|MOLINA MEDICAID|||||1.22||| 82570|EAP|0301||Managed Medicaid|FAMILY PLANNING GRANT|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Medicare|MEDICARE PART A|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Managed Medicaid|FAMILY PLANNING GRANT|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Managed Medicaid|SUPERIOR STAR MCD|||||1.22||| 82570|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.22||| 82570|EAP|0301||Managed Medicaid|MOLINA MEDICAID|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Medicaid|MEDICAID|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|ChampVA|CHAMPVA OF CO DENVER|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Cigna|NALC HLTH BENEFIT|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Cigna|CIGNA OTHER|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.22||||1.22||| 82570|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 82570|EAP|0301|CREATININE, RANDOM URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 82570|EAP|0301|CREATININE, 24-HR (URINE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 82595|EAP|0301|CRYOGLOBULIN, QUAL OR SEMI-QUA|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||46.35||| 82595|EAP|0301|CRYOGLOBULIN, QUAL OR SEMI-QUA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.14||| 82595|EAP|0301|CRYOGLOBULIN, QUAL OR SEMI-QUA|Blue Cross PPO|BLUE CROSS PPO|||||0.14||| 82607|EAP|0301||PHCS|TML GRP INS|||||0.42||| 82607|EAP|0301|B-12|United Healthcare|UMR|||||1.88||| 82607|EAP|0301|B-12|PHCS|WEB TPA|||||1.88||| 82607|EAP|0301|B-12|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.88||||1.88||| 82607|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.88||||0.42||| 82607|EAP|0301|B-12|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.88||| 82607|EAP|0301|B-12|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.88||| 82607|EAP|0301|B-12|PHCS|TML GRP INS|||||1.88||| 82607|EAP|0301|B-12|Multiplan|WEB TPA|||||1.88||| 82607|EAP|0301|B-12|Multiplan|TML GRP INS|||||1.88||| 82607|EAP|0301||Multiplan|TML GRP INS|||||0.42||| 82607|EAP|0301|B-12|NON CONTRACTED|COMMERCIAL OTHER|1.88||||1.88||| 82607|EAP|0301|B-12|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.88||| 82607|EAP|0301|B-12|Medicare|MEDICARE PART A|||||1.88||| 82607|EAP|0301||Medicare|MEDICARE A & B|1.88||||0.42||| 82607|EAP|0301|B-12|Medicaid|MEDICAID|1.88||||1.88||| 82607|EAP|0301||Blue Cross PPO|BCBS WALMART|||||0.42||| 82607|EAP|0301|B-12|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.88||||1.88||| 82607|EAP|0301||Blue Cross PPO|BLUE CROSS POS|1.88||||0.42||| 82607|EAP|0301|B-12|Blue Cross PPO|BLUE CROSS POS|1.88||||1.88||| 82607|EAP|0301|B-12|Blue Cross PPO|BCBS TRANE PPO|||||1.15||| 82607|EAP|0301|B-12|Blue Cross PPO|BCBS WALMART|||||1.88||| 82607|EAP|0301|B-12|Blue Cross PPO|BLUE CROSS PPO|1.15||||1.88||| 82607|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.88||||0.42||| 82607|EAP|0301|B-12|Blue Cross PPO Select|BCBS UTHCT|||||1.88||| 82607|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|1.15||||0.42||| 82607|EAP|0301|B-12|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.88||||1.88||| 82607|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.88||||1.88||| 82607|EAP|0301|B-12|Medicare|MEDICARE A & B|1.88||||1.88||| 82607|EAP|0301|B-12|Aetna|TRS COORDINATED CARE|||||1.88||| 82607|EAP|0301|B-12|Aetna|AETNA EXXON MOBIL|||||1.88||| 82607|EAP|0301|B-12|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.88||| 82607|EAP|0301|B-12|Aetna|AETNA|||||1.15||| 82607|EAP|0301|B-12|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.88||| 82607|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.42||| 82607|EAP|0301|B-12|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.88||||1.88||| 82607|EAP|0311||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.99||| 82607|EAP|0301|B-12|Cigna|CIGNA OPEN ACCESS PLUS|||||1.88||| 82607|EAP|0301|B-12|Cigna|CIGNA OF TN CHATTANOOGA|||||1.88||| 82607|EAP|0301|B-12|Cigna|CIGNA OF TN CHATTANOOGA|||||0.42||| 82607|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||1.15||| 82607|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||0.42||| 82607|EAP|0301|B-12|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.88||||1.88||| 82607|EAP|0301|B-12|Cigna|NALC HLTH BENEFIT|||||1.88||| 82607|EAP|0301|B-12|Cigna|CIGNA OTHER|||||1.88||| 82607|EAP|0301|B-12|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.88||||1.88||| 82607|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.88||||0.42||| 82607|EAP|0301|B-12|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.88||| 82607|EAP|0301|B-12|ChampVA|CHAMPVA OF CO DENVER|||||1.88||| 82607|EAP|0311||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.68||| 82607|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.88||||1.88||| 82607|EAP|0301|B-12|Managed Medicaid|FAMILY PLANNING GRANT|||||1.88||| 82607|EAP|0301|B-12|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.88||||1.88||| 82607|EAP|0301|B-12|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.88||| 82610|EAP|0301|CYSTATIN C, SERUM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.53||| 82626|EAP|0301|DHEA, SERUM (REF)|Medicare|MEDICARE A & B|||||0.55||| 82626|EAP|0301|DHEA, SERUM (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.18||| 82626|EAP|0301|DHEA, SERUM (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.81||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Blue Cross PPO|BCBS TRANE PPO|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|United Healthcare|GOLDEN RULE INSURANCE|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.49||| 82627|EAP|0301|DHEA SULFATE, SERUM (REF)|Medicare|MEDICARE A & B|||||0.49||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Medicare|MEDICARE RAILROAD|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Medicare|MEDICARE A & B|6.28||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|NON CONTRACTED|COMMERCIAL OTHER|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Blue Cross PPO|BLUE CROSS POS|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Blue Cross PPO|BLUE CROSS PPO|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Blue Cross PPO Select|BCBS UTHCT|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.28||| 82652|EAP|0301|VITAMIN D (1.25-DIHYDROXY)(REF|Aetna|AETNA EXXON MOBIL|||||6.28||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|Blue Cross PPO Select|BCBS UTHCT|||||3.00||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.00||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.00||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.00||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|Medicare|MEDICARE A & B|||||3.00||| 82657|EAP|0301|TPMT, ERYTHROCYTES (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.00||| 82657|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||3.00||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Medicare|MEDICARE A & B|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Medicaid|MEDICAID|3.18||||||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|United Healthcare|UMR|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.18||| 82668|EAP|0301|ERYTHROPOIETIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.18||||3.18||| 82670|EAP|0301|ESTRADIOL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Blue Cross PPO|BCBS WALMART|||||0.76||| 82670|EAP|0301|ESTRADIOL (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Managed Medicaid|MOLINA MEDICAID|||||0.76||| 82670|EAP|0301|ESTRADIOL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.76||| 82670|EAP|0301|ESTRADIOL (REF)|Medicare|MEDICARE A & B|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Medicare|MEDICARE RAILROAD|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|Medicaid|MEDICAID|||||2.54||| 82670|EAP|0301|ESTRADIOL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.76||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|United Healthcare|UMR|||||231.30||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.90||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|NON CONTRACTED|COMMERCIAL OTHER|||||231.30||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Medicare|MEDICARE A & B|||||6.90||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||6.90||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||460.65||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Cigna|CIGNA OPEN ACCESS PLUS|||||6.90||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||231.30||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Blue Cross PPO|BLUE CROSS PPO|||||231.30||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||6.90||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Blue Cross PPO|BCBS WALMART|||||231.30||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Blue Cross PPO Select|BCBS UTHCT|||||460.65||| 82671|EAP|0301|ESTROGENS, FRACTIONATED - SERU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||231.30||| 82677|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.11||| 82677|EAP|0301|ESTRIOL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||173.20||| 82679|EAP|0301||Medicare|MEDICARE A & B|||||1.05||| 82679|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||1.05||| 82679|EAP|0301|ESTRONE, SERUM (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||178.75||| 82679|EAP|0301|ESTRONE, SERUM (REF)|Blue Cross PPO Select|BCBS UTHCT|||||178.75||| 82693|EAP|0301|ETHYLENE GLYCOL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.37||| 82705|EAP|0301|FECAL FAT, QUAL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||36.45||| 82705|EAP|0301|FECAL FAT, QUAL (REF)|United Healthcare|UMR|||||0.58||| 82705|EAP|0301|FECAL FAT, QUAL (REF)|Medicare|MEDICARE A & B|||||0.58||| 82728|EAP|0301|FERRITIN (6822)|NON CONTRACTED|COMMERCIAL OTHER|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Multiplan|TML GRP INS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Multiplan|WEB TPA|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|NON CONTRACTED|COMMERCIAL OTHER|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|NON CONTRACTED|COMMERCIAL OTHER 2|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Medicare|MEDICARE A & B|182.99||||182.99||| 82728|EAP|0301||Medicare|MEDICARE A & B|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Medicare|MEDICARE PART A|182.99||||||| 82728|EAP|0301|FERRITIN, SERUM|Medicare|MEDICARE RAILROAD|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|PHCS|TML GRP INS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|PHCS|WEB TPA|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|United Healthcare|AARP OF GA ATLANTA|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Veterans Affairs|VETERANS CHOICE - TRI WEST|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Aetna|TRS COORDINATED CARE|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Aetna|AETNA EL PASO CLAIMS OFFICE|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross PPO|BLUE CROSS POS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|United Healthcare|UMR|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Blue Cross PPO|BLUE CROSS POS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross PPO|BLUE CROSS PPO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross PPO|BCBS TRANE PPO|182.99||||110.50||| 82728|EAP|0301|FERRITIN, SERUM|Medicaid|MEDICAID|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross PPO Select|BCBS UTHCT|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Blue Cross PPO Select|BCBS UTHCT|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Blue Cross PPO|BLUE CROSS PPO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Blue Cross PPO|BCBS WALMART|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Medicare|MEDICARE A & B|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Managed Medicaid|FAMILY PLANNING GRANT|||||0.38||| 82728|EAP|0301|FERRITIN, SERUM|Managed Medicaid|MEDICAID CSHCN|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|182.99||||182.99||| 82728|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Managed Medicaid|SUPERIOR STAR MCD|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Managed Medicaid|MOLINA MEDICAID|182.99||||110.50||| 82728|EAP|0301|FERRITIN, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|ChampVA|CHAMPVA OF CO DENVER|182.99||||182.99||| 82728|EAP|0301|FERRITIN (6822)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.38||| 82728|EAP|0301|FERRITIN (6822)|Humana Medicare Advantage|HUMANA MEDICARE PPO|182.99||||182.99||| 82728|EAP|0301|FERRITIN, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|182.99||||182.99||| 82746|EAP|0301|FOLATE, SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.73||| 82746|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.73||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.73||||1.73||| 82746|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||1.07||| 82746|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Cigna|NALC HLTH BENEFIT|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.73||||1.73||| 82746|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.73||||1.07||| 82746|EAP|0301|FOLATE, SERUM|Managed Medicaid|FAMILY PLANNING GRANT|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.73||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross PPO|BLUE CROSS PPO|0.41||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross PPO|BLUE CROSS POS|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.73||| 82746|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|0.41||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross PPO|BCBS WALMART|||||1.73||| 82746|EAP|0301||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||1.73||| 82746|EAP|0301||Blue Cross PPO|BLUE CROSS POS|||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross PPO Select|BCBS UTHCT|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Aetna|AETNA|||||1.07||| 82746|EAP|0301|FOLATE, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.73||| 82746|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.41||| 82746|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.73||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.73||||1.73||| 82746|EAP|0301|FOLATE, SERUM|PHCS|TML GRP INS|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.73||| 82746|EAP|0301||PHCS|TML GRP INS|||||0.41||| 82746|EAP|0301|FOLATE, SERUM|United Healthcare|UMR|||||1.07||| 82746|EAP|0301|FOLATE, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.73||||1.73||| 82746|EAP|0301|FOLATE, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.73||| 82746|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.73||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.73||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Medicare|MEDICARE PART A|||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Medicare|MEDICARE A & B|1.73||||1.73||| 82746|EAP|0301||Medicare|MEDICARE A & B|1.73||||0.41||| 82746|EAP|0301|FOLATE, SERUM|Medicaid|MEDICAID|1.73||||1.73||| 82746|EAP|0301|FOLATE, SERUM|Multiplan|TML GRP INS|||||1.73||| 82746|EAP|0301||Multiplan|TML GRP INS|||||0.41||| 82746|EAP|0301|FOLATE, SERUM|NON CONTRACTED|COMMERCIAL OTHER|1.73||||1.73||| 82747|EAP|0301|FOLATE, RBC (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.16||| 82747|EAP|0301||Medicare|MEDICARE A & B|2.16||||0.49||| 82747|EAP|0301|FOLATE, RBC (REF)|Medicare|MEDICARE A & B|2.16||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|United Healthcare|UMR|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.16||| 82747|EAP|0301|FOLATE, RBC (REF)|ChampVA|CHAMPVA OF CO DENVER|||||2.16||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|ChampVA|CHAMPVA OF CO DENVER|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|ChampVA|CHAMPVA OF CO DENVER|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Cigna|CIGNA OPEN ACCESS PLUS|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Cigna|CIGNA OPEN ACCESS PLUS|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Cigna|CIGNA OF TN CHATTANOOGA|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Cigna|CIGNA OF TN CHATTANOOGA|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.35||| 82784|EAP|0301|IGD (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.35||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Managed Medicaid|MOLINA MEDICAID|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Managed Medicaid|MOLINA MEDICAID|||||1.35||| 82784|EAP|0301|IGD (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Managed Medicaid|MOLINA MEDICAID|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Blue Cross PPO|BLUE CROSS POS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Blue Cross PPO|BLUE CROSS PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Blue Cross PPO|BLUE CROSS POS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Blue Cross PPO|BLUE CROSS PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBUL-(IGA,IGB,IGG,IGM|Blue Cross PPO|BLUE CROSS PPO|||||2.97||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Blue Cross PPO|BLUE CROSS PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Blue Cross PPO|BLUE CROSS POS|1.35||||1.35||| 82784|EAP|0301|IGD (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.53||| 82784|EAP|0301||Blue Cross PPO|BLUE CROSS POS|1.35||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Blue Cross PPO|BLUE CROSS POS|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Blue Cross PPO|BLUE CROSS POS|1.35||||1.35||| 82784|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||66.60||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Blue Cross PPO|BCBS TRANE PPO|1.35||||||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Blue Cross PPO Select|BCBS UTHCT|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Blue Cross PPO Select|BCBS UTHCT|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Blue Cross PPO Select|BCBS UTHCT|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Blue Cross PPO Select|BCBS UTHCT|||||1.03||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Aetna|AETNA EL PASO CLAIMS OFFICE|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Aetna|AETNA EL PASO CLAIMS OFFICE|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Blue Cross PPO|BLUE CROSS PPO|||||1.35||| 82784|EAP|0301|IGD (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Blue Cross PPO|BLUE CROSS PPO|||||1.35||| 82784|EAP|0301|IGA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Aetna|AETNA EL PASO CLAIMS OFFICE|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Aetna|AETNA EL PASO CLAIMS OFFICE|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.03||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|United Healthcare|UMR|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|United Healthcare|UMR|||||1.35||| 82784|EAP|0301|IGA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|United Healthcare|UMR|||||1.35||| 82784|EAP|0301|IGD (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.71||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.71||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Cigna|CIGNA OPEN ACCESS PLUS|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.35||| 82784|EAP|0301|IGD (REF)|Medicare|MEDICARE A & B|1.35||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|Medicare|MEDICARE A & B|1.35||||1.35||| 82784|EAP|0301|IGD (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Medicare|MEDICARE A & B|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Medicare|MEDICARE PART A|1.35||||||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|ChampVA|CHAMPVA OF CO DENVER|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Medicare|MEDICARE A & B|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM|Medicare|MEDICARE A & B|1.35||||1.35||| 82784|EAP|0301|IGA (REF)|Medicare|MEDICARE A & B|1.53||||1.53||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Medicaid|MEDICAID|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Medicaid|MEDICAID|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Medicaid|MEDICAID|||||1.35||| 82784|EAP|0301||Medicare|MEDICARE A & B|1.53||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|Medicare|MEDICARE A & B|1.35||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGG|NON CONTRACTED|COMMERCIAL OTHER|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA|NON CONTRACTED|COMMERCIAL OTHER|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|NON CONTRACTED|COMMERCIAL OTHER|||||1.35||| 82784|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|NON CONTRACTED|COMMERCIAL OTHER|||||1.35||| 82785|EAP|0301|IGE, TOTAL|NON CONTRACTED|COMMERCIAL OTHER|||||2.35||| 82785|EAP|0301|IGE, TOTAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Multiplan|WEB TPA|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Medicare|MEDICARE PART A|2.35||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Medicare|MEDICARE PART A|0.67||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Medicare|MEDICARE A & B|0.67||||0.67||| 82785|EAP|0301|IGE, TOTAL|Medicaid|MEDICAID|2.35||||176.48||| 82785|EAP|0301||Medicare|MEDICARE A & B|2.35||||2.35||| 82785|EAP|0301|IGE, TOTAL|PHCS|TML GRP INS|||||2.35||| 82785|EAP|0301|IGE, TOTAL|United Healthcare|UMR|||||2.35||| 82785|EAP|0301|IGE, TOTAL|United Healthcare|GOLDEN RULE INSURANCE|||||2.35||| 82785|EAP|0301|IGE, TOTAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||117.95||| 82785|EAP|0301|IGE, TOTAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||176.48||| 82785|EAP|0301|IGE, TOTAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.35||| 82785|EAP|0301|IGE, TOTAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Aetna|TRS COORDINATED CARE|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Aetna|AETNA EL PASO CLAIMS OFFICE|2.35||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.67||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.35||||0.67||| 82785|EAP|0301|IGE, TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Blue Cross PPO|BLUE CROSS POS|2.35||||0.67||| 82785|EAP|0301|IGE, TOTAL|Blue Cross PPO|BCBS TRANE PPO|||||176.48||| 82785|EAP|0301|IGE, TOTAL|Blue Cross PPO|BLUE CROSS POS|2.35||||2.35||| 82785|EAP|0301|IGE, TOTAL|Blue Cross PPO|BLUE CROSS PPO|2.35||||2.35||| 82785|EAP|0301|IGE, TOTAL|Blue Cross PPO|BCBS WALMART|||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Blue Cross PPO|BLUE CROSS PPO|2.35||||0.67||| 82785|EAP|0301|IGE, TOTAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||117.95||| 82785|EAP|0301|IGE, TOTAL|PHCS|WEB TPA|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Blue Cross PPO Select|BCBS UTHCT|||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.67||| 82785|EAP|0301|IGE, TOTAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Managed Medicaid|MOLINA MEDICAID|||||0.67||| 82785|EAP|0301|IGE, TOTAL|Medicare|MEDICARE A & B|0.67||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Managed Medicaid|MEDICAID CSHCN|||||0.67||| 82785|EAP|0301|IGE, TOTAL|Managed Medicaid|OTHER MEDICAID|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Multiplan|TML GRP INS|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Managed Medicaid|MOLINA MEDICAID|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Managed Medicaid|MEDICAID CSHCN|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||176.48||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.35||||0.67||| 82785|EAP|0301|IGE, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.35||| 82785|EAP|0301|IMMUNOGLOBULIN E (5970)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.67||| 82785|EAP|0301|IGE, TOTAL|Cigna|NALC HLTH BENEFIT|2.35||||||| 82785|EAP|0301|IGE, TOTAL|Cigna|CIGNA OTHER|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Cigna|CIGNA OPEN ACCESS PLUS|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.35||| 82785|EAP|0301|IGE, TOTAL|Cigna|CIGNA OF TN CHATTANOOGA|||||117.95||| 82785|EAP|0301|IGE, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.35||||2.35||| 82785|EAP|0301|IGE, TOTAL|ChampVA|CHAMPVA OF CO DENVER|||||117.95||| 82787|EAP|0301|IMMUNO G SUBCLASSES 2,3,4(REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.16||| 82787|EAP|0301|IMMUNO G SUBCLASSES 2,3,4(REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.16||| 82787|EAP|0301|IMMUNO G SUBCLASSES 2,3,4(REF)|Medicare|MEDICARE A & B|||||0.16||| 82787|EAP|0301|IMMUNOGLOBULIN SUBCLASSES(REF)|Medicare|MEDICARE A & B|||||0.16||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|PHCS|TML GRP INS|33.49||||||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Veterans Affairs|VETERANS CHOICE - TRI WEST|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Multiplan|TML GRP INS|33.49||||||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|NON CONTRACTED|COMMERCIAL OTHER 2|33.49||||||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|NON CONTRACTED|COMMERCIAL OTHER|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Medicare|MEDICARE RAILROAD|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Medicare|MEDICARE PART A|33.49||||||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Medicare|MEDICARE A & B|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Medicaid|MEDICAID|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Blue Cross PPO Select|BCBS UTHCT|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Blue Cross PPO|BLUE CROSS PPO|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Blue Cross PPO|BCBS WALMART|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Aetna|AETNA EL PASO CLAIMS OFFICE|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Managed Medicaid|OTHER MEDICAID|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Managed Medicaid|SUPERIOR STAR MCD|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Humana Medicare Advantage|HUMANA MEDICARE PPO|33.49||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||33.49||| 82803|EAP|0300|BLOOD GASES ANY COMBINATION|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|33.49||||||| 82805|EAP|0309|BLOOD GAS COMPLETE|Blue Cross PPO Select|BCBS UTHCT|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE PPO|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Cigna|NALC HLTH BENEFIT|5.39||||||| 82805|EAP|0309|BLOOD GAS COMPLETE|Cigna|CIGNA OF TN CHATTANOOGA|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|ChampVA|CHAMPVA OF CO DENVER|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Managed Medicaid|SUPERIOR STAR MCD|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Managed Medicaid|FAMILY PLANNING GRANT|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Managed Medicaid|MEDICAID CSHCN|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Aetna|AETNA EL PASO CLAIMS OFFICE|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Blue Cross PPO|BLUE CROSS PPO|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Blue Cross PPO|BLUE CROSS POS|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Medicare|MEDICARE PART A|5.39||||||| 82805|EAP|0309|BLOOD GAS COMPLETE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Medicaid|MEDICAID|5.39||||5.39||| 82805|EAP|0301|BLOOD GAS (BEDSIDE) PO2 02|Medicare|MEDICARE PART A|5.39||||||| 82805|EAP|0309|BLOOD GAS COMPLETE|Medicare|MEDICARE A & B|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Medicare|MEDICARE RAILROAD|5.39||||||| 82805|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 82805|EAP|0309|BLOOD GAS COMPLETE|Multiplan|WEB TPA|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|NON CONTRACTED|COMMERCIAL OTHER|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|PHCS|WEB TPA|||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|Veterans Affairs|VETERANS CHOICE - TRI WEST|5.39||||5.39||| 82805|EAP|0309|BLOOD GAS COMPLETE|United Healthcare|UMR|5.39||||5.39||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|PHCS|WEB TPA|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.18||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Multiplan|WEB TPA|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|NON CONTRACTED|COMMERCIAL OTHER|3.18||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|NON CONTRACTED|BOONE CHAPMAN|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Medicare|MEDICARE RAILROAD|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Medicare|MEDICARE PART A|3.18||||||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Medicare|MEDICARE A & B|3.18||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross PPO Select|BCBS UTHCT|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Aetna|AETNA EXXON MOBIL|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross PPO|BCBS TRANE PPO|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross PPO|BLUE CROSS POS|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross PPO|BCBS WALMART|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Blue Cross PPO|BLUE CROSS PPO|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Aetna|AETNA|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|United Healthcare|UMR|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Managed Medicaid|SUPERIOR STAR MCD|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Cigna|NALC HLTH BENEFIT|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Cigna|CIGNA OF TN CHATTANOOGA|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|ChampVA|CHAMPVA OF CO DENVER|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Cigna|CIGNA OPEN ACCESS PLUS|||||3.18||| 82810|EAP|0300|BLOOD GASES, O2 SAT ONLY|Cigna|CIGNA OTHER|||||3.18||| 82941|EAP|0301|GASTRIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 82941|EAP|0301|GASTRIN (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.34||| 82941|EAP|0301|GASTRIN (REF)|Medicare|MEDICARE A & B|||||2.34||| 82941|EAP|0301|GASTRIN (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.34||| 82943|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.93||| 82943|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.93||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Cigna|NALC HLTH BENEFIT|||||1.19||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.19||||1.19||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.19||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.19||||1.19||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Blue Cross PPO|BLUE CROSS PPO|1.19||||1.19||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Blue Cross PPO|BLUE CROSS POS|1.19||||||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Medicare|MEDICARE A & B|1.19||||1.19||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|Medicare|MEDICARE PART A|1.19||||||| 82945|EAP|0301|GLUCOSE,BODY FLUID,OTHER|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.19||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.73||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.07||||||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.07||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|NON CONTRACTED|COMMERCIAL OTHER|1.07||||0.73||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Medicare|MEDICARE PART A|1.07||||||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Medicare|MEDICARE A & B|1.07||||1.07||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Medicare|MEDICARE A & B|1.07||||0.73||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.07||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Blue Cross PPO|BLUE CROSS POS|||||0.25||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Blue Cross PPO|BCBS WALMART|1.07||||||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Blue Cross PPO|BLUE CROSS PPO|||||0.73||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Blue Cross PPO|BLUE CROSS POS|||||0.73||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Blue Cross PPO|BLUE CROSS PPO|||||1.07||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Blue Cross PPO Select|BCBS UTHCT|||||0.73||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Blue Cross PPO Select|BCBS UTHCT|||||1.07||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.07||||0.73||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.66||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|NON CONTRACTED|COMMERCIAL OTHER|1.07||||0.73||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.73||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Managed Medicaid|MOLINA MEDICAID|||||0.25||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|United Healthcare|UMR|1.07||||1.07||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.07||||1.07||| 82947|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.07||||0.73||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.07||||0.73||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.07||||1.07||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Managed Medicaid|FAMILY PLANNING GRANT|||||1.07||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.73||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Cigna|NALC HLTH BENEFIT|1.07||||||| 82947|EAP|0301|GLUCOSE; QUANT, BLOOD|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.07||||1.07||| 82947|EAP|0301|GLUCOSE;QUANTITAIVE,BLOOD|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.07||||1.07||| 82947|EAP|0301|GLUCOSE QUANT BLOOD (6822)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.07||||0.73||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|ChampVA|CHAMPVA OF CO DENVER|||||1.07||| 82948|EAP|0370||Blue Cross PPO Select|BCBS UTHCT|||||1.76||| 82948|EAP|0370||Blue Cross PPO Select|BCBS UTHCT|||||7.02||| 82948|EAP|0750||Blue Cross PPO Select|BCBS UTHCT|||||20.18||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Cigna|NALC HLTH BENEFIT|1.07||||||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Managed Medicaid|MOLINA MEDICAID|1.07||||||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Managed Medicaid|SUPERIOR STAR MCD|1.07||||1.07||| 82948|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.07||||1.07||| 82948|EAP|0750||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| 82948|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|1.07||||||| 82948|EAP|0949||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 82948|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Aetna|AETNA|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.07||||1.07||| 82948|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.07||||1.07||| 82948|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross PPO Select|BCBS UTHCT|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross PPO|BCBS TRANE PPO|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross PPO|BCBS WALMART|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross PPO|BLUE CROSS PPO|1.07||||1.07||| 82948|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.18||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||11.55||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||13.94||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||25.20||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.07||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.06||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||5.25||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||34.80||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Blue Cross PPO|BLUE CROSS POS|1.07||||1.07||| 82948|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 82948|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.38||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||4.90||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Aetna|AETNA EXXON MOBIL|||||1.07||| 82948|EAP|0272||Blue Cross PPO Select|BCBS UTHCT|||||0.62||| 82948|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Medicare|MEDICARE PART A|1.07||||||| 82948|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 82948|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Medicare|MEDICARE PART B|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Medicare|MEDICARE A & B|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Medicare|MEDICARE RAILROAD|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.07||| 82948|EAP|0999||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Medicaid|MEDICAID|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|NON CONTRACTED|COMMERCIAL OTHER 2|1.07||||1.07||| 82948|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 82948|EAP|0750||Blue Cross PPO Select|BCBS UTHCT|||||19.98||| 82948|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Multiplan|TML GRP INS|1.07||||||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|NON CONTRACTED|BOONE CHAPMAN|||||1.07||| 82948|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|NON CONTRACTED|MRAMVA|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|NON CONTRACTED|COMMERCIAL OTHER|1.07||||1.07||| 82948|EAP|0510||NON CONTRACTED|BOONE CHAPMAN|||||2.64||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|PHCS|TML GRP INS|1.07||||||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|United Healthcare|UMR|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.07||| 82948|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.07||||1.07||| 82948|EAP|0301|GLUCOSE (ACCUCHECK)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.07||| 82951|EAP|0301|GLUCOSE TOLERANCE-1ST THREE DR|Medicare|MEDICARE A & B|||||0.38||| 82951|EAP|0301|GLUCOSE TOLERANCE-1ST THREE DR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.38||| 82951|EAP|0301|GLUCOSE TOLERANCE-1ST THREE DR|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.38||| 82951|EAP|0301|GLUCOSE TOLERANCE-1ST THREE DR|Cigna|CIGNA OPEN ACCESS PLUS|||||0.38||| 82952|EAP|0301|GLUCOSE TOLERANCE - 1ST ADDL S|Cigna|CIGNA OPEN ACCESS PLUS|||||2.63||| 82952|EAP|0301|GLUCOSE TOLERANCE - 1ST ADDL S|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.63||| 82952|EAP|0301|GLUCOSE TOLERANCE - 1ST ADDL S|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.63||| 82952|EAP|0301|GLUCOSE TOLERANCE - 1ST ADDL S|Medicare|MEDICARE A & B|||||2.63||| 82962|EAP|0300|POC GLUCOSE BLOOD TEST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.20||| 82962|EAP|0300|POC GLUCOSE BLOOD TEST|Medicare|MEDICARE A & B|||||0.20||| 82962|EAP|0300|POC GLUCOSE BLOOD TEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.20||| 82962|EAP|0301|GLUCOSE (ACCUCHECK) OH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 82962|EAP|0300|POC GLUCOSE BLOOD TEST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.20||| 82977|EAP|0301|GAMMA GT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.66||| 82977|EAP|0301|GGT (6678)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 82977|EAP|0301|GGT (6678)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 82977|EAP|0301|GGT (6678)|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|FAMILY PLANNING GRANT|||||0.25||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.66||| 82977|EAP|0301|GGT (6678)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.65||| 82977|EAP|0301|GGT (6678)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 82977|EAP|0301|GGT (6678)|Blue Cross PPO|BLUE CROSS PPO|1.66||||0.65||| 82977|EAP|0301|GAMMA GT|Blue Cross PPO|BLUE CROSS PPO|1.66||||1.66||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|MOLINA MEDICAID|||||1.66||| 82977|EAP|0301|GAMMA GT|Blue Cross PPO Select|BCBS UTHCT|||||1.66||| 82977|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 82977|EAP|0301|GAMMA GT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.66||| 82977|EAP|0301|GGT (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 82977|EAP|0301|GAMMA GT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.66||| 82977|EAP|0301|GAMMA GT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.66||| 82977|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 82977|EAP|0301|GGT (6678)|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 82977|EAP|0301||Medicare|MEDICARE A & B|1.66||||0.65||| 82977|EAP|0301|GGT (6678)|Medicare|MEDICARE A & B|1.66||||0.65||| 82977|EAP|0301|GGT (PART OF 6576)|Medicare|MEDICARE A & B|1.66||||1.17||| 82977|EAP|0301|GAMMA GT|Medicare|MEDICARE A & B|1.66||||1.66||| 82977|EAP|0301|GGT (6678)|Medicaid|MEDICAID|||||0.65||| 82977|EAP|0301|GGT (6678)|United Healthcare|UMR|||||0.65||| 82977|EAP|0301|GGT (6678)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|United Healthcare|UMR|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Medicare|MEDICARE A & B|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Medicaid|MEDICAID|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|NON CONTRACTED|COMMERCIAL OTHER|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Blue Cross PPO|BLUE CROSS POS|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Blue Cross PPO|BLUE CROSS PPO|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Blue Cross PPO|BCBS WALMART|||||0.52||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Blue Cross PPO Select|BCBS UTHCT|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Managed Medicaid|FAMILY PLANNING GRANT|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Managed Medicaid|MOLINA MEDICAID|||||0.52||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.65||| 83001|EAP|0301|FOLLICLE STIM HORMONE|ChampVA|CHAMPVA OF CO DENVER|||||1.65||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|ChampVA|CHAMPVA OF CO DENVER|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Managed Medicaid|MOLINA MEDICAID|||||0.52||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Blue Cross PPO|BLUE CROSS POS|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Blue Cross PPO|BCBS WALMART|||||0.52||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Blue Cross PPO|BLUE CROSS PPO|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Blue Cross PPO Select|BCBS UTHCT|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|NON CONTRACTED|COMMERCIAL OTHER|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Medicare|MEDICARE A & B|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|Medicaid|MEDICAID|||||2.17||| 83002|EAP|0301|LUTEINIZING HORMONE (LH)|United Healthcare|UMR|||||2.17||| 83003|EAP|0301|GROWTH HORMONE (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.71||| 83003|EAP|0301|GROWTH HORMONE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.71||| 83010|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 83010|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.98||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.98||||0.65||| 83010|EAP|0301|HAPTOGLOBIN, QUANT. (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.98||||1.98||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN, QUANT. (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.98||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN, QUANT. (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.98||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Medicare|MEDICARE A & B|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN, QUANT. (REF)|Medicare|MEDICARE A & B|||||1.98||| 83010|EAP|0301||Medicare|MEDICARE A & B|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|Medicaid|MEDICAID|||||0.65||| 83010|EAP|0301||Medicare|MEDICARE A & B|||||1.98||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|United Healthcare|UMR|||||0.65||| 83010|EAP|0301|HAPTOGLOBIN QUANT (6678)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 83013|EAP|0301||United Healthcare|UMR|||||2.67||| 83013|EAP|0301|H. PYLORI BREATH ADULT (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||2.67||| 83013|EAP|0301|H. PYLORI BREATH ADULT (ARUP)|Medicare|MEDICARE A & B|||||2.67||| 83013|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.67||| 83013|EAP|0301|H. PYLORI BREATH ADULT (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.67||| 83013|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.84||| 83013|EAP|0301|H. PYLORI BREATH PEDS (ARUP)|Managed Medicaid|MOLINA MEDICAID|||||3.28||| 83013|EAP|0301|H. PYLORI BREATH ADULT (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||2.67||| 83013|EAP|0301|H. PYLORI BREATH ADULT (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||2.67||| 83013|EAP|0301|H. PYLORI BREATH PEDS (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||3.28||| 83013|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.84||| 83013|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.84||| 83021|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|||||0.37||| 83021|EAP|0301|HEMOGLOBIN FRACT& QUANT;CHROMA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.37||| 83021|EAP|0301|HEMOGLOBIN FRACT & QUANT;CHROM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.37||| 83021|EAP|0301|HEMOGLOBIN FRACT& QUANT;CHROMA|Blue Cross PPO Select|BCBS UTHCT|||||0.37||| 83021|EAP|0301|HEMOGLOBIN FRACT& QUANT;CHROMA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.37||| 83021|EAP|0301|HEMOGLOBIN FRACT& QUANT;CHROMA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||83.15||| 83021|EAP|0301|HEMOGLOBIN FRACT& QUANT;CHROMA|Medicaid|MEDICAID|0.37||||||| 83021|EAP|0301|HEMOGLOBIN FRACT& QUANT;CHROMA|Medicare|MEDICARE A & B|||||0.37||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Workers Compensation|WC TX MUTUAL INS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|PHCS|WEB TPA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|PHCS|TML GRP INS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|United Healthcare|UMR|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|PHCS|PHCS OF AZ PHEONIX|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|United Healthcare|UMR|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|United Healthcare|GOLDEN RULE INSURANCE|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|United Healthcare|GOLDEN RULE INSURANCE|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|PHCS|WEB TPA|||||1.04||| 83036|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.63||| 83036|EAP|0300|HEMOGLOBIN A1C (ARUP)(0070426)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.63||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Multiplan|PHCS OF AZ PHEONIX|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Multiplan|WEB TPA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|NON CONTRACTED|SIERRA HEALTH & LIFE|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|NON CONTRACTED|COMMERCIAL OTHER|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|NON CONTRACTED|BOONE CHAPMAN|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|NON CONTRACTED|BOONE CHAPMAN|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|NON CONTRACTED|COMMERCIAL OTHER 2|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Multiplan|WEB TPA|||||1.04||| 83036|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|NON CONTRACTED|PPO OTHER|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Optum Behavioral Health|OPTUM|1.63||||||| 83036|EAP|0301||Medicare|MEDICARE A & B|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicare|MEDICARE PART B|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Medicare|MEDICARE A & B|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicare|RESERVE NAT INS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Medicare|MEDICARE RAILROAD|||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicare|MEDICARE A & B|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicaid|MEDICAID|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Medicaid|MEDICAID|1.63||||1.63||| 83036|EAP|0301||Medicaid|MEDICAID|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicare|MEDICARE RAILROAD|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.63||||1.63||| 83036|EAP|0300|HEMOGLOBIN A1C (ARUP)(0070426)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN|ChampVA|CHAMPVA OF CO DENVER|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|ChampVA|CHAMPVA OF CO DENVER|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.04||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Cigna|CIGNA OF TN CHATTANOOGA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Cigna|CIGNA OPEN ACCESS PLUS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Cigna|NALC HLTH BENEFIT|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Cigna|CIGNA OF TN CHATTANOOGA|||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Cigna|CIGNA BEHAVIORAL HEALTH|1.63||||||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Cigna|CIGNA OTHER|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Medicare|MEDICARE PART A|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Medicare|MEDICARE PART A|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Cigna|CIGNA OTHER|||||1.63||| 83036|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|SUPERIOR STAR MCD|||||0.45||| 83036|EAP|0301|GLYCOHEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER 2|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Managed Medicaid|SUPERIOR STAR MCD|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Managed Medicaid|MEDICAID CSHCN|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|FAMILY PLANNING GRANT|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Multiplan|TML GRP INS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Managed Medicaid|FAMILY PLANNING GRANT|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|OTHER MEDICAID|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|MOLINA MEDICAID|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.63||||1.63||| 83036|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Aetna|AETNA EL PASO CLAIMS OFFICE|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Aetna|AETNA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Aetna|AETNA EL PASO CLAIMS OFFICE|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Aetna|AETNA EXXON MOBIL|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Aetna|AETNA|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Aetna|TRS COORDINATED CARE|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Access Direct Platinum|ACCESS DIRECT|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.63||| 83036|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross PPO|BLUE CROSS POS|1.63||||1.63||| 83036|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|1.63||||0.19||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross PPO|BLUE CROSS PPO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross PPO|BLUE CROSS PPO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross PPO|BCBS WALMART|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross PPO|BCBS TRANE PPO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross PPO|BLUE CROSS POS|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross PPO|BCBS TRANE PPO|1.63||||0.45||| 83036|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN|Blue Cross PPO Select|BCBS UTHCT|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross PPO|BCBS WALMART|1.63||||1.63||| 83036|EAP|0301|GLYCOHEMOGLOBIN, POC|Blue Cross PPO Select|BCBS UTHCT|1.63||||1.63||| 83088|EAP|0301|HISTAMINE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 83088|EAP|0301|HISTAMINE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.65||| 83088|EAP|0301|HISTAMINE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 83088|EAP|0301|HISTAMINE (REF)|Medicare|MEDICARE A & B|||||0.65||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|PHCS|TML GRP INS|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|NON CONTRACTED|COMMERCIAL OTHER|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Multiplan|TML GRP INS|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Medicare|MEDICARE RAILROAD|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Medicare|MEDICARE A & B|6.20||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|ChampVA|CHAMPVA OF CO DENVER|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Managed Medicaid|MOLINA MEDICAID|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|6.20||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Blue Cross PPO|BLUE CROSS PPO|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Blue Cross PPO|BLUE CROSS POS|||||6.20||| 83090|EAP|0301|HOMOCYST(E)INE, SERUM|Blue Cross PPO Select|BCBS UTHCT|||||6.20||| 832|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC|NON CONTRACTED|COMMERCIAL OTHER|9,184.34|9184.34|9184.34|9184.34|||| 83497|EAP|0301|HIAA, 24 HR URINE (REF) (V)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 83497|EAP|0301|HIAA, 24 HR URINE (REF) (V)|Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 83497|EAP|0301||Medicare|MEDICARE A & B|||||2.64||| 83497|EAP|0301|HIAA, 24 HR URINE (REF) (V)|Medicare|MEDICARE A & B|||||2.64||| 83498|EAP|0301|17-HYDROXYPROGESTERONE (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.75||| 83498|EAP|0301|17-HYDROXYPROGESTERONE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.75||| 83498|EAP|0301|17-HYDROXYPROGESTERONE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.75||| 835|DRG||ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|104,671.49|7913.88|7913.88|7913.88|||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|United Healthcare|UMR|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|United Healthcare|AARP OF GA ATLANTA|||||2.66||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|United Healthcare|UMR|||||2.66||| 83516|EAP|0301|F-ACTIN SM AB IgG ELISA (ARUP)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.50||| 83516|EAP|0302|GLUTAMIC ACID DECARB AB (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.94||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.66||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.66||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.66||| 83516|EAP|0301|RNA POLYMERASE III AB IGG|NON CONTRACTED|COMMERCIAL OTHER|||||1.53||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|NON CONTRACTED|COMMERCIAL OTHER|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.66||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.66||| 83516|EAP|0301|ANTI-HISTONE AB (REF)|Medicare|MEDICARE A & B|0.50||||2.66||| 83516|EAP|0301|IMMUNOASSAY FOR ANALYTE EACH|Medicare|MEDICARE A & B|2.66||||3.11||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|GLIADIN, IGA (PART OF 4785)|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|SERINE PROTEASE 3 AB (REF)|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|F-ACTIN SM AB IgG ELISA (ARUP)|Medicare|MEDICARE A & B|2.66||||0.50||| 83516|EAP|0301||Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|SMOOTH MUSCLE AB W/REFLEX|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Medicaid|MEDICAID|||||2.66||| 83516|EAP|0302|GLUTAMIC ACID DECARB AB (ARUP)|Medicare|MEDICARE A & B|0.78||||0.94||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Medicare|MEDICARE A & B|0.78||||0.78||| 83516|EAP|0302|FLU NONINF AGT ANTIBBY - REF|Medicare|MEDICARE A & B|0.78||||4.14||| 83516|EAP|0301|MYELOPEROXIDASE (MPO) (REF)|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0302|GLUTAMIC ACID DECARB AB (ARUP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.94||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.66||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.66||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.78||| 83516|EAP|0302|GLUTAMIC ACID DECARB AB (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.94||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.66||| 83516|EAP|0302|IMMUNOASSAY QUAL MULT (6929)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.56||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.66||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Cigna|CIGNA OF TN CHATTANOOGA|||||174.30||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.78||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.66||| 83516|EAP|0301|ANTI-HISTONE AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.66||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.66||| 83516|EAP|0302|IMMUNOASSAY QUAL MULT (6929)|Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6828)|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 83516|EAP|0302|IMMUNOASSAY QUAL MULT (6929)|Medicare|MEDICARE A & B|0.78||||0.56||| 83516|EAP|0302|GLUTAMIC ACID DECARB AB (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.94||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.66||| 83516|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Blue Cross PPO|BLUE CROSS PPO|||||82.60||| 83516|EAP|0301|RNA POLYMERASE III AB IGG|Blue Cross PPO|BLUE CROSS PPO|||||1.53||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Blue Cross PPO Select|BCBS UTHCT|0.50||||2.66||| 83516|EAP|0301|ANTI-HISTONE AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.66||| 83516|EAP|0301|F-ACTIN SM AB IgG ELISA (ARUP)|Blue Cross PPO Select|BCBS UTHCT|0.50||||0.50||| 83516|EAP|0301|GLIADIN, IGG (PART OF 4785)|Medicare|MEDICARE A & B|2.66||||2.66||| 83516|EAP|0301|ANTI-HISTONE AB (REF)|Blue Cross PPO Select|BCBS UTHCT|0.50||||2.66||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Blue Cross PPO Select|BCBS UTHCT|||||0.78||| 83516|EAP|0301|ACHR BLOCKING AB (PARTOF 5301)|Medicare|MEDICARE A & B|2.66||||3.11||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.66||| 83516|EAP|0301||Blue Cross PPO|BLUE CROSS POS|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.66||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Blue Cross PPO|BLUE CROSS POS|||||174.30||| 83516|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|0.50||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.66||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Blue Cross PPO Select|BCBS UTHCT|0.50||||2.66||| 83516|EAP|0301|SERINE PROTEASE 3 AB (REF)|Blue Cross PPO Select|BCBS UTHCT|0.50||||2.66||| 83516|EAP|0301|MYELOPEROXIDASE (MPO) (REF)|Blue Cross PPO Select|BCBS UTHCT|0.50||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.66||| 83516|EAP|0302|IMMUNOASSAY QUAL MULT (6929)|Blue Cross PPO Select|BCBS UTHCT|||||0.56||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|United Healthcare|UMR|||||0.78||| 83516|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||82.60||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| 83516|EAP|0301|ANTI-MITOCHONDRIAL AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.66||| 83516|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.66||| 83516|EAP|0301|TISSUE TRANSGLUTAMINASE AB, IG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| 83516|EAP|0301|SMOOTH MUSCLE AB W/REFLEX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| 83516|EAP|0301|NEURONAL AB IGG BY IMMUN(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.33||| 83516|EAP|0301|F-ACTIN SM AB IgG ELISA (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.50||| 83516|EAP|0301|ANTI-HISTONE AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| 83516|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| 83516|EAP|0302|IMMUNOASSAY QUAL MULT (6929)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.56||| 83516|EAP|0302|IMMUNOASSAY MULT STEP (6350)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.78||| 83516|EAP|0302|GLUTAMIC ACID DECARB AB (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.94||| 83516|EAP|0302|ANTINUCLEAR ABS; TITER (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||96.75||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Blue Cross PPO|BLUE CROSS PPO|0.29||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Blue Cross PPO|BCBS WALMART|||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.29||| 83519|EAP|0301|IMMUNOASSAY ANALY QUAN; RA-REF|Blue Cross PPO Select|BCBS UTHCT|||||96.75||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.29||| 83519|EAP|0301|IMMUNOASSAY ANALY QUAN; RA-REF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||96.75||| 83519|EAP|0301|IMMUNOASSAY ANALY QUAN; RA-REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.29||| 83519|EAP|0301|ACHR BINDING AB (PART 5301)|Medicare|MEDICARE A & B|0.29||||3.11||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|Medicare|MEDICARE A & B|0.29||||0.29||| 83519|EAP|0301|IMMUNOASSAY ANALY QUAN; RA-REF|Medicare|MEDICARE A & B|0.29||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||62.88||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.29||| 83519|EAP|0301|TSH RECEPTOR ANTIBODY (REF)|United Healthcare|UMR|||||0.29||| 83519|EAP|0301|PANCREASTATIN (ARUP)|United Healthcare|UMR|||||3.40||| 83519|EAP|0301|NEUROKININ A (SUB K) (ARUP)|United Healthcare|UMR|||||5.10||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|United Healthcare|UMR|||||3.95||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|PHCS|TML GRP INS|||||3.95||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.95||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.53||| 83520|EAP|0301|INTERFERON GAMMA (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||1.90||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Multiplan|TML GRP INS|||||3.95||| 83520|EAP|0301|PANCREATIC ELASTASE FECAL(REF)|Medicare|MEDICARE A & B|3.95||||3.95||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Medicare|MEDICARE A & B|3.95||||3.95||| 83520|EAP|0300|VEGDF QUANTITATION REF|Medicare|MEDICARE A & B|||||8.33||| 83520|EAP|0301||Medicare|MEDICARE A & B|3.95||||3.95||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|Medicare|MEDICARE A & B|||||0.53||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||92.70||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||92.70||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.53||| 83520|EAP|0301|PANCREATIC ELASTASE FECAL(REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||3.95||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||3.95||| 83520|EAP|0301|INTERFERON GAMMA (ARUP)|Medicare|MEDICARE A & B|3.95||||1.90||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||92.70||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.33||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.95||||3.95||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|Cigna|CIGNA OF TN CHATTANOOGA|||||0.53||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.53||| 83520|EAP|0301|INTERLEUKIN 6 BY MAFD REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.95||||||| 83520|EAP|0301|IMMUNOASSAY ANALYTE|Blue Cross PPO|BLUE CROSS PPO|3.95||||2.97||| 83520|EAP|0301|INTERLEUKIN 6 BY MAFD REF|Blue Cross PPO|BCBS TRANE PPO|3.95||||||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Blue Cross PPO|BLUE CROSS PPO|3.95||||3.95||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Blue Cross PPO|BLUE CROSS POS|||||3.95||| 83520|EAP|0301|PANCREATIC ELASTASE FECAL(REF)|Blue Cross PPO|BLUE CROSS PPO|3.95||||3.95||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Blue Cross PPO Select|BCBS UTHCT|||||3.95||| 83520|EAP|0301|ANTI-MULLERIAN HORMONE (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||1.96||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.95||| 83520|EAP|0301|PANCREATIC ELASTASE FECAL(REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.95||| 83520|EAP|0301|PANCREATIC ELASTASE FECAL(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.95||||3.95||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|Blue Cross PPO|BLUE CROSS PPO|||||0.53||| 83520|EAP|0301|IMMUNOASSAY NOS (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.95||||3.95||| 83520|EAP|0300|IMMUN QUAN NOS NONAB FROM 5223|Blue Cross PPO|BLUE CROSS POS|||||0.53||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Blue Cross PPO|BCBS TRANE PPO|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|ChampVA|CHAMPVA OF CO DENVER|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Managed Medicaid|MOLINA MEDICAID|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Medicare|MEDICARE A & B|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Medicare|MEDICARE RAILROAD|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||109.85||| 83525|EAP|0301|INSULIN, TOTAL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Multiplan|TML GRP INS|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|United Healthcare|UMR|||||109.85||| 83525|EAP|0301|INSULIN, TOTAL (REF)|PHCS|TML GRP INS|||||1.91||| 83525|EAP|0301|INSULIN, TOTAL (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.91||| 83540|EAP|0301|IRON, TOTAL|United Healthcare|UMR|||||1.97||| 83540|EAP|0301|IRON, TOTAL|United Healthcare|AARP OF GA ATLANTA|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.97||| 83540|EAP|0301|IRON, TOTAL|PHCS|TML GRP INS|||||1.97||| 83540|EAP|0301|IRON, TOTAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|NON CONTRACTED|COMMERCIAL OTHER|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Multiplan|WEB TPA|||||1.97||| 83540|EAP|0301|IRON, TOTAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Medicaid|MEDICAID|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Medicare|MEDICARE PART A|1.97||||||| 83540|EAP|0301||Medicare|MEDICARE A & B|1.97||||1.97||| 83540|EAP|0301||Medicaid|MEDICAID|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Medicare|MEDICARE RAILROAD|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Medicare|MEDICARE A & B|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Managed Medicaid|FAMILY PLANNING GRANT|||||0.25||| 83540|EAP|0301|IRON, TOTAL|Managed Medicaid|MEDICAID CSHCN|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Managed Medicaid|MOLINA MEDICAID|||||0.25||| 83540|EAP|0301|IRON, TOTAL|Multiplan|TML GRP INS|||||1.97||| 83540|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|ChampVA|CHAMPVA OF CO DENVER|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.97||| 83540|EAP|0301||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Cigna|CIGNA OTHER|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Cigna|CIGNA OPEN ACCESS PLUS|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|PHCS|WEB TPA|||||1.97||| 83540|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Blue Cross PPO|BLUE CROSS PPO|1.11||||1.97||| 83540|EAP|0301|IRON, TOTAL|Blue Cross PPO|BLUE CROSS POS|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.97||| 83540|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|1.11||||1.97||| 83540|EAP|0301|IRON, TOTAL|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 83540|EAP|0301|IRON, TOTAL|Blue Cross PPO Select|BCBS UTHCT|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Blue Cross PPO|BCBS WALMART|1.97||||1.97||| 83540|EAP|0301|IRON, TOTAL|Aetna|AETNA|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Aetna|TRS COORDINATED CARE|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.97||| 83540|EAP|0301|IRON, TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.97||||1.97||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Aetna|AETNA|||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO Select|BCBS UTHCT|||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Blue Cross PPO|BLUE CROSS PPO|85.50||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO|BLUE CROSS POS|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO|BLUE CROSS PPO|85.50||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO|BCBS WALMART|1.46||||1.46||| 83550|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|85.50||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Blue Cross PPO Select|BCBS UTHCT|||||1.46||| 83550|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|ChampVA|CHAMPVA OF CO DENVER|||||1.46||| 83550|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.46||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Cigna|CIGNA OPEN ACCESS PLUS|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Cigna|CIGNA OTHER|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Cigna|CIGNA OPEN ACCESS PLUS|||||85.50||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Cigna|CIGNA OF TN CHATTANOOGA|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Managed Medicaid|MOLINA MEDICAID|||||0.25||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Managed Medicaid|FAMILY PLANNING GRANT|||||0.25||| 83550|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Managed Medicaid|MEDICAID CSHCN|||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Managed Medicaid|MOLINA MEDICAID|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.46||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.46||| 83550|EAP|0301||Medicaid|MEDICAID|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Medicare|MEDICARE RAILROAD|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Medicare|MEDICARE PART A|1.46||||||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|Medicare|MEDICARE A & B|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Medicare|MEDICARE A & B|1.46||||1.46||| 83550|EAP|0301||Medicare|MEDICARE A & B|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Medicaid|MEDICAID|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Multiplan|WEB TPA|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Multiplan|TML GRP INS|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|NON CONTRACTED|COMMERCIAL OTHER|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.46||| 83550|EAP|0301|UNSATURATED IRON BINDING CAP|NON CONTRACTED|COMMERCIAL OTHER|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.46||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|United Healthcare|AARP OF GA ATLANTA|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|United Healthcare|UMR|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|PHCS|TML GRP INS|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|PHCS|WEB TPA|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.46||| 83550|EAP|0301|IRON/TIBC PANEL INCLUDES % SA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.46||||1.46||| 83550|EAP|0301||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.46||| 83605|EAP|0301|LACTIC ACID, PLASMA|United Healthcare|UMR|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|PHCS|TML GRP INS|1.75||||||| 83605|EAP|0301|LACTIC ACID, PLASMA|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|NON CONTRACTED|COMMERCIAL OTHER 2|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|NON CONTRACTED|COMMERCIAL OTHER|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Medicaid|MEDICAID|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Medicare|MEDICARE A & B|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Medicare|MEDICARE PART A|1.75||||||| 83605|EAP|0301|LACTIC ACID, PLASMA|Medicare|MEDICARE RAILROAD|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Managed Medicaid|OTHER MEDICAID|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Multiplan|TML GRP INS|1.75||||||| 83605|EAP|0301|LACTIC ACID, PLASMA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Managed Medicaid|MEDICAID CSHCN|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Managed Medicaid|MOLINA MEDICAID|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Managed Medicaid|SUPERIOR STAR MCD|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|ChampVA|CHAMPVA OF CO DENVER|1.75||||||| 83605|EAP|0301|LACTIC ACID, PLASMA|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Cigna|CIGNA OPEN ACCESS PLUS|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Cigna|CIGNA OF TN CHATTANOOGA|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Workers Compensation|WC GALLAGHER BASSETT|||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Blue Cross PPO|BCBS TRANE PPO|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Blue Cross PPO|BCBS WALMART|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Blue Cross PPO|BLUE CROSS PPO|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Blue Cross PPO|BLUE CROSS POS|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Blue Cross PPO Select|BCBS UTHCT|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Aetna|AETNA EL PASO CLAIMS OFFICE|1.75||||1.75||| 83605|EAP|0301|LACTIC ACID, PLASMA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.75||||1.75||| 83615|EAP|0301|BODY FLUID, LD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|PHCS|WEB TPA|||||1.58||| 83615|EAP|0301|LD, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.58||| 83615|EAP|0301|LD, SERUM|PHCS|TML GRP INS|1.58||||||| 83615|EAP|0301|LD, SERUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.58||| 83615|EAP|0301|BODY FLUID, LD|Workers Compensation|WC GALLAGHER BASSETT|||||1.58||| 83615|EAP|0301|LD, SERUM|United Healthcare|UMR|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Managed Medicaid|MOLINA MEDICAID|||||1.58||| 83615|EAP|0301|LD, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Blue Cross PPO Select|BCBS UTHCT|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|ChampVA|CHAMPVA OF CO DENVER|1.58||||||| 83615|EAP|0301|LD, SERUM|Blue Cross PPO|BLUE CROSS PPO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Managed Medicaid|SUPERIOR STAR MCD|||||1.58||| 83615|EAP|0301|LD, SERUM|Blue Cross PPO|BLUE CROSS POS|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Multiplan|TML GRP INS|1.58||||||| 83615|EAP|0301|LD, SERUM|Aetna|AETNA|||||1.58||| 83615|EAP|0301|LD, SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Medicare|MEDICARE PART A|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Blue Cross PPO|BCBS WALMART|1.58||||||| 83615|EAP|0301|BODY FLUID, LD|Medicare|MEDICARE A & B|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.58||| 83615|EAP|0301|LD, SERUM|Medicaid|MEDICAID|||||1.58||| 83615|EAP|0301|BODY FLUID, LD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.58||| 83615|EAP|0301|LACTATE DEHYDROGENASE CSF (ARU|Medicare|MEDICARE A & B|1.58||||0.25||| 83615|EAP|0301|LD, SERUM|Medicare|MEDICARE A & B|1.58||||1.58||| 83615|EAP|0301|BODY FLUID, LD|Cigna|NALC HLTH BENEFIT|||||1.58||| 83615|EAP|0301|LD, SERUM|Medicare|MEDICARE RAILROAD|||||1.58||| 83615|EAP|0301|BODY FLUID, LD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.58||||1.58||| 83615|EAP|0301|BODY FLUID, LD|Blue Cross PPO|BLUE CROSS PPO|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|NON CONTRACTED|COMMERCIAL OTHER|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|NON CONTRACTED|COMMERCIAL OTHER 2|1.58||||||| 83615|EAP|0301|LD, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.58||| 83615|EAP|0301|LD, SERUM|Blue Cross PPO|BCBS TRANE PPO|1.58||||||| 83615|EAP|0301|LD, SERUM|Multiplan|WEB TPA|||||1.58||| 83615|EAP|0301|LD, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.58||||1.58||| 83615|EAP|0301|LD, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|1.58||||1.58||| 83655|EAP|0301|LEAD, (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.50||| 83655|EAP|0301|LEAD, (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.84||| 83655|EAP|0301|LEAD, BLOOD (WELL CHILD) TDH|Medicaid|MEDICAID|||||0.00||| 83655|EAP|0301|LEAD, BLOOD (WELL CHILD) TDH|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 83655|EAP|0301|LEAD, (REF)|United Healthcare|UMR|||||0.50||| 83655|EAP|0301|LEAD, WHOLE BLOOD (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||86.70||| 83655|EAP|0301|LEAD, (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.50||| 83655|EAP|0301|LEAD, (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.84||| 83655|EAP|0301|LEAD, (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.50||| 83655|EAP|0301|LEAD, BLOOD (WELL CHILD) TDH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 83655|EAP|0301|LEAD, (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.50||| 83655|EAP|0301|LEAD, WHOLE BLOOD (REF)|Medicare|MEDICARE A & B|||||1.84||| 83690|EAP|0301|LIPASE, (SERUM)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Multiplan|WEB TPA|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|PHCS|WEB TPA|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Medicaid|MEDICAID|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Medicare|MEDICARE PART A|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO|BLUE CROSS POS|||||1.61||| 83690|EAP|0301|BODY FLUID, LIPASE|Medicare|MEDICARE A & B|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Medicare|MEDICARE A & B|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Managed Medicaid|MOLINA MEDICAID|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO|BCBS TRANE PPO|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|United Healthcare|UMR|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|PHCS|WEB TPA OF GRAND PRAIRIE|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Cigna|NALC HLTH BENEFIT|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO|BCBS WALMART|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO Select|BCBS UTHCT|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|NON CONTRACTED|COMMERCIAL OTHER|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Multiplan|WEB TPA OF GRAND PRAIRIE|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|ChampVA|CHAMPVA OF CO DENVER|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Managed Medicaid|SUPERIOR STAR MCD|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Cigna|CIGNA OF TN CHATTANOOGA|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO|BLUE CROSS PPO|1.61||||1.61||| 83690|EAP|0301|LIPASE, (SERUM)|Blue Cross PPO|BLUE CROSS SECONDARY|||||1.61||| 83704|EAP|0301|LDL-P (6010)|PHCS|TML GRP INS|||||0.64||| 83704|EAP|0301|LDL-P (6010)|NON CONTRACTED|COMMERCIAL OTHER|||||0.64||| 83704|EAP|0301|LDL-P (6010)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.64||| 83704|EAP|0301|LDL-P (6010)|Medicare|MEDICARE A & B|||||0.64||| 83704|EAP|0301|LDL-P (6010)|Medicare|MEDICARE PART A|||||0.64||| 83704|EAP|0301|LDL-P (6010)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.64||| 83704|EAP|0301|LDL-P (6010)|Multiplan|TML GRP INS|||||0.64||| 83704|EAP|0301|LDL-P (6010)|Blue Cross PPO Select|BCBS UTHCT|||||0.64||| 83735|EAP|0301|MAGNESIUM|Blue Cross PPO Select|BCBS UTHCT|||||1.29||| 83735|EAP|0301|MAGNESIUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.29||| 83735|EAP|0301|MAGNESIUM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.29||| 83735|EAP|0301|MAGNESIUM|Medicare|MEDICARE A & B|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|1.29||||||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|FAMILY PLANNING GRANT|||||0.25||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|OTHER MEDICAID|||||1.29||| 83735|EAP|0301|MAGNESIUM|Blue Cross PPO|BCBS WALMART|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.29||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|MEDICAID CSHCN|||||1.29||| 83735|EAP|0301|MAGNESIUM, RBC #92079|Medicare|MEDICARE A & B|1.29||||1.08||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|MOLINA MEDICAID|||||1.29||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.29||| 83735|EAP|0301|MAGNESIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM, RBC #92079|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.29||||1.08||| 83735|EAP|0301|MAGNESIUM|United Healthcare|UMR|||||1.29||| 83735|EAP|0301|MAGNESIUM|NON CONTRACTED|COMMERCIAL OTHER|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Medicare|MEDICARE PART A|1.29||||||| 83735|EAP|0301|MAGNESIUM|United Healthcare|GOLDEN RULE INSURANCE|||||1.29||| 83735|EAP|0301|MAGNESIUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.29||| 83735|EAP|0301|MAGNESIUM, RBC #92079|Blue Cross PPO|BLUE CROSS PPO|1.29||||1.08||| 83735|EAP|0301|MAGNESIUM, RBC #92079|Blue Cross PPO Select|BCBS UTHCT|||||1.08||| 83735|EAP|0301|MAGNESIUM|Blue Cross PPO|BLUE CROSS PPO|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Workers Compensation|WC TX MUTUAL INS|||||0.25||| 83735|EAP|0301|MAGNESIUM, RBC #92079|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.29||||1.08||| 83735|EAP|0301|MAGNESIUM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.29||| 83735|EAP|0301|MAGNESIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Managed Medicaid|SUPERIOR STAR MCD|||||1.29||| 83735|EAP|0301|MAGNESIUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|ChampVA|CHAMPVA OF CO DENVER|||||1.29||| 83735|EAP|0301|MAGNESIUM|NON CONTRACTED|PPO OTHER|||||1.29||| 83735|EAP|0301|MAGNESIUM, RBC #92079|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.29||||1.08||| 83735|EAP|0301|MAGNESIUM|Optum Behavioral Health|OPTUM|1.29||||||| 83735|EAP|0301|MAGNESIUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.29||| 83735|EAP|0301|MAGNESIUM|Medicaid|MEDICAID|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Blue Cross PPO|BLUE CROSS POS|1.29||||1.29||| 83735|EAP|0301|MAGNESIUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.29||| 83735|EAP|0301|MAGNESIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|1.29||||1.29||| 83789|EAP|0301|CHROMATOGR,QUAN,ANALYT NESARUP|Blue Cross PPO|BCBS TRANE PPO|||||5.40||| 83789|EAP|0301|MASS SPECT&TAN MASS SPECT(REF)|Medicare|MEDICARE A & B|||||2.87||| 83789|EAP|0301|CHROMATOGR,QUAN,ANALYT NESARUP|Medicare|MEDICARE A & B|||||5.40||| 83789|EAP|0301|CHROMATOGR,QUAN,ANALYT NESARUP|Blue Cross PPO|BLUE CROSS PPO|||||5.40||| 83789|EAP|0301|CHROMATOGR,QUAN,ANALYT NESARUP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.40||| 83825|EAP|0301|MERCURY, WHOLE BLOOD (REF)|Medicare|MEDICARE A & B|||||2.66||| 83825|EAP|0301|MERCURY, WHOLE BLOOD (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||92.90||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||6.71||| 83835|EAP|0301|METANEPHRINES, TOT 24 HR UR (R|Medicare|MEDICARE A & B|||||6.71||| 83835|EAP|0301|METANEPHRINES, TOT 24 HR UR (R|Aetna|AETNA EL PASO CLAIMS OFFICE|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.71||| 83835|EAP|0301|METANEPHRINES, TOT 24 HR UR (R|Blue Cross PPO|BLUE CROSS PPO|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Blue Cross PPO|BLUE CROSS PPO|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Medicare|MEDICARE A & B|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||6.71||| 83835|EAP|0301|METANEPHRINES, TOT 24 HR UR (R|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Blue Cross PPO|BLUE CROSS POS|||||6.71||| 83835|EAP|0301||Medicare|MEDICARE A & B|||||6.71||| 83835|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.71||| 83835|EAP|0301|METANEPHRINES, TOT 24 HR UR (R|Blue Cross PPO Select|BCBS UTHCT|||||6.71||| 83835|EAP|0301|PLASMA METANEPHRINES (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.71||| 83873|EAP|0301|MYELIN BASIC PROTEIN (REF)|Medicare|MEDICARE A & B|5.09||||||| 83874|EAP|0301|MYOGLOBIN, SERUM|ChampVA|CHAMPVA OF CO DENVER|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Aetna|AETNA US HEALTHCARE PA|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Medicare|MEDICARE PART A|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross PPO Select|BCBS UTHCT|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Managed Medicaid|SUPERIOR STAR MCD|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross PPO|BCBS WALMART|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross PPO|BLUE CROSS POS|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Medicare|MEDICARE RAILROAD|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|United Healthcare|UMR|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Managed Medicaid|MOLINA MEDICAID|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Blue Cross PPO|BLUE CROSS PPO|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|NON CONTRACTED|COMMERCIAL OTHER|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|PHCS|WEB TPA|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|NON CONTRACTED|PPO OTHER|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Multiplan|WEB TPA|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|NON CONTRACTED|MRAMVA|||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Medicare|MEDICARE A & B|2.21||||2.21||| 83874|EAP|0301|MYOGLOBIN, SERUM|Medicaid|MEDICAID|2.21||||2.21||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|United Healthcare|UMR|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|PHCS|TML GRP INS|3.51||||||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|United Healthcare|GOLDEN RULE INSURANCE|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Medicare|MEDICARE A & B|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Multiplan|TML GRP INS|3.51||||||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Medicaid|MEDICAID|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Medicare|MEDICARE RAILROAD|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|NON CONTRACTED|PPO OTHER|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|NON CONTRACTED|COMMERCIAL OTHER|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross PPO|BLUE CROSS POS|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross PPO|BLUE CROSS PPO|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Managed Medicaid|SUPERIOR STAR MCD|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross PPO|BCBS TRANE PPO|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Medicare|MEDICARE PART A|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Cigna|NALC HLTH BENEFIT|3.51||||||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Cigna|CIGNA OPEN ACCESS PLUS|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Aetna|AETNA EL PASO CLAIMS OFFICE|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross PPO|BCBS WALMART|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|ChampVA|CHAMPVA OF CO DENVER|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Blue Cross PPO Select|BCBS UTHCT|3.51||||3.51||| 83880|EAP|0301|BNP - TYPE NATRIURETIC PEPTIDE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.51||||3.51||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| 83883|EAP|0301|NEPHELOMETRY ANALYTE NES (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.02||| 83883|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 83883|EAP|0301|NEPHELOMETRY ANALYTE NES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 83883|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 83883|EAP|0301|LAMBDA NEPHELOMETRY EACH (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 83883|EAP|0301|LAMBDA NEPHELOMETRY EACH (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.02||| 83883|EAP|0301|LAMBDA NEPHELOMETRY EACH (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.02||| 83883|EAP|0301|NEPHELOMETRY ANALYTE NES (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Medicaid|MEDICAID|||||0.65||| 83883|EAP|0301|LAMBDA NEPHELOMETRY EACH (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|United Healthcare|UMR|||||0.65||| 83883|EAP|0301|NEPHELOMETRY, EA ANA (PO 6576)|Medicare|MEDICARE A & B|||||1.17||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Medicare|MEDICARE A & B|||||0.65||| 83883|EAP|0301|LAMBDA NEPHELOMETRY EACH (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 83883|EAP|0301|LAMBDA NEPHELOMETRY EACH (REF)|Medicare|MEDICARE A & B|||||1.02||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 83883|EAP|0301|NEPHELOMETRY ANALYTE NES (REF)|Medicare|MEDICARE A & B|||||1.02||| 83883|EAP|0301||Medicare|MEDICARE A & B|||||0.65||| 83883|EAP|0301|NEPHELOMETRY ANALYTE NES (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.02||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.65||| 83883|EAP|0301|NEPHELOMETRY ANALYTE NES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 83883|EAP|0301|NEPHELOMETRY EA NOS (6678)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 83915|EAP|0301|NUCLEOTIDASE 5'(REF)|Medicare|MEDICARE A & B|||||2.00||| 83916|EAP|0301|OLIGOCLONAL IMMUNE BANDS-REF|Medicare|MEDICARE A & B|3.04||||||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Multiplan|TML GRP INS|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.64||||||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Medicare|MEDICARE A & B|2.64||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|PHCS|TML GRP INS|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.64||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| 83921|EAP|0301|METHYLMALONIC ACID,QUANT (REF)|Blue Cross PPO|BCBS TRANE PPO|||||2.64||| 83930|EAP|0301|OSMOLALITY SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.27||| 83930|EAP|0301|OSMOLALITY SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.27||| 83930|EAP|0301|OSMOLALITY SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.27||||0.27||| 83930|EAP|0301|OSMOLALITY SERUM|Blue Cross PPO|BLUE CROSS PPO|||||0.27||| 83930|EAP|0301|OSMOLALITY SERUM|Medicare|MEDICARE A & B|0.27||||0.27||| 83930|EAP|0301|OSMOLALITY SERUM|United Healthcare|UMR|||||0.27||| 83935|EAP|0301|OSMOLALITY URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.28||| 83935|EAP|0301|OSMOLALITY URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.28||||||| 83935|EAP|0301|OSMOLALITY URINE|Blue Cross PPO|BLUE CROSS PPO|0.28||||0.28||| 83935|EAP|0301|OSMOLALITY URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.28||||0.28||| 83935|EAP|0301|OSMOLALITY URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.28||| 83935|EAP|0301|OSMOLALITY URINE|Blue Cross PPO Select|BCBS UTHCT|0.28||||||| 83935|EAP|0301|OSMOLALITY URINE|United Healthcare|UMR|||||0.28||| 83935|EAP|0301|OSMOLALITY URINE|Medicare|MEDICARE A & B|0.28||||0.28||| 83935|EAP|0301|OSMOLALITY URINE|NON CONTRACTED|COMMERCIAL OTHER 2|0.28||||||| 83945|EAP|0300|OXALATE, PLASMA(REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.82||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Managed Medicaid|MEDICAID CSHCN|||||1.50||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Blue Cross PPO|BLUE CROSS PPO|||||1.50||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.50||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Managed Medicaid|MOLINA MEDICAID|||||1.50||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.50||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.50||| 83951|EAP|0301|DES-GAMMA-CARBOXY PROTHROMBIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.50||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Medicare|MEDICARE A & B|4.44||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|NON CONTRACTED|COMMERCIAL OTHER|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Aetna|AETNA|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Medicare|MEDICARE RAILROAD|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|United Healthcare|UMR|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Blue Cross PPO|BLUE CROSS POS|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Blue Cross PPO|BLUE CROSS PPO|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Blue Cross PPO Select|BCBS UTHCT|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Blue Cross PPO|BCBS WALMART|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Cigna|CIGNA OF TN CHATTANOOGA|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.44||| 83970|EAP|0301|PARATHYROID HORMONE- INTACT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.44||| 83986|EAP|0301|PH, BODY FLUID|Blue Cross PPO|BLUE CROSS PPO|||||0.76||| 83986|EAP|0301|PH, BODY FLUID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.76||| 83986|EAP|0301|PH, BODY FLUID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.76||| 83986|EAP|0301|PH, BODY FLUID|Medicare|MEDICARE A & B|||||0.76||| 83986|EAP|0301||Medicare|MEDICARE A & B|||||0.76||| 83986|EAP|0301|PH, FECAL (REF)|United Healthcare|UMR|||||0.76||| 83986|EAP|0301|PH, FECAL (REF)|Medicare|MEDICARE A & B|||||0.76||| 83992|EAP|0301|PHENCYCLIDINE (PCP) CONF (ARUP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.60||| 83993|EAP|0301|CALPROTECTIN, FECAL|Blue Cross PPO|BLUE CROSS PPO|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|Medicare|MEDICARE A & B|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|Blue Cross PPO Select|BCBS UTHCT|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|Blue Cross PPO|BCBS TRANE PPO|||||3.58||| 83993|EAP|0301|CALPROTECTIN, FECAL|United Healthcare|UMR|||||3.58||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Medicare|MEDICARE A & B|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Blue Cross PPO|BLUE CROSS PPO|1.06||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|NON CONTRACTED|COMMERCIAL OTHER|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE, TOTAL|Medicare|MEDICARE A & B|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Aetna|AETNA|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE, TOTAL|Blue Cross PPO|BLUE CROSS POS|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Cigna|CIGNA OF TN CHATTANOOGA|||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE, TOTAL|Blue Cross PPO|BLUE CROSS PPO|1.06||||1.06||| 84075|EAP|0301|ALKALINE PHOSPHATASE,TOTAL-REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.06||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Aetna|AETNA|||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Blue Cross PPO|BLUE CROSS PPO|2.03||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Medicare|MEDICARE A & B|||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.03||| 84080|EAP|0301|ALK PHOS ISOENZYMES (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.03||| 84100|EAP|0301|PHOSPHORUS (SERUM)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.19||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Medicare|MEDICARE RAILROAD|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Medicare|MEDICARE PART A|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.19||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|ChampVA|CHAMPVA OF CO DENVER|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Medicaid|MEDICAID|1.19||||||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Medicare|MEDICARE A & B|1.19||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.19||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Managed Medicaid|SUPERIOR STAR MCD|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Blue Cross PPO|BCBS WALMART|1.19||||||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Aetna|AETNA|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Blue Cross PPO Select|BCBS UTHCT|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Blue Cross PPO|BLUE CROSS POS|||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.25||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Blue Cross PPO|BLUE CROSS PPO|1.19||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.19||||1.19||| 84100|EAP|0301|PHOSPHORUS (SERUM)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.19||| 84132|EAP|0301|POTASSIUM|Cigna|NALC HLTH BENEFIT|||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross PPO|BLUE CROSS PPO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Aetna|AETNA|||||1.14||| 84132|EAP|0301|POTASSIUM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.14||| 84132|EAP|0301|POTASSIUM|Aetna|AETNA EXXON MOBIL|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Blue Cross PPO|BLUE CROSS PPO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross PPO|BCBS TRANE PPO|||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 84132|EAP|0301|POTASSIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|1.14||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross PPO|BLUE CROSS POS|||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Blue Cross PPO|BCBS WALMART|||||1.14||| 84132|EAP|0301|POTASSIUM|ChampVA|CHAMPVA OF CO DENVER|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross PPO Select|BCBS UTHCT|||||1.14||| 84132|EAP|0301|POTASSIUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Cigna|CIGNA OTHER|||||1.14||| 84132|EAP|0301|POTASSIUM|Blue Cross PPO|BCBS WALMART|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Blue Cross PPO Select|BCBS UTHCT|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 84132|EAP|0301|POTASSIUM|Medicare|MEDICARE A & B|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Multiplan|WEB TPA|||||1.14||| 84132|EAP|0301|POTASSIUM|NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.14||| 84132|EAP|0301|POTASSIUM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Medicare|MEDICARE PART A|1.14||||||| 84132|EAP|0301|POTASSIUM, SERUM|Managed Medicaid|SUPERIOR STAR MCD|1.14||||||| 84132|EAP|0301|POTASSIUM|United Healthcare|UMR|||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Medicare|MEDICARE A & B|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Medicare|MEDICARE RAILROAD|||||1.14||| 84132|EAP|0301|POTASSIUM|NON CONTRACTED|BOONE CHAPMAN|||||1.14||| 84132|EAP|0301|POTASSIUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.14||| 84132|EAP|0301||Medicare|MEDICARE A & B|1.14||||1.14||| 84132|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|PHCS|WEB TPA|||||1.14||| 84132|EAP|0301|POTASSIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM, SERUM|Medicaid|MEDICAID|1.14||||||| 84132|EAP|0301|POTASSIUM, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.14||||1.14||| 84132|EAP|0301|POTASSIUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.14||| 84132|EAP|0301|POTASSIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.14||||1.14||| 84133|EAP|0301|POTASSIUM, URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.48||||||| 84133|EAP|0301|POTASSIUM, URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.48||||||| 84133|EAP|0301|POTASSIUM, URINE|NON CONTRACTED|COMMERCIAL OTHER|||||1.48||| 84133|EAP|0301|POTASSIUM, URINE|Medicare|MEDICARE A & B|1.48||||1.48||| 84133|EAP|0301|POTASSIUM, URINE|Medicaid|MEDICAID|||||1.48||| 84133|EAP|0301|POTASSIUM, URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.48||||||| 84133|EAP|0301|POTASSIUM, URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.48||||||| 84133|EAP|0301|POTASSIUM, URINE|Blue Cross PPO|BLUE CROSS PPO|1.48||||||| 84134|EAP|0301|PREALBUMIN (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.96||| 84134|EAP|0301|PREALBUMIN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||128.23||| 84134|EAP|0301|PREALBUMIN (REF)|Medicare|MEDICARE A & B|1.96||||1.96||| 84134|EAP|0301|PREALBUMIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.96||| 84134|EAP|0301|PREALBUMIN (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||60.45||| 84134|EAP|0301|PREALBUMIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.96||||1.96||| 84140|EAP|0301|PREGNENOLONE (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.11||| 84144|EAP|0301|PROGESTERONE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Blue Cross PPO|BCBS WALMART|||||0.57||| 84144|EAP|0301|PROGESTERONE (REF)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Medicaid|MEDICAID|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Medicare|MEDICARE A & B|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||153.50||| 84144|EAP|0301|PROGESTERONE (REF)|Medicare|MEDICARE RAILROAD|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|United Healthcare|UMR|||||0.57||| 84144|EAP|0301|PROGESTERONE (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 84144|EAP|0301|PROGESTERONE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||153.50||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Blue Cross PPO|BLUE CROSS PPO|3.60||||3.60||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.60||||||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Medicare|MEDICARE A & B|3.60||||3.60||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.60||||||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Blue Cross PPO|BLUE CROSS POS|||||3.60||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.60||||||| 84145|EAP|0301|PROCALCITONIN (ARUP)|United Healthcare|UMR|3.60||||||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.60||| 84145|EAP|0301|PROCALCITONIN (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.60||| 84146|EAP|0301|PROLACTIN|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.94||| 84146|EAP|0301|PROLACTIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.94||| 84146|EAP|0301|PROLACTIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.94||| 84146|EAP|0301|PROLACTIN|Medicare|MEDICARE A & B|||||2.94||| 84146|EAP|0301|PROLACTIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.94||| 84146|EAP|0301|PROLACTIN|United Healthcare|GOLDEN RULE INSURANCE|||||2.94||| 84146|EAP|0301|PROLACTIN|Medicaid|MEDICAID|||||2.94||| 84146|EAP|0301|PROLACTIN|Aetna|AETNA|||||2.94||| 84146|EAP|0301|PROLACTIN|Aetna|AETNA EXXON MOBIL|||||2.94||| 84146|EAP|0301|PROLACTIN|United Healthcare|UMR|||||2.94||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO Select|BCBS UTHCT|||||2.94||| 84146|EAP|0301|PROLACTIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.94||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.94||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO|BCBS TRANE PPO|||||2.94||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO|BCBS WALMART|||||2.94||| 84146|EAP|0301|PROLACTIN|Cigna|CIGNA OF TN CHATTANOOGA|||||2.94||| 84146|EAP|0301|PROLACTIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.94||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO|BLUE CROSS PPO|||||2.94||| 84146|EAP|0301|PROLACTIN|NON CONTRACTED|COMMERCIAL OTHER|||||2.94||| 84146|EAP|0301|PROLACTIN|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|2.94||||||| 84146|EAP|0301|PROLACTIN|Managed Medicaid|FAMILY PLANNING GRANT|||||0.55||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO|BLUE CROSS POS|||||2.94||| 84146|EAP|0301|PROLACTIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.94||| 84150|EAP|0301|BETA-PROSTAGLANDIN F2 (MAYO)|Medicare|MEDICARE A & B|||||4.19||| 84153|EAP|0301|PSA; TOTAL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.10||||2.10||| 84153|EAP|0301|PSA, TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|United Healthcare|UMR|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Aetna|AETNA|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.10||| 84153|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.31||| 84153|EAP|0301|PSA, TOTAL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Blue Cross PPO Select|BCBS UTHCT|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Cigna|NALC HLTH BENEFIT|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.10||||2.10||| 84153|EAP|0301|PSA, TOTAL|Blue Cross PPO|BCBS TRANE PPO|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Blue Cross PPO|BLUE CROSS POS|||||170.85||| 84153|EAP|0301|PSA, TOTAL|Blue Cross PPO|BCBS WALMART|||||0.52||| 84153|EAP|0301|PSA, TOTAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.10||| 84153|EAP|0301|PSA, TOTAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Medicare|MEDICARE A & B|2.10||||2.10||| 84153|EAP|0301|PSA, TOTAL|Medicare|MEDICARE RAILROAD|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Medicare|MEDICARE A & B|2.10||||2.10||| 84153|EAP|0301|PSA, TOTAL|Blue Cross PPO|BLUE CROSS POS|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Medicaid|MEDICAID|||||2.10||| 84153|EAP|0301|PSA, TOTAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Tricare|TRICARE WEST UNITED HEALTH|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Cigna|CIGNA OTHER|||||2.10||| 84153|EAP|0301|PSA, TOTAL|NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.10||| 84153|EAP|0301|PSA, TOTAL|NON CONTRACTED|COMMERCIAL OTHER|||||2.10||| 84153|EAP|0301|PSA, TOTAL|United Healthcare|UMR|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Aetna|TRS COORDINATED CARE|||||1.31||| 84153|EAP|0301|PSA, TOTAL|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Blue Cross PPO|BLUE CROSS PPO|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Medicare|MEDICARE PART B|||||2.10||| 84153|EAP|0301|PSA, TOTAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.10||| 84153|EAP|0301|PSA; TOTAL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 84154|EAP|0301|PSA, FREE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|Medicare|MEDICARE A & B|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|United Healthcare|UMR|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.26||| 84154|EAP|0301|PSA, FREE (REF)|Blue Cross PPO|BLUE CROSS POS|||||178.85||| 84154|EAP|0301|PSA, FREE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.26||| 84155|EAP|0301|TOTAL PROTEIN, SERUM|Medicare|MEDICARE A & B|||||0.99||| 84155|EAP|0301|TOTAL PROTEIN, SERUM|Blue Cross PPO|BLUE CROSS PPO|||||0.99||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.94||| 84156|EAP|0301|PROTEIN, 24-HR URINE|Medicare|MEDICARE A & B|0.94||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Access Direct Platinum|ACCESS DIRECT|||||0.94||| 84156|EAP|0301|PROTEIN, 24-HR URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.94||| 84156|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.94||| 84156|EAP|0301|PROTEIN, 24-HR URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.25||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Medicaid|MEDICAID|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Medicare|MEDICARE A & B|0.94||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Managed Medicaid|MOLINA MEDICAID|||||0.94||| 84156|EAP|0301|PROTEIN, 24-HR URINE|Medicare|MEDICARE PART A|0.94||||||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Managed Medicaid|SUPERIOR STAR MCD|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Blue Cross PPO|BLUE CROSS POS|||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.94||| 84156|EAP|0301||Medicare|MEDICARE A & B|0.94||||0.94||| 84156|EAP|0301|PROTEIN, RANDOM URINE|Blue Cross PPO|BLUE CROSS PPO|||||0.94||| 84157|EAP|0301|PROTEIN, CSF|Medicare|MEDICARE A & B|1.21||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|Medicare|MEDICARE A & B|1.21||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|Blue Cross PPO|BLUE CROSS PPO|1.21||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|Cigna|NALC HLTH BENEFIT|||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.21||||1.21||| 84157|EAP|0301|PROTEIN, CSF|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.21||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|NON CONTRACTED|COMMERCIAL OTHER|||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.21||| 84157|EAP|0301|PROTEIN, CSF|Blue Cross PPO|BLUE CROSS PPO|1.21||||1.21||| 84157|EAP|0301|BODY FLUID, PROTEIN|Medicare|MEDICARE PART A|1.21||||||| 84165|EAP|0300|SPE PANEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.74||| 84165|EAP|0300|SPE PANEL|United Healthcare|UMR|||||1.74||| 84165|EAP|0300|SPE PANEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.74||| 84165|EAP|0300|SPE PANEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.02||| 84165|EAP|0300|SPE PANEL|NON CONTRACTED|COMMERCIAL OTHER|||||1.74||| 84165|EAP|0300|SPE PANEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.74||| 84165|EAP|0300|SPE PANEL|Medicare|MEDICARE A & B|1.74||||1.74||| 84165|EAP|0300|SPE PANEL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.74||| 84165|EAP|0300|SPE PANEL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.74||| 84165|EAP|0300|SPE PANEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.30||| 84165|EAP|0300|SPE PANEL|Blue Cross PPO|BLUE CROSS POS|||||0.30||| 84165|EAP|0300|SPE PANEL|Blue Cross PPO Select|BCBS UTHCT|||||1.74||| 84165|EAP|0300|SPE PANEL|Blue Cross PPO|BLUE CROSS PPO|||||1.74||| 84165|EAP|0300|SPE PANEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.74||||1.74||| 84165|EAP|0300|SPE PANEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.74||| 84166|EAP|0301|PROTEIN ELECTRO,URINE** 24-HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.55||| 84166|EAP|0301|PROTEIN ELECTRO,URINE** 24-HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.55||| 84166|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.50||| 84166|EAP|0301|PROTEIN ELECTRO,URINE** 24-HR|Cigna|CIGNA OF TN CHATTANOOGA|||||2.55||| 84166|EAP|0301|PROTEIN ELECTRO,URINE** 24-HR|Medicare|MEDICARE A & B|2.55||||2.55||| 84166|EAP|0301|PROTEIN ELECTRO,URINE** 24-HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.55||| 84206|EAP|0301|PROINSULIN (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.59||| 84206|EAP|0301|PROINSULIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.59||| 84206|EAP|0301|PROINSULIN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||143.30||| 84206|EAP|0301|PROINSULIN (REF)|Blue Cross PPO|BLUE CROSS PPO|1.59||||1.59||| 84207|EAP|0301|VITAMIN B6, PLASMA (PYRIDOXINE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.20||| 84207|EAP|0301|VITAMIN B6, PLASMA (PYRIDOXINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.20||| 84207|EAP|0301|VITAMIN B6, PLASMA (PYRIDOXINE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.20||| 84207|EAP|0301|VITAMIN B6, PLASMA (PYRIDOXINE|Blue Cross PPO|BLUE CROSS PPO|||||3.20||| 84207|EAP|0301|VITAMIN B6, PLASMA (PYRIDOXINE|Blue Cross PPO Select|BCBS UTHCT|||||3.20||| 84238|EAP|0301|SOLUBLE TRANSFERRIN RECPTOR|Medicare|MEDICARE A & B|||||0.73||| 84244|EAP|0301|RENIN, PLASMA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.48||| 84244|EAP|0301|RENIN ARUP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.48||| 84244|EAP|0301|RENIN, PLASMA (REF)|Blue Cross PPO|BLUE CROSS POS|||||3.48||| 84244|EAP|0301|RENIN ARUP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.48||| 84244|EAP|0301|RENIN, PLASMA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.48||| 84244|EAP|0301|RENIN ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.48||| 84244|EAP|0301|RENIN, PLASMA (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.48||| 84244|EAP|0301|RENIN ARUP|Cigna|CIGNA OF TN CHATTANOOGA|||||3.48||| 84244|EAP|0301|RENIN, PLASMA (REF)|Blue Cross PPO Select|BCBS UTHCT|||||252.78||| 84244|EAP|0301|RENIN, PLASMA (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.48||| 84244|EAP|0301|RENIN ARUP|NON CONTRACTED|COMMERCIAL OTHER|||||3.48||| 84244|EAP|0301|RENIN, PLASMA (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.48||| 84244|EAP|0301|RENIN, PLASMA (REF)|Medicare|MEDICARE A & B|||||3.48||| 84244|EAP|0301|RENIN ARUP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.48||| 84244|EAP|0301|RENIN ARUP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.48||| 84244|EAP|0301|RENIN ARUP|Medicare|MEDICARE A & B|||||3.48||| 84252|EAP|0301|VITAMIN B2 (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.94||| 84252|EAP|0301|VITAMIN B2 (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.94||| 84255|EAP|0301|SELENIUM, SERUM OR PLASMA (REF|Medicare|MEDICARE A & B|||||1.16||| 84260|EAP|0301|SEROTONIN, SERUM (REF)|United Healthcare|UMR|||||7.54||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.53||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.53||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|Medicare|MEDICARE A & B|||||0.53||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|United Healthcare|UMR|||||0.53||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|Blue Cross PPO Select|BCBS UTHCT|||||0.53||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.53||| 84270|EAP|0301|SEX HORMONE BINDING GLOB. (REF|Cigna|CIGNA OF TN CHATTANOOGA|||||0.53||| 84295|EAP|0301|SODIUM|NON CONTRACTED|BOONE CHAPMAN|||||0.96||| 84295|EAP|0301|SODIUM|United Healthcare|UMR|||||0.96||| 84295|EAP|0301|SODIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.96||| 84295|EAP|0301|SODIUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.96||| 84295|EAP|0301|SODIUM|Multiplan|WEB TPA|||||0.96||| 84295|EAP|0301|SODIUM|PHCS|WEB TPA|||||0.96||| 84295|EAP|0301||Medicare|MEDICARE A & B|||||0.96||| 84295|EAP|0301|SODIUM, SERUM|Medicare|MEDICARE PART A|0.96||||||| 84295|EAP|0301|SODIUM, SERUM|Medicare|MEDICARE A & B|||||0.96||| 84295|EAP|0301|SODIUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.96||| 84295|EAP|0301|SODIUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.96||| 84295|EAP|0301|SODIUM|NON CONTRACTED|COMMERCIAL OTHER|||||0.96||| 84295|EAP|0301|SODIUM|Medicare|MEDICARE A & B|||||0.96||| 84295|EAP|0301|SODIUM|Medicare|MEDICARE RAILROAD|||||0.96||| 84295|EAP|0301|SODIUM|ChampVA|CHAMPVA OF CO DENVER|||||0.96||| 84295|EAP|0301|SODIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.96||| 84295|EAP|0301|SODIUM|Cigna|NALC HLTH BENEFIT|||||0.96||| 84295|EAP|0301|SODIUM|Cigna|CIGNA OTHER|||||0.96||| 84295|EAP|0301|SODIUM|Cigna|CIGNA OPEN ACCESS PLUS|||||0.96||| 84295|EAP|0301|SODIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.96||| 84295|EAP|0301|SODIUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.96||| 84295|EAP|0301|SODIUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross PPO|BLUE CROSS POS|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross PPO|BCBS WALMART|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross PPO Select|BCBS UTHCT|||||0.96||| 84295|EAP|0301|SODIUM|Aetna|AETNA EXXON MOBIL|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross PPO|BLUE CROSS PPO|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross PPO|BCBS TRANE PPO|||||0.96||| 84295|EAP|0301|SODIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.96||| 84295|EAP|0301|SODIUM|Aetna|AETNA|||||0.96||| 84295|EAP|0301|SODIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 84300|EAP|0301|SODIUM, URINE|Aetna|AETNA EL PASO CLAIMS OFFICE|1.17||||||| 84300|EAP|0301|SODIUM, URINE|Blue Cross PPO|BLUE CROSS POS|||||1.17||| 84300|EAP|0301|SODIUM, URINE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.17||||1.17||| 84300|EAP|0301|SODIUM, URINE|Blue Cross PPO|BLUE CROSS PPO|1.17||||1.17||| 84300|EAP|0301|SODIUM, URINE|Blue Cross PPO Select|BCBS UTHCT|1.17||||||| 84300|EAP|0301|SODIUM, URINE|Medicaid|MEDICAID|1.17||||1.17||| 84300|EAP|0301|SODIUM, URINE|NON CONTRACTED|COMMERCIAL OTHER 2|1.17||||||| 84300|EAP|0301|SODIUM, URINE|NON CONTRACTED|COMMERCIAL OTHER|||||1.17||| 84300|EAP|0301|SODIUM, URINE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.17||||1.17||| 84300|EAP|0301|SODIUM, URINE|Medicare|MEDICARE A & B|1.17||||1.17||| 84300|EAP|0301|SODIUM, URINE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.17||| 84300|EAP|0301|SODIUM, URINE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.17||||1.17||| 84300|EAP|0301|SODIUM, URINE|United Healthcare|UMR|1.17||||||| 84300|EAP|0301|SODIUM, URINE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.17||| 84300|EAP|0301|SODIUM, URINE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.17||||1.17||| 84302|EAP|0301|SODIUM FECAL (ARUP)|Medicare|MEDICARE A & B|||||0.26||| 84302|EAP|0301|SODIUM FECAL (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.26||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.28||| 84305|EAP|0300|IGF-1 W/Z SCORE (REF)|Medicare|MEDICARE A & B|||||0.28||| 84307|EAP|0301|SOMATOSTATIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||130.95||| 84311|EAP|0301|SPECTROPHOTOMETRY ANALYTE(REF)|Medicare|MEDICARE A & B|0.32||||0.32||| 84311|EAP|0301|SPECTROPHOTOMETRY ANALYTE(REF)|Medicare|MEDICARE PART A|0.32||||||| 84311|EAP|0301|SPECTROPHOTOMETRY ANALYTE(REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.32||||||| 84311|EAP|0301|SPECTROPHOTOMETRY ANALYTE(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.32||| 84311|EAP|0301|SPECTROPHOTOMETRY ANALYTE(REF)|Blue Cross PPO|BLUE CROSS PPO|0.32||||||| 84376|EAP|0301|REDUCING SUBSTANCES-STOOL (REF|United Healthcare|UMR|||||0.10||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|ChampVA|CHAMPVA OF CO DENVER|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross PPO|BCBS TRANE PPO|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross PPO|BCBS WALMART|||||0.70||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Medicaid|MEDICAID|||||0.70||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|United Healthcare|UMR|||||0.67||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.70||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Medicare|MEDICARE A & B|||||0.64||| 84402|EAP|0301|TESTOSTERONE, FREE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.64||| 84403|EAP|0301|TESTOSTERONE, TOTAL|United Healthcare|UMR|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Medicaid|MEDICAID|||||0.73||| 84403|EAP|0301|TESTOSTERONE, TOTAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|NON CONTRACTED|COMMERCIAL OTHER|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross PPO|BCBS WALMART|||||153.50||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross PPO|BLUE CROSS PPO|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross PPO|BLUE CROSS POS|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Aetna|AETNA|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross PPO|BCBS TRANE PPO|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Aetna|AETNA EXXON MOBIL|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Medicare|MEDICARE PART B|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Medicare|MEDICARE RAILROAD|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Medicare|MEDICARE A & B|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.34||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.73||| 84403|EAP|0301|TESTOSTERONE, TOTAL|ChampVA|CHAMPVA OF CO DENVER|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Blue Cross PPO Select|BCBS UTHCT|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Cigna|NALC HLTH BENEFIT|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Cigna|CIGNA OTHER|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Cigna|CIGNA OPEN ACCESS PLUS|||||0.73||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Managed Medicaid|MOLINA MEDICAID|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Managed Medicaid|FAMILY PLANNING GRANT|||||0.73||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.34||| 84403|EAP|0301|TESTOSTERONE, TOTAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.34||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.31||||||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.31||||48.65||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.31||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.31||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Blue Cross PPO|BLUE CROSS POS|||||48.65||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Medicare|MEDICARE A & B|0.31||||0.31||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.31||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Blue Cross PPO|BLUE CROSS PPO|||||39.83||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.31||| 84425|EAP|0301|VITAMIN B1, PLASMA (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.31||| 84432|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.10||| 84432|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.10||| 84432|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|NON CONTRACTED|COMMERCIAL OTHER|||||1.10||| 84432|EAP|0301||Blue Cross PPO|BLUE CROSS POS|||||1.10||| 84432|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Blue Cross PPO|BLUE CROSS PPO|||||1.10||| 84432|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Managed Medicaid|MOLINA MEDICAID|||||1.10||| 84432|EAP|0301||Blue Cross PPO|BCBS WALMART|||||1.10||| 84432|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.10||| 84432|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.10||| 84432|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.10||| 84432|EAP|0301|THYROGLOBULIN BY LC REF (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.47||| 84432|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.10||| 84432|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||1.10||| 84432|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.10||| 84432|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.10||| 84432|EAP|0301||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.10||| 84432|EAP|0301|THYROGLOBULIN BY LC REF (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||1.47||| 84432|EAP|0301|THYROGLOBULIN SERUM/PLAS (ARUP|Medicare|MEDICARE A & B|||||1.10||| 84432|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.10||| 84432|EAP|0301||Medicare|MEDICARE A & B|||||1.10||| 84432|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||1.10||| 84432|EAP|0301||Aetna|TRS COORDINATED CARE|||||1.10||| 84436|EAP|0301|T4, TOTAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.80||| 84436|EAP|0301|T4, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.80||| 84436|EAP|0301|T4, TOTAL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.80||| 84436|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.80||| 84436|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||1.80||| 84436|EAP|0301|T4, TOTAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.80||| 84436|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.80||| 84436|EAP|0301|T4, TOTAL|Blue Cross PPO|BLUE CROSS POS|||||1.80||| 84436|EAP|0301|T4, TOTAL|Blue Cross PPO|BLUE CROSS PPO|||||1.80||| 84436|EAP|0301||Blue Cross PPO|BCBS WALMART|||||1.80||| 84436|EAP|0301|T4, TOTAL|Medicare|MEDICARE A & B|1.80||||1.80||| 84436|EAP|0301|T4, TOTAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.80||| 84436|EAP|0301|T4, TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.80||| 84436|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 84436|EAP|0301||Medicare|MEDICARE A & B|1.80||||1.80||| 84436|EAP|0301|T4, TOTAL|Medicaid|MEDICAID|||||1.80||| 84436|EAP|0301|T4, TOTAL|NON CONTRACTED|COMMERCIAL OTHER|||||1.80||| 84436|EAP|0301|T4, TOTAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.80||| 84436|EAP|0301|T4, TOTAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.80||| 84436|EAP|0301|T4, TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.80||| 84436|EAP|0301|T4, TOTAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.80||| 84439|EAP|0301|T4, FREE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.63||| 84439|EAP|0301|T4, FREE|PHCS|TML GRP INS|||||2.63||| 84439|EAP|0301|T4, FREE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.63||| 84439|EAP|0301|T4, FREE|United Healthcare|UNITED HEALTHCARE STUDENT RES|||||2.63||| 84439|EAP|0301|T4, FREE|Workers Compensation|WC OTHER|||||2.63||| 84439|EAP|0301|T4, FREE|United Healthcare|GOLDEN RULE INSURANCE|||||2.63||| 84439|EAP|0301|T4, FREE|PHCS|WEB TPA|||||2.63||| 84439|EAP|0301|T4, FREE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Multiplan|TML GRP INS|||||2.63||| 84439|EAP|0301|T4, FREE|Multiplan|WEB TPA|||||2.63||| 84439|EAP|0301|T4, FREE|NON CONTRACTED|COMMERCIAL OTHER|2.63||||2.63||| 84439|EAP|0301|T4, FREE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.63||| 84439|EAP|0301|T4, FREE|Optum Behavioral Health|OPTUM|2.63||||||| 84439|EAP|0301|T4, FREE|Medicaid|MEDICAID|||||2.63||| 84439|EAP|0301|T4, FREE|Aetna|AETNA EL PASO CLAIMS OFFICE|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.63||| 84439|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 84439|EAP|0301|T4, FREE|Medicare|MEDICARE A & B|2.63||||2.63||| 84439|EAP|0301|T4, FREE|United Healthcare|UMR|||||2.63||| 84439|EAP|0301|T4, FREE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Blue Cross PPO Select|BCBS UTHCT|||||2.63||| 84439|EAP|0301|T4, FREE|Aetna|AETNA EXXON MOBIL|||||2.63||| 84439|EAP|0301|T4, FREE|Blue Cross PPO|BLUE CROSS PPO|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Aetna|AETNA|||||2.63||| 84439|EAP|0301|T4, FREE|Multiplan|PHCS OF AZ PHEONIX|||||2.63||| 84439|EAP|0301|T4, FREE|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.63||| 84439|EAP|0301|T4, FREE|Aetna|TRS COORDINATED CARE|||||1.44||| 84439|EAP|0301|T4, FREE|Blue Cross PPO|BCBS TRANE PPO|||||2.63||| 84439|EAP|0301|T4, FREE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.63||||2.63||| 84439|EAP|0301|T4, FREE|PHCS|PHCS OF AZ PHEONIX|||||2.63||| 84439|EAP|0301|T4, FREE|Medicare|MEDICARE RAILROAD|||||1.44||| 84439|EAP|0301|T4, FREE|ChampVA|CHAMPVA OF CO DENVER|||||2.63||| 84439|EAP|0301|T4, FREE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Cigna|CIGNA OPEN ACCESS PLUS|||||2.63||| 84439|EAP|0301|T4, FREE|Cigna|CIGNA BEHAVIORAL HEALTH|||||2.63||| 84439|EAP|0301|T4, FREE|Cigna|CIGNA OF TN CHATTANOOGA|||||2.63||| 84439|EAP|0301|T4, FREE|Cigna|CIGNA OTHER|||||2.63||| 84439|EAP|0301|T4, FREE|Blue Cross PPO|BLUE CROSS POS|||||2.63||| 84439|EAP|0301|T4, FREE|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.63||| 84439|EAP|0301|T4, FREE|Managed Medicaid|MOLINA MEDICAID|||||2.63||| 84439|EAP|0301|T4, FREE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Blue Cross PPO|BCBS WALMART|2.63||||2.63||| 84439|EAP|0301|T4, FREE|Managed Medicaid|FAMILY PLANNING GRANT|||||2.63||| 84439|EAP|0301|T4, FREE|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.63||| 84439|EAP|0301|T4, FREE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.44||| 84439|EAP|0301|T4, FREE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.63||||2.63||| 84442|EAP|0301|THYROXINE BINDING GLOBULIN (RE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.34||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|CIGNA BEHAVIORAL HEALTH|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.28||||174.15||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Blue Cross PPO|BLUE CROSS POS|2.28||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.28||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||174.15||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Medicaid|MEDICAID|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|CIGNA OTHER|||||2.28||| 84443|EAP|0301||Medicare|MEDICARE A & B|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicare|RESERVE NAT INS|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Medicare|MEDICARE A & B|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Medicare|MEDICARE PART A|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|ChampVA|CHAMPVA OF CO DENVER|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Multiplan|WEB TPA|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|PPO OTHER|||||137.50||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Multiplan|PHCS OF AZ PHEONIX|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|MOLINA MEDICAID|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Healthcare|UMR|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|MRAMVA|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|BOONE CHAPMAN|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Medicare|MEDICARE PART B|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|COMMUNITY CARE|||||0.47||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|COMMERCIAL OTHER|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Multiplan|TML GRP INS|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Optum Behavioral Health|OPTUM|2.28||||||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Healthcare|UNITED HEALTHCARE STUDENT RES|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|PHCS|PHCS OF AZ PHEONIX|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|PHCS|TML GRP INS|||||2.28||| 84443|EAP|0301||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Workers Compensation|WC OTHER|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Workers Compensation|WC TX MUTUAL INS|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|MEDICAID CSHCN|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|COMMERCIAL OTHER 2|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|PHCS|WEB TPA|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Multiplan|GILSBAR INC|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|SUPERIOR STAR MCD|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|United Healthcare|UMR|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.28||| 84443|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|NALC HLTH BENEFIT|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|United Healthcare|GOLDEN RULE INSURANCE|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|CIGNA OF TN CHATTANOOGA|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO|BCBS TRANE PPO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|CIGNA OF TN CHATTANOOGA|||||137.50||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|NON CONTRACTED|SIERRA HEALTH & LIFE|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Access Direct Platinum|ACCESS DIRECT|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO|BLUE CROSS PPO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Aetna|AETNA EXXON MOBIL|||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|NON CONTRACTED|COMMERCIAL OTHER|2.28||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Medicare|MEDICARE RAILROAD|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.28||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Aetna|AETNA EXXON MOBIL|||||2.28||| 84443|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Aetna|AETNA US HEALTHCARE PA|||||2.28||| 84443|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.28||||71.15||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Aetna|AETNA|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Medicare|MEDICARE A & B|2.28||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO|BCBS WALMART|2.28||||2.28||| 84443|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO|BLUE CROSS POS|2.28||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (REF)|Blue Cross PPO|BLUE CROSS PPO|2.28||||120.30||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Aetna|TRS COORDINATED CARE|||||2.28||| 84443|EAP|0301|THYROID STIM HORMONE (TSH)|Blue Cross PPO Select|BCBS UTHCT|2.28||||2.28||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Blue Cross PPO|BLUE CROSS POS|||||0.78||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.78||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.78||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Blue Cross PPO|BLUE CROSS PPO|||||0.78||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Blue Cross PPO Select|BCBS UTHCT|||||2.01||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Cigna|CIGNA OPEN ACCESS PLUS|||||3.24||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.24||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|United Healthcare|UMR|||||0.78||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Medicare|MEDICARE A & B|||||0.78||| 84445|EAP|0301|THYROID STIMULATING IMMUNOGLOB|Cigna|CIGNA OF TN CHATTANOOGA|||||0.78||| 84446|EAP|0301|VITAMIN E (REF)|Managed Medicaid|MEDICAID CSHCN|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|NON CONTRACTED|PPO OTHER|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|United Healthcare|UMR|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Medicaid|MEDICAID|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Medicare|MEDICARE A & B|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Managed Medicaid|MOLINA MEDICAID|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Managed Medicaid|OTHER MEDICAID|||||0.31||| 84446|EAP|0301|VITAMIN E (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.31||| 84450|EAP|0301|AST SGOT (6822)|Blue Cross PPO|BLUE CROSS POS|||||0.73||| 84450|EAP|0301|AST SGOT (6822)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.73||| 84450|EAP|0301|AST (SGOT)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.56||| 84450|EAP|0301|AST SGOT (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.73||| 84450|EAP|0301|AST (SGOT)|Blue Cross PPO|BLUE CROSS PPO|||||1.56||| 84450|EAP|0301|AST (SGOT)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 84450|EAP|0301|AST SGOT (6822)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.73||| 84450|EAP|0301|AST SGOT (6822)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.73||| 84450|EAP|0301|AST (SGOT)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 84450|EAP|0301|AST (SGOT)|Medicare|MEDICARE A & B|||||1.56||| 84450|EAP|0301|AST (SGOT)|Managed Medicaid|MOLINA MEDICAID|||||0.25||| 84450|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.73||| 84450|EAP|0301|AST SGOT (6822)|NON CONTRACTED|COMMERCIAL OTHER|||||0.73||| 84450|EAP|0301|AST (SGOT)|Blue Cross PPO|BCBS WALMART|||||1.56||| 84450|EAP|0301|AST SGOT (6822)|Medicare|MEDICARE A & B|||||0.73||| 84450|EAP|0301|AST SGOT (PART OF 6576)|Medicare|MEDICARE A & B|||||1.17||| 84450|EAP|0301|AST SGOT (6822)|Blue Cross PPO|BLUE CROSS PPO|||||0.73||| 84450|EAP|0301|AST SGOT (6822)|Blue Cross PPO Select|BCBS UTHCT|||||0.73||| 84450|EAP|0301|AST SGOT (6822)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.73||| 84450|EAP|0301|AST (SGOT)|Blue Cross PPO|BLUE CROSS POS|||||0.25||| 84450|EAP|0301|AST SGOT (6822)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.73||| 84460|EAP|0301|ALT (SGPT)|Blue Cross PPO|BLUE CROSS POS|||||0.25||| 84460|EAP|0301|ALT (SGPT)|Blue Cross PPO|BCBS WALMART|||||1.26||| 84460|EAP|0301|ALT SGPT (6678)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 84460|EAP|0301|ALT SGPT (6822)|Blue Cross PPO|BLUE CROSS POS|||||0.73||| 84460|EAP|0301|ALT SGPT (6678)|Medicaid|MEDICAID|||||0.65||| 84460|EAP|0301|ALT SGPT (6822)|Blue Cross PPO|BLUE CROSS PPO|||||0.73||| 84460|EAP|0301|ALT SGPT (6822)|Medicare|MEDICARE A & B|||||0.73||| 84460|EAP|0301|ALT (SGPT)|Managed Medicaid|MOLINA MEDICAID|||||0.25||| 84460|EAP|0301|ALT SGPT (6678)|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 84460|EAP|0301|ALT SGPT (6678)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 84460|EAP|0301|ALT SGPT (6678)|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| 84460|EAP|0301|ALT SGPT (6822)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.73||| 84460|EAP|0301|ALT SGPT (PART OF 6576)|Medicare|MEDICARE A & B|||||1.17||| 84460|EAP|0301|ALT (SGPT)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 84460|EAP|0301|ALT SGPT (6822)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.73||| 84460|EAP|0301|ALT SGPT (6678)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| 84460|EAP|0301|ALT SGPT (6678)|United Healthcare|UMR|||||0.65||| 84460|EAP|0301|ALT (SGPT)|Medicare|MEDICARE A & B|||||1.26||| 84460|EAP|0301|ALT SGPT (6678)|Medicare|MEDICARE A & B|||||0.65||| 84460|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.73||| 84460|EAP|0301|ALT SGPT (6822)|NON CONTRACTED|COMMERCIAL OTHER|||||0.73||| 84460|EAP|0301|ALT SGPT (6678)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 84460|EAP|0301|ALT (SGPT)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 84460|EAP|0301||Medicare|MEDICARE A & B|||||0.65||| 84460|EAP|0301|ALT SGPT (6678)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 84460|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 84460|EAP|0301|ALT SGPT (6822)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.73||| 84460|EAP|0301|ALT SGPT (6678)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 84460|EAP|0301||Aetna|AETNA EXXON MOBIL|||||0.65||| 84460|EAP|0301|ALT (SGPT)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.26||| 84460|EAP|0301|ALT SGPT (6822)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.73||| 84460|EAP|0301|ALT (SGPT)|Blue Cross PPO|BLUE CROSS PPO|||||1.26||| 84460|EAP|0301|ALT SGPT (6822)|Blue Cross PPO Select|BCBS UTHCT|||||0.73||| 84460|EAP|0301|ALT SGPT (6822)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.73||| 84460|EAP|0301|ALT SGPT (6678)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.65||| 84460|EAP|0301|ALT SGPT (6822)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.73||| 84466|EAP|0301|TRANSFERRIN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Medicare|MEDICARE A & B|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Medicaid|MEDICAID|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|United Healthcare|UMR|||||1.74||| 84466|EAP|0301|TRANSFERRIN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.74||| 84478|EAP|0301|TRIGLYCERIDES|Multiplan|WEB TPA|||||1.86||| 84478|EAP|0301|TRIGLYCERIDES|Medicare|MEDICARE A & B|||||1.86||| 84478|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.86||| 84478|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.86||| 84478|EAP|0301||Multiplan|TML GRP INS|||||1.86||| 84478|EAP|0301||Blue Cross PPO|BLUE CROSS POS|||||1.86||| 84478|EAP|0301|TRIGLYCERIDES|Blue Cross PPO Select|BCBS UTHCT|||||1.86||| 84478|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.86||| 84478|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|1.86||||1.86||| 84478|EAP|0301||PHCS|TML GRP INS|||||1.86||| 84478|EAP|0301||Medicare|MEDICARE A & B|||||1.86||| 84478|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||1.86||| 84478|EAP|0301|TRIGLYCERIDES|PHCS|WEB TPA|||||1.86||| 84480|EAP|0301|TOTAL T3 (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.58||| 84480|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Blue Cross PPO|BLUE CROSS POS|||||0.58||| 84480|EAP|0301||Blue Cross PPO|BLUE CROSS POS|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.58||| 84480|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Blue Cross PPO|BCBS WALMART|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||48.50||| 84480|EAP|0301|TOTAL T3 (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.58||| 84480|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.39||| 84480|EAP|0301|TOTAL T3 (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.58||| 84480|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.58||| 84480|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||0.39||| 84480|EAP|0301|TOTAL T3 (ARUP)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|United Healthcare|UMR|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.58||| 84480|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.58||| 84480|EAP|0301||Medicare|MEDICARE A & B|||||0.58||| 84480|EAP|0301||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|Medicare|MEDICARE A & B|||||0.58||| 84480|EAP|0301|TOTAL T3 (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||0.58||| 84481|EAP|0301|T3 FREE|Multiplan|WEB TPA|||||3.03||| 84481|EAP|0301|T3 FREE|Medicare|MEDICARE A & B|3.03||||3.03||| 84481|EAP|0301|T3 FREE|Medicaid|MEDICAID|||||3.03||| 84481|EAP|0301|T3 FREE|Medicare|MEDICARE RAILROAD|||||175.50||| 84481|EAP|0301|T3 FREE|United Healthcare|GOLDEN RULE INSURANCE|||||3.03||| 84481|EAP|0301|T3 FREE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.03||| 84481|EAP|0301|T3 FREE|United Healthcare|UMR|||||3.03||| 84481|EAP|0301|T3 FREE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.03||| 84481|EAP|0301|T3 FREE|PHCS|WEB TPA|||||3.03||| 84481|EAP|0301|T3 FREE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.03||| 84481|EAP|0301|T3 FREE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.03||| 84481|EAP|0301|T3 FREE|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.03||||3.03||| 84481|EAP|0301|T3 FREE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.03||||3.03||| 84481|EAP|0301|T3 FREE|Cigna|CIGNA OPEN ACCESS PLUS|||||3.03||| 84481|EAP|0301|T3 FREE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.03||| 84481|EAP|0301|T3 FREE|Managed Medicaid|MOLINA MEDICAID|||||3.03||| 84481|EAP|0301|T3 FREE|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||3.03||| 84481|EAP|0301|T3 FREE|Managed Medicaid|FAMILY PLANNING GRANT|||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross PPO Select|BCBS UTHCT|||||3.03||| 84481|EAP|0301|T3 FREE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.03||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross PPO|BCBS TRANE PPO|||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross PPO|BLUE CROSS PPO|3.03||||3.03||| 84481|EAP|0301|T3 FREE|NON CONTRACTED|COMMERCIAL OTHER|3.03||||3.03||| 84481|EAP|0301|T3 FREE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross PPO|BLUE CROSS POS|||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross PPO|BCBS WALMART|||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.03||| 84481|EAP|0301|T3 FREE|Cigna|CIGNA OTHER|||||3.03||| 84481|EAP|0301|T3 FREE|ChampVA|CHAMPVA OF CO DENVER|||||3.03||| 84481|EAP|0301|T3 FREE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.03||| 84481|EAP|0301|T3 FREE|Aetna|TRS COORDINATED CARE|||||0.48||| 84481|EAP|0301|T3 FREE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.03||| 84481|EAP|0301|T3 FREE|Aetna|AETNA EXXON MOBIL|||||3.03||| 84481|EAP|0301|T3 FREE|Aetna|AETNA|||||3.03||| 84481|EAP|0301|T3 FREE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.03||| 84481|EAP|0301|T3 FREE|Cigna|CIGNA OF TN CHATTANOOGA|||||3.03||| 84482|EAP|0301|REVERSE T3 (REF)|Blue Cross PPO|BLUE CROSS PPO|||||55.10||| 84482|EAP|0301|REVERSE T3 (REF)|Cigna|CIGNA OTHER|||||3.89||| 84484|EAP|0301|TROPONIN T|United Healthcare|UMR|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|PHCS|WEB TPA|||||2.59||| 84484|EAP|0301|TROPONIN T|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.59||| 84484|EAP|0301|TROPONIN T|PHCS|TML GRP INS|2.59||||||| 84484|EAP|0301|TROPONIN T|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Medicare|MEDICARE PART A|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Medicaid|MEDICAID|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Multiplan|WEB TPA|||||2.59||| 84484|EAP|0301|TROPONIN T|NON CONTRACTED|MRAMVA|||||2.59||| 84484|EAP|0301|TROPONIN T|Managed Medicaid|MOLINA MEDICAID|||||2.59||| 84484|EAP|0301|TROPONIN T|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|2.59||||||| 84484|EAP|0301|TROPONIN T|NON CONTRACTED|PPO OTHER|||||2.59||| 84484|EAP|0301|TROPONIN T|NON CONTRACTED|COMMERCIAL OTHER|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Managed Medicaid|SUPERIOR STAR MCD|||||2.59||| 84484|EAP|0301|TROPONIN T|NON CONTRACTED|COMMERCIAL OTHER 2|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|ChampVA|CHAMPVA OF CO DENVER|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Multiplan|TML GRP INS|2.59||||||| 84484|EAP|0301|TROPONIN T|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Cigna|CIGNA OPEN ACCESS PLUS|||||2.59||| 84484|EAP|0301|TROPONIN T|Cigna|CIGNA OF TN CHATTANOOGA|||||2.59||| 84484|EAP|0301|TROPONIN T|Aetna|AETNA EL PASO CLAIMS OFFICE|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Medicare|MEDICARE RAILROAD|||||2.59||| 84484|EAP|0301|TROPONIN T|Aetna|AETNA US HEALTHCARE PA|||||2.59||| 84484|EAP|0301|TROPONIN T|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Aetna|AETNA|||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross PPO Select|BCBS UTHCT|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.59||| 84484|EAP|0301|TROPONIN T|Medicare|MEDICARE A & B|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross PPO|BLUE CROSS POS|||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross PPO|BCBS WALMART|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross PPO|BCBS TRANE PPO|2.59||||2.59||| 84484|EAP|0301|TROPONIN T|Blue Cross PPO|BLUE CROSS PPO|2.59||||2.59||| 84520|EAP|0301|BUN|Blue Cross PPO|BLUE CROSS PPO|||||0.84||| 84520|EAP|0301|BUN|Blue Cross PPO|BLUE CROSS POS|||||0.84||| 84520|EAP|0301|BUN|Blue Cross PPO Select|BCBS UTHCT|||||0.84||| 84520|EAP|0301|BUN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.84||| 84520|EAP|0301|BUN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.84||| 84520|EAP|0301|BUN|NON CONTRACTED|COMMERCIAL OTHER|||||0.84||| 84520|EAP|0301|UREA NITROGEN (PART OF 6576)|Medicare|MEDICARE A & B|||||1.17||| 84520|EAP|0301|BUN|Medicare|MEDICARE A & B|||||0.84||| 84520|EAP|0301||Medicare|MEDICARE A & B|||||0.84||| 84550|EAP|0301|URIC ACID, SERUM|PHCS|TML GRP INS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.97||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|United Healthcare|UMR|||||0.25||| 84550|EAP|0301|URIC ACID, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Medicare|MEDICARE RAILROAD|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Medicare|MEDICARE A & B|0.97||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|NON CONTRACTED|COMMERCIAL OTHER|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Optum Behavioral Health|OPTUM|0.97||||||| 84550|EAP|0301|URIC ACID, SERUM|Managed Medicaid|SUPERIOR STAR MCD|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|ChampVA|CHAMPVA OF CO DENVER|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Multiplan|TML GRP INS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 84550|EAP|0301|URIC ACID, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.97||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross PPO|BLUE CROSS POS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross PPO Select|BCBS UTHCT|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross PPO|BCBS WALMART|||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross PPO|BLUE CROSS PPO|0.97||||0.97||| 84550|EAP|0301|URIC ACID, SERUM|Blue Cross PPO|BCBS TRANE PPO|||||0.61||| 84550|EAP|0301|URIC ACID, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.97||| 84560|EAP|0301|URIC ACID, URINE|Blue Cross PPO|BLUE CROSS PPO|||||1.09||| 84560|EAP|0301|URIC ACID, URINE|Medicare|MEDICARE A & B|1.09||||1.09||| 84585|EAP|0301||Medicare|MEDICARE A & B|||||2.83||| 84585|EAP|0301|VMA URINE, QUANT (REF) (V)|Medicare|MEDICARE A & B|||||111.05||| 84585|EAP|0301|VMA URINE, QUANT (REF) (V)|Blue Cross PPO Select|BCBS UTHCT|||||2.83||| 84586|EAP|0301|VASOACTIVE INTESTINAL PEPTIDE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.72||| 84588|EAP|0301|ADH (ANTIDIURETIC HORMONE (REF|Blue Cross PPO|BLUE CROSS PPO|||||5.36||| 84590|EAP|0301|VITAMIN A (REF)|NON CONTRACTED|PPO OTHER|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Medicare|MEDICARE A & B|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Medicaid|MEDICAID|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|United Healthcare|UMR|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Managed Medicaid|OTHER MEDICAID|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Managed Medicaid|MOLINA MEDICAID|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Managed Medicaid|MEDICAID CSHCN|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.78||| 84590|EAP|0301|VITAMIN A (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.78||| 84591|EAP|0301|NIACIN (VITB3) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.40||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|United Healthcare|UMR|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Medicaid|MEDICAID|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Medicare|MEDICARE A & B|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|NON CONTRACTED|PPO OTHER|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Managed Medicaid|OTHER MEDICAID|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Managed Medicaid|MEDICAID CSHCN|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Managed Medicaid|MOLINA MEDICAID|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Blue Cross PPO|BLUE CROSS POS|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Blue Cross PPO|BLUE CROSS PPO|||||0.71||| 84597|EAP|0301|VITAMIN K, PLASMA OR SERUM (RE|Blue Cross PPO Select|BCBS UTHCT|||||0.71||| 84630|EAP|0301|ZINC, SERUM (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Managed Medicaid|MOLINA MEDICAID|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Managed Medicaid|OTHER MEDICAID|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Managed Medicaid|MEDICAID CSHCN|||||1.10||| 84630|EAP|0301|ZINC, SERUM (REF)|Medicare|MEDICARE A & B|||||1.10||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Managed Medicaid|SUPERIOR STAR MCD|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.49||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||166.50||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Blue Cross PPO|BLUE CROSS PPO|1.84||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Blue Cross PPO|BCBS WALMART|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Managed Medicaid|MOLINA MEDICAID|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Medicare|MEDICARE PART A|1.84||||||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Medicare|MEDICARE A & B|||||1.84||| 84681|EAP|0301|C-PEPTIDE, SERUM (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.84||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Blue Cross PPO|BLUE CROSS PPO|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.76||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Blue Cross PPO Select|BCBS UTHCT|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.11||| 84702|EAP|0301|BETA HCG, TUMOR MARKER (REF)|Aetna|AETNA|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Managed Medicaid|SUPERIOR STAR MCD|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Managed Medicaid|MOLINA MEDICAID|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Managed Medicaid|FAMILY PLANNING GRANT|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Blue Cross PPO|BLUE CROSS POS|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Medicare|MEDICARE A & B|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|Medicaid|MEDICAID|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|NON CONTRACTED|COMMERCIAL OTHER|||||3.11||| 84702|EAP|0301|BETA HCG, TUMOR MARKER (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|United Healthcare|GOLDEN RULE INSURANCE|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.11||| 84702|EAP|0301|HCG, SERUM QUANTITATIVE|United Healthcare|UMR|||||3.11||| 84703|EAP|0331||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|United Healthcare|UMR|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|United Healthcare|GOLDEN RULE INSURANCE|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|PHCS|WEB TPA OF GRAND PRAIRIE|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|PHCS|WEB TPA|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Multiplan|WEB TPA OF GRAND PRAIRIE|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|NON CONTRACTED|BOONE CHAPMAN|||||1.44||| 84703|EAP|0981||Medicaid|MEDICAID|||||0.00||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Medicare|MEDICARE A & B|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Medicare|MEDICARE PART A|1.44||||||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Managed Medicaid|MOLINA MEDICAID|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Managed Medicaid|SUPERIOR STAR MCD|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Multiplan|WEB TPA|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Medicaid|MEDICAID|||||1.44||| 84703|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 84703|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|NON CONTRACTED|COMMERCIAL OTHER|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|NON CONTRACTED|MRAMVA|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|ChampVA|CHAMPVA OF CO DENVER|||||1.44||| 84703|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Aetna|AETNA|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.44||||1.44||| 84703|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.44||||1.44||| 84703|EAP|0459||Blue Cross PPO|BCBS TRANE PPO|||||3.00||| 84703|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 84703|EAP|0301|BETA-HCG, SERUM QUAL (REF)|Blue Cross PPO Select|BCBS UTHCT|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross PPO|BLUE CROSS POS|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross PPO|BCBS WALMART|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross PPO|BLUE CROSS PPO|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross PPO|BCBS TRANE PPO|1.44||||1.44||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.44||||1.44||| 84703|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 84703|EAP|0301|HCG, URINE (QUALITATIVE)|Blue Cross PPO Select|BCBS UTHCT|1.44||||1.44||| 84703|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||4.15||| 84704|EAP|0301|BETA HCG, TUMOR MARKER (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.31||| 84704|EAP|0301|BETA HCG, TUMOR MARKER (REF)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.31||| 84704|EAP|0301|BETA HCG, TUMOR MARKER (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.31||| 84999|EAP|0301|POTASSIUM FECAL (ARUP)|Medicare|MEDICARE A & B|||||0.26||| 84999|EAP|0301|POTASSIUM FECAL (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.26||| 84999|EAP|0301|OSMOLALITY, FECAL (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.01||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.78||||0.78||| 85007|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Cigna|NALC HLTH BENEFIT|0.78||||||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Cigna|CIGNA OPEN ACCESS PLUS|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross PPO Select|BCBS UTHCT|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|ChampVA|CHAMPVA OF CO DENVER|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.78||| 85007|EAP|0305||Cigna|CIGNA OF TN CHATTANOOGA|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||51.50||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Managed Medicaid|SUPERIOR STAR MCD|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Managed Medicaid|MEDICAID CSHCN|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Managed Medicaid|FAMILY PLANNING GRANT|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.78||| 85007|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Aetna|AETNA EL PASO CLAIMS OFFICE|0.78||||0.78||| 85007|EAP|0305||Aetna|AETNA EL PASO CLAIMS OFFICE|0.78||||0.25||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Aetna|AETNA EXXON MOBIL|||||0.25||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.78||||0.78||| 85007|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross PPO|BLUE CROSS POS|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||0.78||| 85007|EAP|0305||Managed Medicaid|MOLINA MEDICAID|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross PPO|BLUE CROSS PPO|0.78||||0.78||| 85007|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.78||||0.25||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|PHCS|TML GRP INS|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|United Healthcare|UMR|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross PPO|BCBS TRANE PPO|0.78||||0.78||| 85007|EAP|0305||United Healthcare|UMR|0.78||||0.78||| 85007|EAP|0305||United Healthcare|GOLDEN RULE INSURANCE|||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Blue Cross PPO|BCBS WALMART|0.78||||0.78||| 85007|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Multiplan|TML GRP INS|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|NON CONTRACTED|COMMERCIAL OTHER 2|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|NON CONTRACTED|COMMERCIAL OTHER|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Medicaid|MEDICAID|||||0.78||| 85007|EAP|0305||Medicare|MEDICARE A & B|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Medicare|MEDICARE A & B|0.78||||0.78||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Medicare|MEDICARE RAILROAD|0.78||||||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Medicare|MEDICARE PART A|0.78||||||| 85007|EAP|0305|BLOOD COUNT; MANUAL DIFFERENTI|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.78||| 85014|EAP|0305|HEMATOCRIT (HCT)|Medicare|MEDICARE A & B|0.59||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|NON CONTRACTED|COMMERCIAL OTHER|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Medicaid|MEDICAID|0.59||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.59||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|United Healthcare|UMR|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Blue Cross PPO|BLUE CROSS PPO|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.59||||||| 85014|EAP|0305|HEMATOCRIT (HCT)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.59||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.59||||||| 85014|EAP|0305|HEMATOCRIT (HCT)|Managed Medicaid|SUPERIOR STAR MCD|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Managed Medicaid|MOLINA MEDICAID|||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.59||||0.59||| 85014|EAP|0305|HEMATOCRIT (HCT)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.59||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.58||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Blue Cross PPO Select|BCBS UTHCT|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.58||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Managed Medicaid|SUPERIOR STAR MCD|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (WELL CHILD) TDH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 85018|EAP|0305|HEMOGLOBIN (WELL CHILD) TDH|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.58||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Managed Medicaid|MOLINA MEDICAID|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.58||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Blue Cross PPO|BCBS WALMART|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Blue Cross PPO|BLUE CROSS PPO|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.58||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|NON CONTRACTED|COMMERCIAL OTHER|||||0.58||| 85018|EAP|0305|HEMOGLOBIN (WELL CHILD) TDH|Medicaid|MEDICAID|0.58||||0.00||| 85018|EAP|0305|HEMOGLOBIN (HGB)|United Healthcare|UMR|||||41.50||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Medicaid|MEDICAID|0.58||||0.58||| 85018|EAP|0305|HEMOGLOBIN (HGB)|Medicare|MEDICARE A & B|0.58||||0.58||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Medicare|MEDICARE PART A|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Medicare|MEDICARE A & B|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Medicare|MEDICARE PART B|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Medicare|MEDICARE RAILROAD|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Multiplan|WEB TPA OF GRAND PRAIRIE|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Multiplan|PHCS OF AZ PHEONIX|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Multiplan|GILSBAR INC|||||1.68||| 85025|EAP|0305||Multiplan|TML GRP INS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|COMMERCIAL OTHER 2|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Multiplan|WEB TPA|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|SIERRA HEALTH & LIFE|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|MRAMVA|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|COMMERCIAL OTHER|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|BOONE CHAPMAN|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|PPO OTHER|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Workers Compensation|WC OTHER|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Workers Compensation|WC TX MUTUAL INS|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|PHCS|WEB TPA OF GRAND PRAIRIE|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|PHCS|WEB TPA|||||1.68||| 85025|EAP|0305||PHCS|TML GRP INS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|PHCS|PHCS OF AZ PHEONIX|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|PHCS|TML GRP INS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Healthcare|UMR|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Healthcare|AARP OF GA ATLANTA|||||96.50||| 85025|EAP|0305||United Healthcare|UMR|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.68||||1.68||| 85025|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross PPO|BCBS WALMART|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross PPO|BLUE CROSS POS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross PPO|BCBS TRANE PPO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Aetna|TRS COORDINATED CARE|||||96.50||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross PPO|BLUE CROSS PPO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Aetna|AETNA EXXON MOBIL|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Aetna|AETNA|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Healthcare|GOLDEN RULE INSURANCE|||||1.68||| 85025|EAP|0305||Aetna|AETNA EL PASO CLAIMS OFFICE|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Aetna|AETNA US HEALTHCARE PA|||||1.68||| 85025|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Aetna|AETNA EL PASO CLAIMS OFFICE|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|SUPERIOR STAR MCD|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|OTHER MEDICAID|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Workers Compensation|WC GALLAGHER BASSETT|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|MOLINA MEDICAID|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|FAMILY PLANNING GRANT|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|MEDICAID CSHCN|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|NON CONTRACTED|COMMUNITY CARE|||||0.25||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Multiplan|TML GRP INS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|CIGNA BEHAVIORAL HEALTH|1.68||||1.68||| 85025|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|ChampVA|CHAMPVA OF CO DENVER|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Managed Medicare|RESERVE NAT INS|||||1.68||| 85025|EAP|0305||Medicare|MEDICARE A & B|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Blue Cross PPO Select|BCBS UTHCT|1.68||||1.68||| 85025|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|CIGNA OF TN CHATTANOOGA|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Medicaid|MEDICAID|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|CIGNA OTHER|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|NALC HLTH BENEFIT|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|CIGNA OPEN ACCESS PLUS|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Cigna|CIGNA OF TN CHATTANOOGA|||||96.50||| 85025|EAP|0305||Cigna|CIGNA OPEN ACCESS PLUS|||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.68||||1.68||| 85025|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.68||||1.68||| 85025|EAP|0305|HEMOGRAM & PLATELET COUNT, AUT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.68||||1.68||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|ChampVA|CHAMPVA OF CO DENVER|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Cigna|NALC HLTH BENEFIT|1.55||||||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.55||||0.25||| 85027|EAP|0305||Cigna|CIGNA OF TN CHATTANOOGA|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.55||||1.55||| 85027|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross PPO Select|BCBS UTHCT|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Managed Medicaid|SUPERIOR STAR MCD|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.55||| 85027|EAP|0305||Managed Medicaid|MOLINA MEDICAID|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.55||||1.55||| 85027|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Aetna|AETNA EXXON MOBIL|||||0.25||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Aetna|AETNA EL PASO CLAIMS OFFICE|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Managed Medicaid|FAMILY PLANNING GRANT|||||1.55||| 85027|EAP|0305||Aetna|AETNA EL PASO CLAIMS OFFICE|1.55||||0.25||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross PPO|BCBS TRANE PPO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Managed Medicaid|MEDICAID CSHCN|||||1.55||| 85027|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross PPO|BLUE CROSS PPO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross PPO|BCBS WALMART|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Blue Cross PPO|BLUE CROSS POS|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.55||| 85027|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.90||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|PHCS|TML GRP INS|1.55||||1.55||| 85027|EAP|0305||United Healthcare|UMR|1.55||||1.55||| 85027|EAP|0305||United Healthcare|GOLDEN RULE INSURANCE|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|United Healthcare|UMR|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|NON CONTRACTED|COMMERCIAL OTHER|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|NON CONTRACTED|COMMERCIAL OTHER 2|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Medicaid|MEDICAID|||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Multiplan|TML GRP INS|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Medicare|MEDICARE RAILROAD|1.55||||||| 85027|EAP|0305||Medicare|MEDICARE A & B|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Medicare|MEDICARE PART A|1.55||||||| 85027|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|1.55||||1.55||| 85027|EAP|0305|BLOOD COUNT; COMPLETE AUTOMATE|Medicare|MEDICARE A & B|1.55||||1.55||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Medicaid|MEDICAID|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Medicare|MEDICARE A & B|0.76||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Multiplan|WEB TPA|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|NON CONTRACTED|COMMERCIAL OTHER|0.76||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|PHCS|WEB TPA|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|United Healthcare|UMR|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Blue Cross PPO|BLUE CROSS PPO|||||0.76||| 85045|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.76||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Cigna|CIGNA OF TN CHATTANOOGA|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|ChampVA|CHAMPVA OF CO DENVER|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.76||| 85045|EAP|0305|RETIC COUNT, AUTOMATED|Blue Cross PPO Select|BCBS UTHCT|||||0.76||| 85048|EAP|0305|EOSINOPHILS, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.48||| 85048|EAP|0305|EOSINOPHILS, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.48||| 85048|EAP|0305|EOSINOPHILS, SERUM|Blue Cross PPO|BLUE CROSS PPO|||||0.48||| 85048|EAP|0305|EOSINOPHILS, SERUM|Medicare|MEDICARE A & B|||||0.48||| 85049|EAP|0305|PLATELET COUNT, AUTOMATED|Medicare|MEDICARE A & B|||||0.94||| 85049|EAP|0305|PLATELET COUNT, AUTOMATED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.94||| 85049|EAP|0305|PLATELET COUNT, AUTOMATED|Aetna|AETNA EL PASO CLAIMS OFFICE|0.94||||0.94||| 85240|EAP|0305|FACTOR VIII ACTIVITY (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.95||| 85240|EAP|0305|FACTOR VIII ASSAY|Aetna|AETNA EL PASO CLAIMS OFFICE|4.95||||||| 85240|EAP|0305|FACTOR VIII ACTIVITY(PART OF 4|Blue Cross PPO Select|BCBS UTHCT|||||4.95||| 85240|EAP|0305|FACTOR VIII ACTIVITY(PART OF 4|Blue Cross PPO|BCBS WALMART|||||4.95||| 85240|EAP|0305|FACTOR VIII ACTIVITY (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.95||| 85245|EAP|0305|RISTOCETIN COFACTOR (REF)|Blue Cross PPO|BCBS WALMART|||||3.92||| 85245|EAP|0305|VON WILLEBRAND COFACTOR ASSAY(|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.92||| 85245|EAP|0305|RISTOCETIN COFACTOR (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.92||| 85245|EAP|0305|VON WILLEBRAND COFACTOR ASSAY(|NON CONTRACTED|COMMERCIAL OTHER|||||3.92||| 85245|EAP|0305|RISTOCETIN COFACTOR (REF)|Blue Cross PPO Select|BCBS UTHCT|||||3.92||| 85246|EAP|0305|VON WILLEBRAND ANTIGEN(PART OF|Blue Cross PPO|BCBS WALMART|||||3.09||| 85246|EAP|0305|VWF ANTIGEN (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.09||| 85246|EAP|0305|VWF ANTIGEN (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.09||| 85246|EAP|0305|VWF ANTIGEN (REF)|United Healthcare|UMR|||||3.09||| 85246|EAP|0305|VWF ANTIGEN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.09||| 85246|EAP|0305|VON WILLEBRAND ANTIGEN(PART OF|Blue Cross PPO Select|BCBS UTHCT|||||3.09||| 85247|EAP|0305|VON WILLE MULTIMERS (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.00||| 85300|EAP|0305|ANTI-THROMBIN III - FUNCTIONAL|Medicare|MEDICARE A & B|||||2.29||| 85300|EAP|0305|ANTI-THROMBIN III - FUNCTIONAL|Blue Cross PPO Select|BCBS UTHCT|||||2.29||| 85300|EAP|0305|ANTI-THROMBIN III - FUNCTIONAL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.29||| 85300|EAP|0305|ANTI-THROMBIN III - FUNCTIONAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.29||| 85300|EAP|0305|ANTI-THROMBIN III - FUNCTIONAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.29||| 85300|EAP|0305|ANTI-THROMBIN III - FUNCTIONAL|Aetna|AETNA EL PASO CLAIMS OFFICE|2.29||||||| 85302|EAP|0305|PROTEIN C ANTIGEN (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.78||| 85302|EAP|0305|PROTEIN C ANTIGEN (REF)|Medicare|MEDICARE A & B|4.78||||||| 85303|EAP|0305|PROTEIN C ACTIVITY,FUNCTIONAL|Aetna|AETNA EL PASO CLAIMS OFFICE|4.04||||||| 85303|EAP|0305|PROTEIN C ACTIVITY,FUNCTIONAL|Blue Cross PPO Select|BCBS UTHCT|||||4.04||| 85303|EAP|0305|PROTEIN C ACTIVITY,FUNCTIONAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.04||| 85303|EAP|0305|PROTEIN C ACTIVITY,FUNCTIONAL|Blue Cross PPO|BLUE CROSS PPO|||||4.04||| 85303|EAP|0305|PROTEIN C ACTIVITY,FUNCTIONAL|Medicare|MEDICARE A & B|||||4.04||| 85306|EAP|0305|CLOT INHIB/ANTICOAG; PROT S FR|Blue Cross PPO Select|BCBS UTHCT|||||4.15||| 85306|EAP|0305|CLOT INHIB/ANTICOAG; PROT S FR|Cigna|CIGNA OF TN CHATTANOOGA|||||4.15||| 85306|EAP|0305|CLOT INHIB/ANTICOAG; PROT S FR|Aetna|AETNA EL PASO CLAIMS OFFICE|4.15||||||| 85306|EAP|0305|CLOT INHIB/ANTICOAG; PROT S FR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.15||| 85306|EAP|0305|CLOT INHIB/ANTICOAG; PROT S FR|Medicare|MEDICARE A & B|4.15||||4.15||| 85362|EAP|0305|FIBRIN/FIBRINOGEN DEGRA (ARUP)|Blue Cross PPO|BLUE CROSS PPO|0.66||||||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|PHCS|WEB TPA|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|United Healthcare|UMR|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|NON CONTRACTED|PPO OTHER|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|NON CONTRACTED|COMMERCIAL OTHER|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Medicare|MEDICARE PART A|2.77||||||| 85378|EAP|0305||Medicare|MEDICARE A & B|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Medicaid|MEDICAID|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Medicare|MEDICARE A & B|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Medicare|MEDICARE RAILROAD|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|NON CONTRACTED|COMMERCIAL OTHER 2|2.77||||||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Managed Medicaid|SUPERIOR STAR MCD|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Managed Medicaid|MOLINA MEDICAID|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Multiplan|TML GRP INS|2.77||||||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Multiplan|WEB TPA|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross PPO Select|BCBS UTHCT|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|ChampVA|CHAMPVA OF CO DENVER|2.77||||||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|PHCS|TML GRP INS|2.77||||||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Aetna|AETNA US HEALTHCARE PA|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross PPO|BCBS TRANE PPO|2.77||||2.77||| 85378|EAP|0305||Blue Cross PPO|BLUE CROSS POS|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross PPO|BCBS WALMART|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross PPO|BLUE CROSS POS|2.77||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.77||| 85378|EAP|0305|D-DIMER (QUANTITATIVE)|Blue Cross PPO|BLUE CROSS PPO|2.77||||2.77||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Blue Cross PPO|BLUE CROSS PPO|1.44||||1.44||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.44||||||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Blue Cross PPO Select|BCBS UTHCT|||||1.44||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.44||||||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Managed Medicaid|SUPERIOR STAR MCD|||||1.44||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.44||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|Medicare|MEDICARE A & B|1.44||||1.44||| 85384|EAP|0305|FIBRINOGEN ACTIVITY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.44||||||| 85520|EAP|0305|HEPARIN ASSAY (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.99||| 85540|EAP|0305|LEUKOCYTE ALK PHOS (LAP) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 85540|EAP|0305|LEUKOCYTE ALK PHOS (LAP) (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.66||| 85549|EAP|0305|LYSOZYME (MURAMIDASE) (REF)|Medicare|MEDICARE A & B|||||1.51||| 85576|EAP|0301|PLATELET FUNCTION ASSAY EPI/AD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.48||| 85597|EAP|0305|PLATELET NEUTRALIZATION - REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 85598|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.83||| 85610|EAP|0305|PT WITH INR FINGER STICK|NON CONTRACTED|COMMERCIAL OTHER 2|1.22||||1.22||| 85610|EAP|0305|PT W/INR|PHCS|TML GRP INS|1.22||||||| 85610|EAP|0305|PT W/INR|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.22||| 85610|EAP|0305|PT W/INR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.22||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.22||||1.22||| 85610|EAP|0305|PT W/INR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.22||| 85610|EAP|0305|PT W/INR|PHCS|WEB TPA|||||1.22||| 85610|EAP|0305|PT W/INR|United Healthcare|UMR|1.22||||1.22||| 85610|EAP|0305|PT W/INR|United Healthcare|GOLDEN RULE INSURANCE|||||1.22||| 85610|EAP|0305|PT W/INR|United Healthcare|AARP OF GA ATLANTA|||||1.22||| 85610|EAP|0305|PT W/INR|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.22||||1.22||| 85610|EAP|0305|PT W/INR|NON CONTRACTED|COMMERCIAL OTHER|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Multiplan|WEB TPA|||||1.22||| 85610|EAP|0305|PT W/INR|NON CONTRACTED|PPO OTHER|||||1.22||| 85610|EAP|0305|PT W/INR|NON CONTRACTED|MRAMVA|||||1.22||| 85610|EAP|0305|PT W/INR|NON CONTRACTED|COMMERCIAL OTHER 2|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.22||| 85610|EAP|0305|PT W/INR|Medicaid|MEDICAID|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Medicare|MEDICARE RAILROAD|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Medicare|MEDICARE A & B|1.22||||1.22||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Medicare|MEDICARE A & B|0.30||||0.30||| 85610|EAP|0305||Medicare|MEDICARE A & B|1.22||||1.22||| 85610|EAP|0305||Medicare|MEDICARE A & B|1.22||||0.49||| 85610|EAP|0305|PROTHROMBIN TIME (REF)|Medicare|MEDICARE A & B|1.22||||0.49||| 85610|EAP|0305|PT W/INR|Medicare|MEDICARE A & B|1.22||||1.22||| 85610|EAP|0302|PT INR (POC)|Medicare|MEDICARE A & B|0.30||||0.25||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Blue Cross PPO|BLUE CROSS PPO|||||0.30||| 85610|EAP|0305|PT WITH INR FINGER STICK|Blue Cross PPO|BCBS WALMART|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross PPO|BCBS WALMART|1.22||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|Blue Cross PPO|BLUE CROSS PPO|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross PPO|BLUE CROSS PPO|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross PPO|BLUE CROSS POS|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross PPO|BCBS TRANE PPO|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Blue Cross PPO|BLUE CROSS PPO|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Blue Cross PPO|BLUE CROSS POS|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Medicare|MEDICARE PART A|1.22||||||| 85610|EAP|0305|PT W/INR|Aetna|TRS COORDINATED CARE|||||1.22||| 85610|EAP|0305|PT W/INR|Aetna|AETNA EL PASO CLAIMS OFFICE|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Aetna|AETNA|||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Aetna|AETNA EL PASO CLAIMS OFFICE|0.49||||1.22||| 85610|EAP|0305|PT; PROTHROMBIN TIME|Aetna|AETNA EL PASO CLAIMS OFFICE|1.22||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.22||||1.22||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.30||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.30||| 85610|EAP|0305|PT W/INR|Managed Medicaid|MOLINA MEDICAID|||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|Medicare|MEDICARE A & B|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Medicaid|MEDICAID|1.22||||1.22||| 85610|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.22||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|Managed Medicaid|FAMILY PLANNING GRANT|||||1.22||| 85610|EAP|0305|PT W/INR|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.22||| 85610|EAP|0305|PT W/INR|Managed Medicaid|SUPERIOR STAR MCD|||||1.22||| 85610|EAP|0305|PT W/INR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Multiplan|TML GRP INS|1.22||||||| 85610|EAP|0305|PT W/INR|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|Blue Cross PPO Select|BCBS UTHCT|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|United Healthcare|UMR|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Blue Cross PPO Select|BCBS UTHCT|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Cigna|CIGNA OPEN ACCESS PLUS|||||1.22||| 85610|EAP|0305|PT W/INR|Managed Medicaid|FAMILY PLANNING GRANT|||||1.22||| 85610|EAP|0305|PT W/INR|Cigna|CIGNA OF TN CHATTANOOGA|||||1.22||| 85610|EAP|0305|PT W/INR|Cigna|NALC HLTH BENEFIT|1.22||||||| 85610|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|1.22||||0.49||| 85610|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||0.49||| 85610|EAP|0305|PT W/INR|ChampVA|CHAMPVA OF CO DENVER|1.22||||1.22||| 85610|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.22||||0.49||| 85610|EAP|0305|PT W/INR|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Workers Compensation|WC OTHER|||||1.22||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.30||| 85610|EAP|0305|PROTHROMBIN TIME (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 85610|EAP|0305|PT WITH INR FINGER STICK|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.22||||1.22||| 85610|EAP|0305|PT WITH INR FINGER STICK|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 85610|EAP|0305|PT W/INR|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 85610|EAP|0305|PROTHROMBIN TIME W/INR|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.30||| 85610|EAP|0302|PROTHROMBIN TIME (6315)|Blue Cross PPO Select|BCBS UTHCT|||||0.30||| 85610|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.22||||1.22||| 85613|EAP|0305|DRVVT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 85613|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.49||| 85613|EAP|0305|DRVVT (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.32||| 85613|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|||||0.49||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Cigna|CIGNA OF TN CHATTANOOGA|||||0.32||| 85613|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.49||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.32||| 85613|EAP|0305|DRVVT (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.49||||||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.32||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Blue Cross PPO|BLUE CROSS PPO|||||0.30||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Blue Cross PPO Select|BCBS UTHCT|||||0.32||| 85613|EAP|0302|RUSSELL VIPER VENOM TIME (6315|Medicare|MEDICARE A & B|0.32||||0.32||| 85613|EAP|0305||Medicare|MEDICARE A & B|||||0.49||| 85613|EAP|0305|DRVVT (REF)|Medicare|MEDICARE A & B|||||0.49||| 85651|EAP|0305|SED RATE (ESR)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|United Healthcare|GOLDEN RULE INSURANCE|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|PHCS|WEB TPA|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|United Healthcare|UMR|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Workers Compensation|WC RISK MANAGEMENT|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Workers Compensation|WC OTHER|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|NON CONTRACTED|COMMERCIAL OTHER|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Multiplan|WEB TPA|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|NON CONTRACTED|COMMERCIAL OTHER 2|0.94||||||| 85651|EAP|0305|SED RATE (ESR)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Medicaid|MEDICAID|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Medicare|MEDICARE A & B|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Medicare|MEDICARE PART A|0.94||||||| 85651|EAP|0305|SED RATE (ESR)|Medicare|MEDICARE RAILROAD|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross PPO|BLUE CROSS PPO|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross PPO|BCBS TRANE PPO|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross PPO|BLUE CROSS POS|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross PPO|BCBS WALMART|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Aetna|TRS COORDINATED CARE|||||0.25||| 85651|EAP|0305|SED RATE (ESR)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 85651|EAP|0305|SED RATE (ESR)|Managed Medicaid|SUPERIOR STAR MCD|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Managed Medicaid|MOLINA MEDICAID|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Cigna|CIGNA OTHER|||||0.25||| 85651|EAP|0305|SED RATE (ESR)|Blue Cross PPO Select|BCBS UTHCT|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|ChampVA|CHAMPVA OF CO DENVER|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.94||||0.94||| 85651|EAP|0305|SED RATE (ESR)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.94||||0.94||| 85660|EAP|0305|SICKLING OF RBC,REDUCTION(REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||39.50||| 85670|EAP|0305|THROMBIN TIME|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.20||| 85670|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.20||| 85670|EAP|0305|THROMBIN TIME 1:1 MIX (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.20||| 85670|EAP|0305||Medicare|MEDICARE A & B|||||0.20||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|United Healthcare|UMR|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Multiplan|WEB TPA|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|NON CONTRACTED|COMMERCIAL OTHER 2|1.38||||||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|NON CONTRACTED|COMMERCIAL OTHER|1.38||||1.38||| 85730|EAP|0305|PARTIAL THROMBP TIME (REF)|Medicare|MEDICARE A & B|1.38||||0.49||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Blue Cross PPO|BLUE CROSS PPO|1.38||||1.38||| 85730|EAP|0302|PTT (6315)|Blue Cross PPO Select|BCBS UTHCT|||||0.30||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.38||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Aetna|AETNA EL PASO CLAIMS OFFICE|1.38||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Aetna|AETNA EL PASO CLAIMS OFFICE|0.49||||1.38||| 85730|EAP|0302|PTT (6315)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.30||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Managed Medicaid|MOLINA MEDICAID|||||1.38||| 85730|EAP|0305||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.38||||0.49||| 85730|EAP|0302|PTT (6315)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.30||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Cigna|CIGNA OF TN CHATTANOOGA|||||1.38||| 85730|EAP|0302|PTT (6315)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.30||| 85730|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.38||||0.49||| 85730|EAP|0305||Blue Cross PPO Select|BCBS UTHCT|1.38||||0.49||| 85730|EAP|0305|PARTIAL THROMBP TIME (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.38||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Blue Cross PPO Select|BCBS UTHCT|1.38||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Managed Medicaid|SUPERIOR STAR MCD|||||1.38||| 85730|EAP|0302|PTT (6315)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.30||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Blue Cross PPO|BLUE CROSS POS|1.38||||||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Blue Cross PPO|BCBS TRANE PPO|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.38||| 85730|EAP|0302|PTT (6315)|Blue Cross PPO|BLUE CROSS PPO|||||0.30||| 85730|EAP|0305||Medicare|MEDICARE A & B|1.38||||0.49||| 85730|EAP|0302|PTT (6315)|Medicare|MEDICARE A & B|0.30||||0.30||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Medicaid|MEDICAID|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Medicare|MEDICARE A & B|1.38||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|NON CONTRACTED|MRAMVA|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|United Healthcare|GOLDEN RULE INSURANCE|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|PHCS|WEB TPA|||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|PHCS|TML GRP INS|1.38||||||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.38||||1.38||| 85730|EAP|0305|PTT; PARTIAL THROMBOPLASTIN TI|Multiplan|TML GRP INS|1.38||||||| 85732|EAP|0300||Medicare|MEDICARE A & B|||||0.32||| 85732|EAP|0300||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.32||| 85732|EAP|0300|PTT 2 HOUR 1:1 MIX REFLEX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.32||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.38||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||34.25||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.43||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|United Healthcare|UMR|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|PHCS|TML GRP INS|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|PHCS|TML GRP INS|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|PHCS|WEB TPA|||||1.13||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A8 REF|United Healthcare|UMR|||||190.50||| 86003|EAP|0300|HAZELNUT COMP RCOR A14 REF|United Healthcare|UMR|||||190.50||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A9 REF|United Healthcare|UMR|||||190.50||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Multiplan|TML GRP INS|||||1.13||| 86003|EAP|0300|ANISAKIS PARASITE IgE (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||199.20||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.13||| 86003|EAP|0302|ALLERGEN MITES GLYC DOM IgE(A|NON CONTRACTED|COMMERCIAL OTHER|||||0.13||| 86003|EAP|0302|ALLERGEN MITES B. TROPIC (ARUP|NON CONTRACTED|COMMERCIAL OTHER|||||0.13||| 86003|EAP|0302|ALLERGEN MITES A. SIRO IgE (AR|NON CONTRACTED|COMMERCIAL OTHER|||||0.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.13||| 86003|EAP|0302|STAPHYLOC ENTEROT A/B IgE ARUP|NON CONTRACTED|COMMERCIAL OTHER|||||0.15||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Multiplan|WEB TPA|||||1.13||| 86003|EAP|0300|HAZELNUT COMP RCOR A14 REF|Medicare|MEDICARE A & B|||||1.27||| 86003|EAP|0300|Allergen, Insect, rVes v1(REF)|Medicare|MEDICARE A & B|||||0.65||| 86003|EAP|0300||Medicare|MEDICARE A & B|||||0.65||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A1 REF|Medicare|MEDICARE A & B|||||1.27||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Medicare|MEDICARE PART A|1.13||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Medicare|MEDICARE PART A|0.67||||1.13||| 86003|EAP|0302|GALACTOSE-ALPHA 1,3-GALAC IGE|Medicare|MEDICARE A & B|0.67||||0.68||| 86003|EAP|0302|ALLERGEN MITES B. TROPIC (ARUP|Medicare|MEDICARE A & B|0.67||||0.13||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Medicare|MEDICARE A & B|0.67||||1.13||| 86003|EAP|0301||Medicare|MEDICARE A & B|||||29.92||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Medicare|MEDICARE A & B|0.67||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Medicare|MEDICARE A & B|1.70||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Medicaid|MEDICAID|||||34.25||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Medicaid|MEDICAID|||||0.43||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A9 REF|Medicare|MEDICARE A & B|||||1.27||| 86003|EAP|0302||Medicaid|MEDICAID|||||0.15||| 86003|EAP|0302|ALLERGEN MITES A. SIRO IgE (AR|Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 86003|EAP|0302|ALLERGEN MITES B. TROPIC (ARUP|Blue Cross PPO|BLUE CROSS POS|||||0.19||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Blue Cross PPO|BCBS WALMART|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Blue Cross PPO|BLUE CROSS PPO|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Blue Cross PPO|BLUE CROSS POS|||||1.13||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Blue Cross PPO|BLUE CROSS PPO|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.43||| 86003|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||97.50||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||34.25||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Blue Cross PPO|BLUE CROSS PPO|||||0.67||| 86003|EAP|0302|ALLERGEN MITES GLYC DOM IgE(A|Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross PPO|BCBS TRANE PPO|||||34.25||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross PPO|BCBS WALMART|||||34.25||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Blue Cross PPO|BLUE CROSS POS|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross PPO|BLUE CROSS POS|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Blue Cross PPO Select|BCBS UTHCT|||||0.43||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross PPO Select|BCBS UTHCT|||||34.25||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Blue Cross PPO|BLUE CROSS POS|||||0.67||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.13||| 86003|EAP|0302|GALACTOSE-ALPHA 1,3-GALAC IGE|Blue Cross PPO|BLUE CROSS PPO|||||0.68||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Aetna|TRS COORDINATED CARE|||||34.25||| 86003|EAP|0302|ALLERGEN MITES GLYC DOM IgE(A|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.19||| 86003|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.15||| 86003|EAP|0302|STAPHYLOC ENTEROT A/B IgE ARUP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.34||| 86003|EAP|0302|ALLERGEN MITES B. TROPIC (ARUP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.19||| 86003|EAP|0302|GALACTOSE-ALPHA 1,3-GALAC IGE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.68||| 86003|EAP|0302|ALLERGEN MITES GLYC DOM IgE(A|Blue Cross PPO|BLUE CROSS POS|||||0.19||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.67||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A9 REF|Blue Cross PPO|BCBS TRANE PPO|||||190.50||| 86003|EAP|0300|RAST;RMAL D3, APPLE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||52.50||| 86003|EAP|0302|ALLERGEN MITES A. SIRO IgE (AR|Blue Cross PPO|BLUE CROSS POS|||||0.19||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|NON CONTRACTED|COMMERCIAL OTHER|||||0.43||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A8 REF|Medicare|MEDICARE A & B|||||1.27||| 86003|EAP|0302|ALLERGEN MITES B. TROPIC (ARUP|Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Aetna|TRS COORDINATED CARE|||||0.43||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.13||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A9 REF|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||190.50||| 86003|EAP|0302|ALLERGEN MITES A. SIRO IgE (AR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.19||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A8 REF|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||190.50||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A8 REF|Blue Cross PPO|BCBS TRANE PPO|||||190.50||| 86003|EAP|0302|ALLERGEN MITES A. SIRO IgE (AR|Medicare|MEDICARE A & B|0.67||||0.13||| 86003|EAP|0302|ALLERGEN MITES GLYC DOM IgE(A|Medicare|MEDICARE A & B|0.67||||0.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Medicare|MEDICARE A & B|0.67||||0.67||| 86003|EAP|0300|HAZELNUT COMP RCOR A14 REF|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||190.50||| 86003|EAP|0300|ANISAKIS PARASITE IgE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||132.80||| 86003|EAP|0302|OMEGA-5 GLIADIN WHEAT (PHADIA)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.28||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.67||| 86003|EAP|0302|ALLERGEN MITES B. TROPIC (ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.13||| 86003|EAP|0302|ALLERGEN MITES A. SIRO IgE (AR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Managed Medicaid|OTHER MEDICAID|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.43||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||34.25||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Managed Medicaid|MOLINA MEDICAID|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||34.25||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Cigna|CIGNA OTHER|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Cigna|CIGNA OF TN CHATTANOOGA|||||0.43||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.43||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.67||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Cigna|CIGNA OTHER|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.67||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Cigna|CIGNA OPEN ACCESS PLUS|||||1.13||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Cigna|CIGNA OF TN CHATTANOOGA|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Multiplan|TML GRP INS|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|ChampVA|CHAMPVA OF CO DENVER|||||34.25||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|ChampVA|CHAMPVA OF CO DENVER|||||0.43||| 86003|EAP|0300|ANISAKIS PARASITE IgE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||199.20||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A1 REF|United Healthcare|UMR|||||190.50||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Managed Medicaid|MOLINA MEDICAID|||||1.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Managed Medicaid|OTHER MEDICAID|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Managed Medicaid|MEDICAID CSHCN|||||0.67||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Managed Medicaid|MEDICAID CSHCN|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.13||| 86003|EAP|0302|STAPHYLOC ENTEROT A/B IgE ARUP|Managed Medicaid|MOLINA MEDICAID|||||0.34||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.78||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Managed Medicaid|MOLINA MEDICAID|||||0.67||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IgE (5970)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.67||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Managed Medicaid|MOLINA MEDICAID|||||1.13||| 86003|EAP|0302|ALLERGEN MITES GLYC DOM IgE(A|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.13||| 86003|EAP|0302|ALL SPEC IGE QUANT/SEM IBT ADL|United Healthcare|UMR|||||1.13||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.13||| 86003|EAP|0302|GALACTOSE-ALPHA 1,3-GALAC IGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.68||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A1 REF|Blue Cross PPO|BCBS TRANE PPO|||||190.50||| 86003|EAP|0300|HAZELNUT COMP RCOR A14 REF|Blue Cross PPO|BCBS TRANE PPO|||||190.50||| 86003|EAP|0302|ASPERGILLUS FUMIGATUS, IGE (R|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.13||| 86003|EAP|0300||Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 86003|EAP|0300|HAZELNUT COMPONENT RCOR A1 REF|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||190.50||| 86003|EAP|0302|ALLERGEN SPECIFIC IGE,EA.(REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||34.25||| 86003|EAP|0300|Allergen, Insect, rApi m 1 REF|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 86022|EAP|0302|AB ID; PLATELET AB, HEPARIN-IN|Blue Cross PPO|BLUE CROSS PPO|3.66||||||| 86022|EAP|0302|AB ID; PLATELET AB, HEPARIN-IN|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.66||||||| 86022|EAP|0302|AB ID; PLATELET AB, HEPARIN-IN|Medicare|MEDICARE PART A|3.66||||||| 86038|EAP|0302|ANA|United Healthcare|AARP OF GA ATLANTA|||||4.14||| 86038|EAP|0302|ANA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.24||| 86038|EAP|0302|ANA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.14||| 86038|EAP|0302|ANA|PHCS|TML GRP INS|||||0.34||| 86038|EAP|0302|ANA|NON CONTRACTED|COMMERCIAL OTHER|||||4.14||| 86038|EAP|0302|ANTINUCLEAR ANTIBODIES (REF)|Medicare|MEDICARE A & B|1.57||||1.57||| 86038|EAP|0302|ANA|Medicare|MEDICARE A & B|4.14||||4.14||| 86038|EAP|0302|ANA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.14||| 86038|EAP|0302|ANA|Aetna|AETNA EL PASO CLAIMS OFFICE|4.14||||4.14||| 86038|EAP|0302|ANA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|4.14||||4.14||| 86038|EAP|0302|ANTINUCLEAR ANTIBODIES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|4.14||||1.57||| 86038|EAP|0302|ANA|Blue Cross PPO|BLUE CROSS POS|||||4.14||| 86038|EAP|0302|ANA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.14||| 86038|EAP|0302|ANA|Blue Cross PPO|BLUE CROSS PPO|4.14||||4.14||| 86038|EAP|0302|ANA|Blue Cross PPO|BCBS WALMART|||||4.14||| 86038|EAP|0302|ANTINUCLEAR ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS PPO|4.14||||1.57||| 86038|EAP|0302|ANA|Blue Cross PPO Select|BCBS UTHCT|4.14||||4.14||| 86038|EAP|0302|ANTINUCLEAR ANTIBODIES (REF)|Medicaid|MEDICAID|||||1.57||| 86038|EAP|0302|ANA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 86038|EAP|0302|ANTINUCLEAR ANTIBODIES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.57||| 86038|EAP|0302|ANA|Medicaid|MEDICAID|||||4.14||| 86038|EAP|0302|ANA|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.34||| 86038|EAP|0302|ANA|Blue Cross PPO|BCBS TRANE PPO|||||2.24||| 86038|EAP|0302|ANA|ChampVA|CHAMPVA OF CO DENVER|||||4.14||| 86038|EAP|0302|ANA|Cigna|CIGNA OPEN ACCESS PLUS|||||4.14||| 86038|EAP|0302|ANA|Cigna|CIGNA OF TN CHATTANOOGA|1.57||||4.14||| 86038|EAP|0302|ANA|Cigna|CIGNA OF TN CHATTANOOGA|||||4.14||| 86038|EAP|0302|ANTINUCLEAR ANTIBODIES (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.57||| 86038|EAP|0302|ANA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.14||| 86038|EAP|0302|ANA|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.14||| 86038|EAP|0302|ANA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 86038|EAP|0302|ANA|Multiplan|TML GRP INS|||||0.34||| 86038|EAP|0302|ANA|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.14||| 86038|EAP|0302|ANA|United Healthcare|UMR|||||4.14||| 86039|EAP|0302|ANA BY IFA, IGG|Medicare|MEDICARE A & B|1.95||||||| 86039|EAP|0302|ANTINUCLEAR ATB TITER (6828)|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 86060|EAP|0302|ASO TITER (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||52.30||| 86078|EAP|0305|TRANSFUSION REACTION WORKUP|Medicare|MEDICARE A & B|1.68||||1.68||| 86140|EAP|0302|C-REACTIVE PROTEIN|ChampVA|CHAMPVA OF CO DENVER|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|Managed Medicaid|FAMILY PLANNING GRANT|||||1.11||| 86140|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Managed Medicaid|SUPERIOR STAR MCD|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Managed Medicaid|MOLINA MEDICAID|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Aetna|AETNA EL PASO CLAIMS OFFICE|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Aetna|AETNA|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Aetna|TRS COORDINATED CARE|||||0.68||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross PPO|BCBS TRANE PPO|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross PPO|BCBS WALMART|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross PPO|BLUE CROSS PPO|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross PPO|BLUE CROSS POS|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Workers Compensation|WC OTHER|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.25||| 86140|EAP|0302|C-REACTIVE PROTEIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Aetna|AETNA EXXON MOBIL|||||0.25||| 86140|EAP|0302|C-REACTIVE PROTEIN|PHCS|TML GRP INS|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|NON CONTRACTED|COMMERCIAL OTHER|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Medicare|MEDICARE PART A|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|Medicaid|MEDICAID|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.11||| 86140|EAP|0302||Medicare|MEDICARE A & B|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Medicare|MEDICARE RAILROAD|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Medicare|MEDICARE A & B|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.11||||1.11||| 86140|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Multiplan|WEB TPA|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Multiplan|TML GRP INS|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|PHCS|WEB TPA|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|NON CONTRACTED|COMMERCIAL OTHER 2|1.11||||||| 86140|EAP|0302|C-REACTIVE PROTEIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|United Healthcare|UMR|1.11||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Workers Compensation|WC RISK MANAGEMENT|||||1.11||| 86140|EAP|0302|C-REACTIVE PROTEIN|Blue Cross PPO Select|BCBS UTHCT|1.11||||1.11||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Cigna|CIGNA OF TN CHATTANOOGA|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.16||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.16||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Medicare|MEDICARE RAILROAD|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Medicare|MEDICARE A & B|1.16||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Medicaid|MEDICAID|||||104.35||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Multiplan|TML GRP INS|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|NON CONTRACTED|COMMERCIAL OTHER|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|United Healthcare|UMR|||||104.35||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|PHCS|TML GRP INS|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Blue Cross PPO|BCBS TRANE PPO|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Blue Cross PPO|BLUE CROSS POS|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Blue Cross PPO|BLUE CROSS PPO|1.16||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Blue Cross PPO|BCBS WALMART|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Blue Cross PPO Select|BCBS UTHCT|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.16||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Managed Medicaid|SUPERIOR STAR MCD|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||104.35||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|ChampVA|CHAMPVA OF CO DENVER|||||1.16||| 86141|EAP|0302|C-REACTIVE PROT, HIGH SENSITIV|Cigna|CIGNA OPEN ACCESS PLUS|||||92.70||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.32||| 86146|EAP|0302|BETA-2 GLYCOPROTEIN 1 AB, IGG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.37||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.32||| 86146|EAP|0302|BETA-2 GLYCOPROTEIN 1 AB, IGG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.37||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.32||| 86146|EAP|0302|BETA-2 GLYCOPROTEIN 1 AB, IGG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.37||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.32||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Blue Cross PPO|BLUE CROSS PPO|||||0.32||| 86146|EAP|0302|BETA-2 GLYCOPROTEIN 1 AB, IGG|Blue Cross PPO|BLUE CROSS POS|||||0.37||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Blue Cross PPO Select|BCBS UTHCT|||||0.32||| 86146|EAP|0302|BETA-2 GLYCOPROTEIN 1 AB, IGG|Blue Cross PPO Select|BCBS UTHCT|||||0.37||| 86146|EAP|0302|BETA-2 GLYCOPROTEIN 1 AB, IGG|Medicare|MEDICARE A & B|0.32||||0.37||| 86146|EAP|0302|BETA 2 GLYC I AB (6315)|Medicare|MEDICARE A & B|0.32||||0.32||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Medicare|MEDICARE A & B|0.32||||0.32||| 86147|EAP|0302|CARDIOLIPIN (PHOSPHOLIPID) AB,|Medicare|MEDICARE A & B|0.32||||1.51||| 86147|EAP|0302|CARDIOLIPIN (PHOSPHOLIPID) AB,|Blue Cross PPO|BLUE CROSS POS|||||1.51||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Blue Cross PPO|BLUE CROSS PPO|||||0.32||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Blue Cross PPO|BLUE CROSS PPO|||||0.33||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Blue Cross PPO Select|BCBS UTHCT|||||0.32||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.32||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.32||| 86147|EAP|0302|CARDIOLIPIN (PHOSPHOLIPID) AB,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.51||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.32||| 86147|EAP|0302|CARDIOLIPIN AB EA IG (6315)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.32||| 86147|EAP|0302|CARDIOLIPIN (PHOSPHOLIPID) AB,|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.51||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.60||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.86||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Aetna|AETNA EXXON MOBIL|||||0.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Aetna|AETNA EXXON MOBIL|||||0.86||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Blue Cross PPO|BLUE CROSS PPO|||||2.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.86||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.60||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Blue Cross PPO|BLUE CROSS POS|||||0.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Blue Cross PPO|BLUE CROSS PPO|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Blue Cross PPO|BLUE CROSS POS|||||0.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Blue Cross PPO Select|BCBS UTHCT|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Blue Cross PPO Select|BCBS UTHCT|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|United Healthcare|UMR|||||2.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|United Healthcare|UMR|||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|United Healthcare|UMR|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.86||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.34||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|NON CONTRACTED|COMMERCIAL OTHER|||||0.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|NON CONTRACTED|COMMERCIAL OTHER|||||0.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.86||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Medicare|MEDICARE A & B|292.50||||2.34||| 86160|EAP|0302|C3;COMPLEMENT;ANTIGEN,EACH COM|Medicare|MEDICARE A & B|292.50||||2.34||| 86160|EAP|0302||Medicare|MEDICARE A & B|292.50||||2.34||| 86160|EAP|0302|COMPLEMENT;ANTIGEN EACH (REF)|Medicare|MEDICARE A & B|292.50||||0.86||| 86160|EAP|0302|C4;COMPLEMENT;AG,EACH COMPONEN|Medicaid|MEDICAID|||||0.34||| 86161|EAP|0302|C1;COMPLEMENT;FA,EACH - REF|Medicare|MEDICARE A & B|||||3.06||| 86161|EAP|0302|C-1 ESTERASE INHIB FUNCT (ARUP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.58||| 86162|EAP|0302|CH 50 (REF)|Blue Cross PPO|BLUE CROSS PPO|||||45.90||| 86162|EAP|0302|CH 50 (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.41||| 86162|EAP|0302|CH 50 (REF)|Aetna|TRS COORDINATED CARE|||||0.41||| 86162|EAP|0302|CH 50 (REF)|Medicare|MEDICARE A & B|||||0.41||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Medicaid|MEDICAID|||||1.89||| 86200|EAP|0301||Medicare|MEDICARE A & B|||||0.50||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|United Healthcare|UMR|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Medicare|MEDICARE A & B|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Blue Cross PPO|BCBS WALMART|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.89||| 86200|EAP|0302|CYCLIC CITRULL PEPTIDE AB(REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.89||| 86215|EAP|0302|DNASE-B ANTIBODY (ARUP)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.36||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.77||| 86235|EAP|0302|SMITH (ENA) AB, IGG (REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 86235|EAP|0302|NUCLEAR AG EA ADD AB (6929)|Medicare|MEDICARE A & B|2.23||||0.56||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Medicare|MEDICARE A & B|2.23||||2.23||| 86235|EAP|0302|NUCLEAR AG EA AB (6929)|Medicare|MEDICARE A & B|2.23||||0.56||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|NON CONTRACTED|COMMERCIAL OTHER|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|NON CONTRACTED|COMMERCIAL OTHER|||||0.77||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|United Healthcare|UMR|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|United Healthcare|UMR|||||0.77||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.77||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.77||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.77||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86235|EAP|0302|SMITH (ENA) AB, IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86235|EAP|0302|NUCLEAR AG EA ADD AB (6929)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.56||| 86235|EAP|0302|NUCLEAR AG EA AB (6929)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.56||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86235|EAP|0302|SMITH (ENA) AB, IGG (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.49||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.77||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.23||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Aetna|AETNA EL PASO CLAIMS OFFICE|2.23||||2.23||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.23||||0.77||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.77||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86235|EAP|0302|SMITH (ENA) AB, IGG (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86235|EAP|0302|NUCLEAR AG EA ADD AB (6929)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.56||| 86235|EAP|0302|NUCLEAR AG EA AB (6929)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.56||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.77||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86235|EAP|0302|NUCLEAR AG EA ADD AB (6929)|Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 86235|EAP|0302|EXTRACTABLE NUCLEAR AG, AB, EA|Medicare|MEDICARE A & B|2.23||||128.45||| 86235|EAP|0302|SMITH (ENA) AB, IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.23||| 86235|EAP|0302|NUCLEAR AG EA AB (6929)|Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Medicare|MEDICARE A & B|2.23||||0.77||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Blue Cross PPO|BCBS WALMART|||||2.23||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86235|EAP|0302|EXTRACT NUC ANTIGEN EA (6828)|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 86235|EAP|0302|EXTRACTABLE NUCLEAR AG, AB, EA|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Blue Cross PPO|BLUE CROSS PPO|||||0.77||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Blue Cross PPO|BLUE CROSS POS|||||0.77||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86235|EAP|0302|NUCLEAR AG EA AB (6929)|Blue Cross PPO Select|BCBS UTHCT|||||0.56||| 86235|EAP|0302|SCLERODERMA (SCL-70) (ENA) AB,|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86235|EAP|0302|ANTI-JO-1 AB (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86235|EAP|0302|RNP (ENA) AB, IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86235|EAP|0302|SSB (LA) (ENA) AB, IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86235|EAP|0302|SMITH (ENA) AB, IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86235|EAP|0302|NUCLEAR AG EA ADD AB (6929)|Blue Cross PPO Select|BCBS UTHCT|||||0.56||| 86235|EAP|0302|EXT NUCLEAR ANTIGEN EA (6628)|Blue Cross PPO Select|BCBS UTHCT|||||0.77||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Blue Cross PPO|BLUE CROSS PPO|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||4.14||| 86255|EAP|0302|AQUAPORIN-4 REC ATB IGG (ARUP)|Blue Cross PPO|BLUE CROSS POS|||||5.00||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Blue Cross PPO|BLUE CROSS PPO|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Blue Cross PPO Select|BCBS UTHCT|||||4.14||| 86255|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||4.14||| 86255|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.14||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.14||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.14||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Blue Cross PPO Select|BCBS UTHCT|||||4.14||| 86255|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.14||| 86255|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|United Healthcare|UMR|||||4.14||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.14||| 86255|EAP|0302|ANTI-DOUBLE STRANDED DNA|Medicare|MEDICARE A & B|4.14||||4.14||| 86255|EAP|0302|ANCA, IGG (REF)|Medicare|MEDICARE A & B|4.14||||4.14||| 86255|EAP|0302|FLURESCENT NONINF AB EA (5301)|Medicare|MEDICARE A & B|4.14||||0.95||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Medicare|MEDICARE A & B|||||4.14||| 86255|EAP|0301||Medicare|MEDICARE A & B|||||4.14||| 86255|EAP|0302|AQUAPORIN-4 REC ATB IGG (ARUP)|Medicare|MEDICARE A & B|4.14||||2.50||| 86255|EAP|0301|ANTI-DOUBLE STRANDED DNA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.14||| 86256|EAP|0302|FLUO NONINF AGT AB,TITER(REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 86256|EAP|0302|ANA TITER|Medicare|MEDICARE A & B|2.23||||2.23||| 86256|EAP|0302||Medicare|MEDICARE A & B|2.23||||2.23||| 86256|EAP|0302|SMOOTH MUSC AB IgG TITER (ARUP|Medicare|MEDICARE A & B|2.23||||0.86||| 86256|EAP|0302|ANA TITER|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||128.50||| 86256|EAP|0302||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.23||| 86256|EAP|0302|ANA TITER|United Healthcare|AARP OF GA ATLANTA|||||2.23||| 86256|EAP|0302||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.23||| 86256|EAP|0302|ANA TITER|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.23||| 86256|EAP|0302||United Healthcare|UMR|||||2.23||| 86256|EAP|0302|ANA TITER|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.34||| 86256|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.23||| 86256|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86256|EAP|0302|ANA TITER|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.23||| 86256|EAP|0302|SMOOTH MUSCLE ANITBODY IGG ARU|Medicare|MEDICARE A & B|2.23||||2.23||| 86256|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86256|EAP|0302|ANA TITER|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.23||| 86256|EAP|0302|ANA TITER|Aetna|AETNA EL PASO CLAIMS OFFICE|2.23||||2.23||| 86256|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|2.23||||2.23||| 86256|EAP|0302|SMOOTH MUSC AB IgG TITER (ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 86256|EAP|0302|SMOOTH MUSCLE ANITBODY IGG ARU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86256|EAP|0302|ANA TITER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86256|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.23||| 86256|EAP|0302|ANA TITER|Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86256|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||2.23||| 86256|EAP|0302|ANA TITER|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86256|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86256|EAP|0302|FLUO NONINF AGT AB,TITER(REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross PPO|BLUE CROSS POS|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross PPO|BLUE CROSS PPO|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross PPO Select|BCBS UTHCT|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Aetna|AETNA|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|NON CONTRACTED|COMMERCIAL OTHER|||||3.10||| 86300|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Medicare|MEDICARE A & B|||||3.10||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Medicare|MEDICARE A & B|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Medicare|MEDICARE PART B|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross PPO|BCBS WALMART|||||3.26||| 86301|EAP|0302|IMMUNO FOR TUMOR AG,QUANT; CA|Blue Cross PPO|BLUE CROSS POS|||||3.26||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Blue Cross PPO|BLUE CROSS PPO|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Blue Cross PPO|BLUE CROSS POS|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Blue Cross PPO|BCBS WALMART|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Blue Cross PPO Select|BCBS UTHCT|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Cigna|CIGNA OF TN CHATTANOOGA|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|NON CONTRACTED|COMMERCIAL OTHER|||||3.00||| 86304|EAP|0302|IMMUNO FOR TUMOR, CA 125|Medicare|MEDICARE A & B|||||3.00||| 86308|EAP|0302|MONO SPOT|Medicare|MEDICARE A & B|0.88||||||| 86308|EAP|0302|MONO SPOT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.88||| 86308|EAP|0302|MONO SPOT|Medicaid|MEDICAID|||||0.88||| 86308|EAP|0302|MONO SPOT|NON CONTRACTED|COMMERCIAL OTHER|||||0.88||| 86308|EAP|0302|MONO SPOT|United Healthcare|UMR|||||0.88||| 86308|EAP|0302|MONO SPOT|Managed Medicaid|MOLINA MEDICAID|||||0.88||| 86308|EAP|0302|MONO SPOT|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.88||| 86308|EAP|0302|MONO SPOT|Managed Medicaid|SUPERIOR STAR MCD|||||0.88||| 86308|EAP|0302|MONO SPOT|Blue Cross PPO Select|BCBS UTHCT|||||0.88||| 86308|EAP|0302|HETEROPHILE AB (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.88||| 86308|EAP|0302|MONO SPOT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.88||| 86308|EAP|0302|MONO SPOT|Blue Cross PPO|BLUE CROSS PPO|||||0.88||| 86308|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Blue Cross PPO|BLUE CROSS POS|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Blue Cross PPO|BLUE CROSS PPO|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|United Healthcare|UMR|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|NON CONTRACTED|COMMERCIAL OTHER|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Medicare|MEDICARE A & B|||||3.35||| 86316|EAP|0302|IMMUNOASSAY FOR TUMOR AG; QUAN|Medicare|MEDICARE RAILROAD|||||3.35||| 86317|EAP|0302|PNEUMO 7F (PART OF 4302) (REF|Medicare|MEDICARE A & B|0.66||||0.66||| 86317|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|Medicare|MEDICARE A & B|0.66||||0.65||| 86317|EAP|0302|PNEUMO 3 (PART OF 4302) (REF)|Medicare|MEDICARE A & B|0.66||||0.66||| 86317|EAP|0302|IMMUNOASSAY INFECT AGENT - REF|Medicare|MEDICARE A & B|0.66||||0.66||| 86317|EAP|0302|IMMONOASSAY QUANT NOS (6596)|Medicare|MEDICARE A & B|0.66||||0.65||| 86317|EAP|0302|PNEUMO 9N (PART OF 4302) (REF|Medicare|MEDICARE A & B|0.66||||0.66||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Medicare|MEDICARE A & B|0.66||||107.35||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Medicare|MEDICARE A & B|0.66||||0.65||| 86317|EAP|0302|HEMOPHILUS INFL TYPE B AB-REF|Medicare|MEDICARE A & B|0.66||||107.35||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Medicaid|MEDICAID|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Multiplan|TML GRP INS|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Multiplan|PHCS OF AZ PHEONIX|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER|||||0.65||| 86317|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|United Healthcare|UMR|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|United Healthcare|UMR|||||0.65||| 86317|EAP|0302|IMMONOASSAY QUANT NOS (6596)|United Healthcare|UMR|||||0.65||| 86317|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.41||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||107.35||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|PHCS|PHCS OF AZ PHEONIX|||||0.65||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||107.35||| 86317|EAP|0302|IMMONOASSAY QUANT NOS (6596)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Managed Medicaid|SUPERIOR STAR MCD|||||0.55||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Managed Medicaid|MOLINA MEDICAID|||||0.55||| 86317|EAP|0302|PNEUMO 3 (PART OF 4302) (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 86317|EAP|0302||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 86317|EAP|0302|PNEUMO 7F (PART OF 4302) (REF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 86317|EAP|0302|IMMUNOASSAY INFECT AGENT - REF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Managed Medicaid|FAMILY PLANNING GRANT|||||0.65||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|ChampVA|CHAMPVA OF CO DENVER|||||0.66||| 86317|EAP|0302||ChampVA|CHAMPVA OF CO DENVER|||||0.65||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Blue Cross PPO Select|BCBS UTHCT|||||0.65||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|ChampVA|CHAMPVA OF CO DENVER|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Cigna|CIGNA OF TN CHATTANOOGA|||||0.65||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Cigna|CIGNA OPEN ACCESS PLUS|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Cigna|CIGNA OF TN CHATTANOOGA|||||0.55||| 86317|EAP|0302|PNEUMO 9N (PART OF 4302) (REF|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 86317|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| 86317|EAP|0302|PNEUMO 7F (PART OF 4302) (REF|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 86317|EAP|0302|PNEUMO 3 (PART OF 4302) (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 86317|EAP|0302|IMMUNOASSAY INFECT AGENT - REF|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 86317|EAP|0302|HEMOPHILUS INFL TYPE B AB-REF|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 86317|EAP|0302|RUBELLA IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| 86317|EAP|0302|PNEUMO 9N (PART OF 4302) (REF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 86317|EAP|0302|HEMOPHILUS INFL TYPE B AB-REF|Blue Cross PPO Select|BCBS UTHCT|||||0.66||| 86317|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.65||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Aetna|AETNA|||||0.60||| 86317|EAP|0302|RUBELLA IGG (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||107.35||| 86317|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|Aetna|TRS COORDINATED CARE|||||0.65||| 86317|EAP|0302|TOXOPLASMA AB IGG (REF)|United Healthcare|UMR|||||0.66||| 86317|EAP|0302|IMMONOASSAY QUANT NOS (6596)|Aetna|TRS COORDINATED CARE|||||0.65||| 86317|EAP|0302|HEMOPHILUS INFL TYPE B AB-REF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.66||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Aetna|TRS COORDINATED CARE|||||0.66||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|PHCS|TML GRP INS|||||0.65||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Aetna|TRS COORDINATED CARE|||||0.66||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Aetna|AETNA EXXON MOBIL|||||0.65||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.66||| 86317|EAP|0302|RUBELLA IGG (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||86.68||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 86317|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 86317|EAP|0302|IMMONOASSAY QUANT NOS (6596)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 86317|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.65||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.66||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.66||| 86317|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302||Medicare|MEDICARE A & B|0.66||||0.41||| 86317|EAP|0302|DIPTHERIA TOXOID AB (REF)|Medicare|MEDICARE A & B|0.66||||107.35||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Blue Cross PPO|BLUE CROSS POS|||||0.65||| 86317|EAP|0302||Blue Cross PPO|BLUE CROSS POS|||||0.53||| 86317|EAP|0302|PNEUMO 7F (PART OF 4302) (REF|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302|PNEUMO 3 (PART OF 4302) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302|TETANUS TOXOID AB (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.66||| 86317|EAP|0302|RUBELLA IGG ANTIBODY|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 86317|EAP|0302|TOXOPLASMA AB IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302|RUBELLA IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.61||| 86317|EAP|0302|PNEUMO 9N (PART OF 4302) (REF|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302|IMMONOASSAY QUANT NOS (6596)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 86317|EAP|0302|IMMUNOASSAY INFECT AGENT - REF|Blue Cross PPO|BLUE CROSS PPO|||||0.66||| 86317|EAP|0302|IMMUNOASSAY QUANT NOS (6596)|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.34||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.34||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.34||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.34||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.34||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.34||| 86331|EAP|0302|IMMUNODIFF;GEL DIFF, EA (REF)|Medicare|MEDICARE A & B|0.34||||0.34||| 86331|EAP|0302|IMMUNODIFF; GEL DIFF,EA (REF)|Medicare|MEDICARE A & B|0.34||||0.34||| 86332|EAP|0302|C1Q COMPLEMENT COMPONENT (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.50||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|NON CONTRACTED|COMMERCIAL OTHER|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Medicare|MEDICARE A & B|3.63||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.63||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Blue Cross PPO|BLUE CROSS PPO|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Blue Cross PPO|BLUE CROSS POS|||||0.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.63||| 86334|EAP|0302|IMMUNOFIXATION ELECTR,** SERUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.63||| 86335|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.14||| 86335|EAP|0302|IMMUNOFIXATION ELECTR,** URINE|Medicare|MEDICARE A & B|||||4.14||| 86336|EAP|0302|INHIBIN A (DIMER) (ARUP)|Medicare|MEDICARE A & B|1.12||||||| 86337|EAP|0302|INSULIN ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 86337|EAP|0302|INSULIN ANTIBODIES (REF)|Medicare|MEDICARE A & B|||||1.63||| 86337|EAP|0302|INSULIN ANTIBODIES (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.63||| 86340|EAP|0302|INTRINSIC FACT BLOCKING AB (RE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.87||| 86340|EAP|0302|INTRINSIC FACT BLOCKING AB (RE|Medicare|MEDICARE A & B|||||1.87||| 86340|EAP|0302|INTRINSIC FACT BLOCKING AB (RE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.87||| 86341|EAP|0302|ISLET CELL ANTIBODY, IGG (RE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.95||| 86341|EAP|0302|ISLET CELL ANTIBODY, IGG (RE|Blue Cross PPO|BLUE CROSS PPO|||||0.95||| 86341|EAP|0302|ISLET CELL ANTIBODY, IGG (RE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.95||| 86341|EAP|0302|ISLET CELL ANTIBODY, IGG (RE|Medicare|MEDICARE A & B|||||0.95||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|United Healthcare|UMR|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|NON CONTRACTED|COMMERCIAL OTHER|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Medicare|MEDICARE A & B|3.11||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Cigna|CIGNA OPEN ACCESS PLUS|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Blue Cross PPO|BLUE CROSS PPO|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Blue Cross PPO|BLUE CROSS POS|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Aetna|AETNA EXXON MOBIL|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.07||| 86352|EAP|0302|CELLULAR FUNCT ASSAY/DETEC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.07||| 86353|EAP|0302|LYMPHOCYTE AG - REF|Aetna|TRS COORDINATED CARE|||||2.67||| 86353|EAP|0302|LYMPHOCYTE AG - REF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.67||| 86353|EAP|0302|LYMPHOCYTE AG - REF|Blue Cross PPO|BLUE CROSS PPO|||||2.67||| 86353|EAP|0302|LYMPHOCYTE AG - REF|Blue Cross PPO Select|BCBS UTHCT|||||2.67||| 86353|EAP|0302|LYMPHOCYTE AG - REF|Medicare|MEDICARE A & B|||||351.10||| 86355|EAP|0300|B CELLS TOTAL COUNT FROM 8900|Medicare|MEDICARE A & B|||||0.49||| 86355|EAP|0302|B CELLS, TOTAL COUNT|Medicare|MEDICARE A & B|||||1.33||| 86355|EAP|0302|B CELLS, TOTAL COUNT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.33||| 86356|EAP|0302|FLOW CYTOMETRY EA ANTIGEN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.94||| 86356|EAP|0300|MONONUC CELL ANTIGEN FROM 8900|Medicare|MEDICARE A & B|||||0.47||| 86356|EAP|0302|FLOW CYTOMETRY EA ANTIGEN|Medicare|MEDICARE A & B|||||0.94||| 86357|EAP|0302|NATURAL KILLER CELLS, TOTAL CO|Medicare|MEDICARE A & B|||||1.33||| 86357|EAP|0302|NATURAL KILLER CELLS, TOTAL CO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.33||| 86359|EAP|0302|T CELLS; TOTAL COUNT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.41||| 86359|EAP|0302|T CELLS; TOTAL COUNT|Medicare|MEDICARE A & B|||||1.37||| 86360|EAP|0302|T CELLS; ABS CD4/CD8 CNT RATIO|Medicare|MEDICARE A & B|||||1.70||| 86360|EAP|0302|T CELLS; ABS CD4/CD8 CNT RATIO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.75||| 86361|EAP|0302|CD4-ABSOLUTE COUNT ONLY (REF|Blue Cross PPO|BCBS WALMART|||||3.44||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.94||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|Cigna|CIGNA OF TN CHATTANOOGA|||||0.94||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|Blue Cross PPO|BLUE CROSS PPO|||||0.94||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.94||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.94||| 86361|EAP|0302|CD4-ABSOLUTE COUNT ONLY (REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.44||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|United Healthcare|GOLDEN RULE INSURANCE|||||0.94||| 86361|EAP|0302|CD4-ABSOLUTE COUNT ONLY (REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.44||| 86361|EAP|0302|CD4-ABSOLUTE COUNT ONLY (REF|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.44||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.94||| 86361|EAP|0302|CD4-ABSOLUTE COUNT ONLY (REF|NON CONTRACTED|COMMERCIAL OTHER|3.44||||||| 86361|EAP|0301|CD4-PERCENT & ABSOLUTE - REF|Medicare|MEDICARE A & B|0.94||||0.94||| 86361|EAP|0302|CD4-ABSOLUTE COUNT ONLY (REF|Medicare|MEDICARE A & B|3.44||||||| 86376|EAP|0302|LIVER, KIDNEY, MICROSOME AUTOA|Medicare|MEDICARE A & B|1.40||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Medicare|MEDICARE A & B|1.40||||104.20||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Medicare|MEDICARE A & B|1.40||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Medicaid|MEDICAID|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||98.60||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||104.20||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|United Healthcare|UMR|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.93||| 86376|EAP|0302|LIVER, KIDNEY, MICROSOME AUTOA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||104.20||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Cigna|CIGNA OTHER|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.93||| 86376|EAP|0302|LIVER, KIDNEY, MICROSOME AUTOA|Cigna|CIGNA OF TN CHATTANOOGA|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||98.60||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.93||| 86376|EAP|0302|LIVER, KIDNEY, MICROSOME AUTOA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Managed Medicaid|MOLINA MEDICAID|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|United Healthcare|UMR|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Aetna|TRS COORDINATED CARE|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Aetna|AETNA EXXON MOBIL|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||104.20||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Aetna|AETNA|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Aetna|AETNA EXXON MOBIL|||||104.20||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||104.20||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 86376|EAP|0302|LIVER, KIDNEY, MICROSOME AUTOA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||67.10||| 86376|EAP|0302|LIVER, KIDNEY, MICROSOME AUTOA|Blue Cross PPO|BLUE CROSS PPO|||||0.93||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||98.60||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Blue Cross PPO|BCBS WALMART|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||104.20||| 86376|EAP|0302|THYROID PEROXIDASE AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.93||| 86376|EAP|0302|ANTI-MICROSOMAL AB (REF)|Blue Cross PPO|BLUE CROSS POS|||||104.20||| 864|DRG||FEVER AND INFLAMMATORY CONDITIONS|Medicare|MEDICARE A & B|28,523.21|8138.73|8138.73|8138.73|||| 86403|EAP|0302|CRYPTOCOCCAL AG, SERUM - QUALI|Blue Cross PPO|BLUE CROSS PPO|||||1.91||| 86403|EAP|0302|CRYPTOCOCCAL AG, SERUM - QUALI|Blue Cross PPO|BLUE CROSS POS|||||1.91||| 86403|EAP|0302|CRYPTOCOCCAL AG, SERUM - QUALI|Medicare|MEDICARE A & B|1.91||||1.91||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|United Healthcare|UMR|||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.20||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.25||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Medicare|MEDICARE A & B|0.78||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Medicare|MEDICARE A & B|1.80||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Medicaid|MEDICAID|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Blue Cross PPO Select|BCBS UTHCT|||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|ChampVA|CHAMPVA OF CO DENVER|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Cigna|CIGNA OTHER|||||0.25||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||72.50||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|United Healthcare|UMR|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Aetna|TRS COORDINATED CARE|||||0.25||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.20||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.20||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.20||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR QUANT (6350)|Blue Cross PPO|BLUE CROSS PPO|1.20||||0.78||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Blue Cross PPO|BLUE CROSS PPO|1.20||||1.20||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.25||| 86431|EAP|0302|RHEUMATOID FACTOR (IGG) (REF)|Blue Cross PPO|BCBS WALMART|||||1.20||| 86431|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|1.20||||0.78||| 86481|EAP|0302||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross PPO|BLUE CROSS PPO|2.31||||2.31||| 86481|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.18||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Aetna|AETNA|||||224.50||| 86481|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.31||| 86481|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Managed Medicaid|MOLINA MEDICAID|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.18||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.18||| 86481|EAP|0302||Cigna|CIGNA OPEN ACCESS PLUS|||||2.31||| 86481|EAP|0302||Cigna|CIGNA OF TN CHATTANOOGA|||||2.18||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.31||| 86481|EAP|0302|QFT IN-TUBE (PHLET CLIENT)|Blue Cross PPO Select|BCBS UTHCT|||||1.20||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Aetna|AETNA EXXON MOBIL|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.20||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.31||| 86481|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||2.31||| 86481|EAP|0302||Medicare|MEDICARE A & B|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Blue Cross PPO|BLUE CROSS POS|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Medicare|MEDICARE A & B|2.31||||2.31||| 86481|EAP|0302|QFT IN-TUBE (PHLET CLIENT)|Medicare|MEDICARE A & B|2.31||||1.20||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Medicaid|MEDICAID|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|NON CONTRACTED|COMMERCIAL OTHER|2.31||||2.31||| 86481|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|1.20||||2.31||| 86481|EAP|0302||Workers Compensation|WC TX MUTUAL INS|||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|United Healthcare|UMR|2.31||||265.50||| 86481|EAP|0302||United Healthcare|UMR|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.31||||2.31||| 86481|EAP|0302|QUANTIFERON TB GOLD (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.31||| 86580|EAP|0300|SKIN TEST; TB, ID|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.90||| 86580|EAP|0300|SKIN TEST; TB, ID|Blue Cross PPO|BLUE CROSS PPO|||||0.90||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|ChampVA|CHAMPVA OF CO DENVER|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.12||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Blue Cross PPO|BLUE CROSS PPO|0.18||||0.15||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Blue Cross PPO|BLUE CROSS POS|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.18||| 86592|EAP|0302|VDRL - (REF)|Blue Cross PPO|BLUE CROSS PPO|0.18||||0.86||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|United Healthcare|GOLDEN RULE INSURANCE|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.18||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|0.18||||||| 86592|EAP|0302|VDRL - (REF)|Medicare|MEDICARE A & B|0.86||||0.86||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Medicare|MEDICARE A & B|0.18||||0.15||| 86592|EAP|0302|RPR REFLEX TO TITER (ARUP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.18||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Medicare|MEDICARE A & B|0.25||||0.35||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|0.25||||||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|United Healthcare|GOLDEN RULE INSURANCE|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Blue Cross PPO|BLUE CROSS PPO|0.25||||0.45||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.45||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|ChampVA|CHAMPVA OF CO DENVER|||||0.25||| 86593|EAP|0302|REFLEX RPR TITER (ARUP)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 86606|EAP|0302|ASPERGILLUS (5970)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.67||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.21||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.21||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.21||| 86606|EAP|0302|ASPERGILLUS (5970)|Managed Medicaid|MEDICAID CSHCN|||||0.67||| 86606|EAP|0302|ASPERGILLUS (5970)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.67||| 86606|EAP|0302|ASPERGILLUS (5970)|Blue Cross PPO|BLUE CROSS POS|0.21||||0.67||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Blue Cross PPO|BLUE CROSS POS|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.21||| 86606|EAP|0302|ASPERGILLUS (5970)|Blue Cross PPO|BLUE CROSS PPO|||||0.67||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS (5970)|Managed Medicaid|MOLINA MEDICAID|||||0.67||| 86606|EAP|0302|ASPERGILLUS (5970)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.67||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS (5970)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.21||||0.67||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.21||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.21||| 86606|EAP|0302|ASPERGILLUS (5970)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.67||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|United Healthcare|UMR|||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.21||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Medicare|MEDICARE A & B|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS (5970)|Medicare|MEDICARE PART A|0.67||||||| 86606|EAP|0302|ASPERGILLUS AB, CF (REF)|Medicare|MEDICARE A & B|0.21||||0.21||| 86606|EAP|0302|ASPERGILLUS ANTIBODY ID (REF)|Medicare|MEDICARE PART A|0.21||||||| 86606|EAP|0302|ASPERGILLUS (5970)|Medicare|MEDICARE A & B|0.67||||0.67||| 86611|EAP|0302|BARTONELLA HENSELAE AB, IGM|NON CONTRACTED|COMMERCIAL OTHER|||||0.19||| 86611|EAP|0302|BARTONELLA HENSELAE AB, IGG|NON CONTRACTED|COMMERCIAL OTHER|||||0.30||| 86611|EAP|0302|BARTONELLA HENSELAE AB, IGG|Managed Medicaid|MOLINA MEDICAID|||||0.30||| 86611|EAP|0302|BARTONELLA HENSELAE AB, IGM|Managed Medicaid|MOLINA MEDICAID|||||0.19||| 86612|EAP|0302|BLASTOMYCES DERM ATB W RF (ARU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.50||| 86612|EAP|0302|BLASTOMYCES AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.18||||0.18||| 86612|EAP|0302|BLASTOMYCES AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.18||| 86612|EAP|0302|BLASTOMYCES AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.18||| 86612|EAP|0302|BLASTOMYCES AB (REF)|Blue Cross PPO|BLUE CROSS POS|0.18||||0.18||| 86612|EAP|0302|BLASTOMYCES DERM ATB W RF (ARU|Blue Cross PPO|BLUE CROSS PPO|||||0.50||| 86612|EAP|0302|BLASTOMYCES AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.18||| 86612|EAP|0302|BLASTOMYCES DERM ATB W RF (ARU|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.50||| 86612|EAP|0302|BLASTOMYCES AB (REF)|United Healthcare|UMR|||||0.18||| 86612|EAP|0302|BLASTOMYCES AB (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.18||| 86612|EAP|0302|BLASTOMYCES DERM ATB W RF (ARU|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.18||||0.50||| 86612|EAP|0302|BLASTOMYCES AB (REF)|Medicare|MEDICARE A & B|0.18||||0.18||| 86612|EAP|0302|BLASTOMYCES DERM ATB W RF (ARU|Medicare|MEDICARE A & B|0.18||||0.50||| 86615|EAP|0302|BORD PERTUSSIS AB IGG BY IMMUB|Medicare|MEDICARE A & B|||||0.67||| 86615|EAP|0302|BORD. PERTUSSIS AB (IGA/IGM)|Medicare|MEDICARE A & B|||||2.59||| 86615|EAP|0302|BORD. PERTUSSIS AB (IGG)|Medicare|MEDICARE A & B|||||2.59||| 86615|EAP|0302|BORD PERTUSSIS AB IGG BY IMMUB|United Healthcare|GOLDEN RULE INSURANCE|||||0.67||| 86615|EAP|0302|BORDETELLA PERT AB IGA (IGG,M)|United Healthcare|GOLDEN RULE INSURANCE|||||0.67||| 86615|EAP|0302|BORD. PERTUSSIS AB (IGA/IGM)|Blue Cross PPO|BLUE CROSS PPO|||||2.59||| 86615|EAP|0302|BORD. PERTUSSIS AB (IGG)|Blue Cross PPO|BLUE CROSS PPO|||||2.59||| 86615|EAP|0302|BORDETELLA PERTUSSIS AB IGM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.11||| 86615|EAP|0302|BORD. PERTUSSIS AB (IGG)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.59||| 86615|EAP|0302|BORD. PERTUSSIS AB (IGA/IGM)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.59||| 86615|EAP|0302|BORD PERTUSSIS AB IGG BY IMMUB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.67||| 86617|EAP|0302|LYME AB,IGG\IGM WEST BLO (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||110.95||| 86617|EAP|0302|LYME AB,IGG\IGM WEST BLO (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.34||| 86617|EAP|0302|LYME AB,IGG\IGM WEST BLO (REF)|United Healthcare|UMR|||||0.34||| 86618|EAP|0302|LYME DISEASE DETECTION (REF)|Medicare|MEDICARE A & B|||||2.61||| 86618|EAP|0302||Medicare|MEDICARE A & B|||||2.61||| 86618|EAP|0302|LYME DISEASE DETECTION (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.61||| 86618|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.61||| 86618|EAP|0302|LYME DISEASE DETECTION (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.61||| 86618|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||2.61||| 86618|EAP|0302|LYME DISEASE DETECTION (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.61||| 86618|EAP|0302|LYME DISEASE DETECTION (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.61||| 86631|EAP|0302|CHLAMYDIA (REF)|Medicare|MEDICARE A & B|||||3.01||| 86632|EAP|0302|CHLAMYDIA, IGM (REF)|Medicare|MEDICARE A & B|||||0.35||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|Blue Cross PPO|BLUE CROSS POS|0.18||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.18||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|United Healthcare|UMR|||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.18||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.18||| 86635|EAP|0302|COCCIDIOIDES AB (REF)|Medicare|MEDICARE A & B|0.18||||0.18||| 86638|EAP|0302|Q-FEVER AB IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.23||| 86638|EAP|0302|Q FEVER AB IGG ADL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.23||| 86644|EAP|0302|CMV, IGG - ELISA (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.66||| 86645|EAP|0302|CMV, IGM - ELISA (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.16||| 86645|EAP|0302|CMV, IGM - ELISA (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.16||| 86658|EAP|0302|COXSACKIE B VIRUS AB (PART OF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.55||||||| 86658|EAP|0302|COXSACKIE B VIRUS (PART OF 410|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.55||||||| 86658|EAP|0302|ANTIB; ENTEROVIRUS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.55||||||| 86658|EAP|0302|COXSACKIE B VIRUS (PART OF 410|Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 86658|EAP|0302|ANTIB; ENTEROVIRUS|Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 86658|EAP|0302|COXSACKIE B VIRUS AB (PART OF|Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.94||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Medicare|MEDICARE A & B|||||0.94||| 86663|EAP|0302||United Healthcare|UMR|||||0.29||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Managed Medicaid|MOLINA MEDICAID|||||0.94||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.29||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.29||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.29||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.29||| 86663|EAP|0302|EARLY AG ANTIBODIES (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.29||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.59||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.59||| 86664|EAP|0302|EBV AB TO NUCLEAR AG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||109.55||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Blue Cross PPO|BLUE CROSS PPO|||||1.59||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Blue Cross PPO|BLUE CROSS POS|||||1.59||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Blue Cross PPO Select|BCBS UTHCT|||||1.59||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Managed Medicaid|MOLINA MEDICAID|||||109.55||| 86664|EAP|0302||United Healthcare|UMR|||||1.59||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|Medicare|MEDICARE A & B|||||109.55||| 86664|EAP|0302|NUCLEAR ANTIGEN IGG(PART OF 41|NON CONTRACTED|COMMERCIAL OTHER|||||109.55||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Medicare|MEDICARE A & B|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|United Healthcare|UMR|||||1.67||| 86665|EAP|0302||United Healthcare|UMR|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Managed Medicaid|MOLINA MEDICAID|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Medicare|MEDICARE A & B|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Managed Medicaid|MOLINA MEDICAID|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||129.90||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGM) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.67||| 86665|EAP|0302|EBV AB TO VCA (IGG) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.67||| 86666|EAP|0302|EHRLICHIA CHAFFEENSIS AB, IGM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.18||| 86666|EAP|0302|EHRLICHIA CHAFFEENSIS AB (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.15||| 86666|EAP|0302|EHRLICHIA CHAFFEENSIS AB (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.15||| 86666|EAP|0302|EHRLICHIA CHAFFEENSIS AB (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.15||| 86671|EAP|0302|ANTIBODY FUNGUS NES (REF-ARUP)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||58.55||| 86671|EAP|0301|SACCHAROMYCES CEREV IGGIGA ADL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.50||| 86671|EAP|0301|SACCHAROMYCES CEREVISIA IGGIGA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.50||| 86671|EAP|0302||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||58.55||| 86671|EAP|0302|ANTIBODY FUNGUS NES (REF-ARUP)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||58.55||| 86671|EAP|0302|ANTIBODY FUNGUS NES (REF-ARUP)|Blue Cross PPO Select|BCBS UTHCT|||||58.55||| 86671|EAP|0302|RAST; MOLDMIX1 (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.50||| 86671|EAP|0302|ANTIBODY FUNGUS NES (REF-ARUP)|Blue Cross PPO|BLUE CROSS POS|||||58.55||| 86671|EAP|0302|ANTIBODY FUNGUS NES (REF-ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||1.50||| 86674|EAP|0302|GIARDIA AB IGM, IGA (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|1.40||||||| 86674|EAP|0302|GIARDIA AB IGG (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|1.40||||||| 86682|EAP|0302|ECHINOCOCCUS AB TITER,IGG (|Blue Cross PPO|BLUE CROSS POS|||||0.25||| 86682|EAP|0302|ECHINOCOCCUS AB TITER,IGG (|Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 86682|EAP|0302|HELMINTH ANTIBODY (REF)|United Healthcare|UMR|||||0.24||| 86682|EAP|0302|ECHINOCOCCUS AB TITER,IGG (|Medicare|MEDICARE A & B|0.24||||0.25||| 86682|EAP|0302|HELMINTH ANTIBODY (REF)|Medicare|MEDICARE A & B|0.24||||0.24||| 86692|EAP|0302|HEPATITIS DELTA AGENT (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.97||| 86692|EAP|0302|HEPATITIS DELTA AGENT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.97||| 86692|EAP|0302|HEPATITIS DELTA AGENT (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.97||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.89||| 86694|EAP|0302|HSV IGM (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||103.10||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Medicare|MEDICARE A & B|1.77||||2.89||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Medicaid|MEDICAID|||||5.39||| 86694|EAP|0302|HSV IGM (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||5.39||| 86694|EAP|0302|HSV IGM (REF)|Medicaid|MEDICAID|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|United Healthcare|UMR|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.39||| 86694|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||103.10||| 86694|EAP|0302|HSV IGM (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||103.10||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.39||| 86694|EAP|0302|HSV IGM (REF)|Blue Cross PPO|BLUE CROSS PPO|||||64.05||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.89||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Aetna|AETNA|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.39||| 86694|EAP|0302|HSV IGM (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.39||| 86694|EAP|0302|HSV IGM (REF)|Blue Cross PPO Select|BCBS UTHCT|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||5.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.89||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.39||| 86694|EAP|0302|HSV1&2 COMBINED AB IGG (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.39||| 86695|EAP|0302|HSV-1, IGG ANTIBODIES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.69||| 86695|EAP|0302|HSV 1 (5982)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.53||| 86695|EAP|0302|HSV 1 (5982)|Blue Cross PPO Select|BCBS UTHCT|||||1.15||| 86695|EAP|0302|HSV 1 (5982)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.53||| 86695|EAP|0302|HSV-1, IGG ANTIBODIES (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.69||| 86695|EAP|0302|HSV 1 (5982)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.15||| 86695|EAP|0302|HSV-1, IGG ANTIBODIES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||94.45||| 86695|EAP|0302|HSV 1 (5982)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.84||| 86695|EAP|0302|HSV-1, IGG ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS PPO|||||94.45||| 86695|EAP|0302|HSV 1 (5982)|Blue Cross PPO|BLUE CROSS POS|||||0.53||| 86695|EAP|0302|HSV 1 (5982)|Blue Cross PPO|BLUE CROSS PPO|||||1.15||| 86695|EAP|0302|HSV 1 (5982)|United Healthcare|UMR|||||1.15||| 86695|EAP|0302|HSV-1, IGG ANTIBODIES (REF)|Medicare|MEDICARE A & B|||||94.45||| 86695|EAP|0302|HSV 1 (5982)|Medicare|MEDICARE A & B|||||0.53||| 86695|EAP|0302|HSV-1, IGG ANTIBODIES (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||94.45||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|NON CONTRACTED|COMMERCIAL OTHER|||||138.60||| 86696|EAP|0302|HSV 2 (5982)|Medicare|MEDICARE A & B|||||0.53||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|Medicare|MEDICARE A & B|||||138.60||| 86696|EAP|0302|HSV 2 (5982)|United Healthcare|UMR|||||1.15||| 86696|EAP|0302|HSV 2 (5982)|Blue Cross PPO|BLUE CROSS POS|||||0.53||| 86696|EAP|0302|HSV 2 (5982)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.84||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|Blue Cross PPO|BLUE CROSS PPO|||||211.80||| 86696|EAP|0302|HSV 2 (5982)|Blue Cross PPO|BLUE CROSS PPO|||||1.15||| 86696|EAP|0302|HSV 2 (5982)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.15||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.85||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||138.60||| 86696|EAP|0302|HSV 2 (5982)|Blue Cross PPO Select|BCBS UTHCT|||||1.15||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|Cigna|CIGNA OPEN ACCESS PLUS|||||2.85||| 86696|EAP|0302|HSV 2 (5982)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.53||| 86696|EAP|0302|HSV 2 (5982)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.53||| 86696|EAP|0302|HERPES SIMPLEX, TYPE 2 IGG AB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.85||| 86698|EAP|0301|HYSTOPLASMA - YEAST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.18||| 86698|EAP|0301|HYSTOPLASMA - YEAST|Cigna|CIGNA OF TN CHATTANOOGA|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.18||| 86698|EAP|0301|HYSTOPLASMA - YEAST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.18||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|Blue Cross PPO|BLUE CROSS POS|0.18||||0.18||| 86698|EAP|0301|HYSTOPLASMA - YEAST|Blue Cross PPO|BLUE CROSS POS|0.18||||0.18||| 86698|EAP|0301|HYSTOPLASMA - YEAST|Blue Cross PPO|BLUE CROSS PPO|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|United Healthcare|UMR|||||0.18||| 86698|EAP|0301|HYSTOPLASMA - YEAST|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.18||||||| 86698|EAP|0301|HYSTOPLASMA - YEAST|Medicare|MEDICARE A & B|||||0.18||| 86698|EAP|0302|HISTOPLASMA AB BY ID (REF)|Medicare|MEDICARE A & B|0.18||||0.18||| 86701|EAP|0302|HIV-1 ANTIBODY (6770)|Medicare|MEDICARE A & B|1.03||||1.03||| 86701|EAP|0302||United Healthcare|GOLDEN RULE INSURANCE|||||1.03||| 86701|EAP|0302|HIV-1 ANTIBODY (6770)|Blue Cross PPO|BCBS WALMART|||||1.03||| 86701|EAP|0302|HIV-1 ANTIBODY (6770)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.03||| 86701|EAP|0302|HIV-1 ANTIBODY (6770)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.03||| 86702|EAP|0302|HIV-2 ANTIBODY (6770)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.03||| 86702|EAP|0302|HIV-2 ANTIBODY (6770)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.03||| 86702|EAP|0302|HIV-2 ANTIBODY (6770)|Blue Cross PPO|BCBS WALMART|||||1.03||| 86702|EAP|0302||United Healthcare|GOLDEN RULE INSURANCE|||||1.03||| 86702|EAP|0302|HIV-2 ANTIBODY (6770)|Medicare|MEDICARE A & B|1.03||||1.03||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|NON CONTRACTED|COMMERCIAL OTHER|1.17||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|NON CONTRACTED|BOONE CHAPMAN|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Medicaid|MEDICAID|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|United Healthcare|UMR|||||0.34||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Medicare|MEDICARE A & B|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Blue Cross PPO|BCBS TRANE PPO|1.17||||||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Blue Cross PPO|BLUE CROSS POS|||||75.50||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Blue Cross PPO|BLUE CROSS PPO|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Blue Cross PPO Select|BCBS UTHCT|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Cigna|CIGNA OF TN CHATTANOOGA|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.17||| 86704|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.17||| 86704|EAP|0302|HEPATITIS B CORE AB TOTAL, REF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.17||| 86705|EAP|0302||Managed Medicaid|FAMILY PLANNING GRANT|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.48||| 86705|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Blue Cross PPO Select|BCBS UTHCT|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Cigna|CIGNA OTHER|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.48||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.49||| 86705|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.48||| 86705|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||0.49||| 86705|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||0.48||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Blue Cross PPO|BLUE CROSS PPO|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Blue Cross PPO|BLUE CROSS POS|||||0.49||| 86705|EAP|0302|OH HEPATITIS B SURF ANTIBODY|Blue Cross PPO|BLUE CROSS PPO|||||0.57||| 86705|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 86705|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Aetna|AETNA|||||0.48||| 86705|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.48||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.49||| 86705|EAP|0302||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.49||| 86705|EAP|0302||Medicaid|MEDICAID|||||0.49||| 86705|EAP|0302|HEPATITIS B CORE ATB IgM (811)|Medicare|MEDICARE A & B|0.49||||0.49||| 86705|EAP|0302||Medicare|MEDICARE A & B|0.49||||0.48||| 86705|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.48||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Medicaid|MEDICAID|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Medicare|MEDICARE A & B|0.44||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|United Healthcare|UNITED HEALTHCARE STUDENT RES|||||0.41||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||42.50||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Aetna|AETNA|||||0.41||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|United Healthcare|UMR|||||0.41||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Blue Cross PPO|BLUE CROSS POS|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Blue Cross PPO|BCBS TRANE PPO|0.44||||||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Blue Cross PPO|BLUE CROSS PPO|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Blue Cross PPO Select|BCBS UTHCT|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Cigna|CIGNA OTHER|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Cigna|CIGNA OPEN ACCESS PLUS|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Cigna|CIGNA OF TN CHATTANOOGA|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Cigna|CIGNA OF TN CHATTANOOGA|||||0.41||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.41||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.44||| 86706|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Managed Medicaid|MOLINA MEDICAID|||||0.41||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.44||| 86706|EAP|0302|HEPATITIS B SURF ANTIBODY|Managed Medicaid|FAMILY PLANNING GRANT|||||0.44||| 86707|EAP|0302|HEPATITIS BE ANTIBODY (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.94||| 86707|EAP|0302|HEPATITIS BE ANTIBODY (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.94||| 86707|EAP|0302|HEPATITIS BE ANTIBODY (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.94||| 86707|EAP|0302|HEPATITIS BE ANTIBODY (REF)|Medicare|MEDICARE A & B|||||1.94||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|NON CONTRACTED|COMMERCIAL OTHER|1.79||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Medicaid|MEDICAID|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Medicare|MEDICARE A & B|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Blue Cross PPO|BLUE CROSS PPO|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Blue Cross PPO|BLUE CROSS POS|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Blue Cross PPO Select|BCBS UTHCT|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.79||| 86708|EAP|0302|HEPATITIS A AB TOTAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.79||| 86708|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.79||| 86709|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|0.49||||0.49||| 86709|EAP|0302|HEPATITIS A ATB IgM (811)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 86709|EAP|0302|HEPATITIS A ATB IgM (811)|Blue Cross PPO|BLUE CROSS PPO|||||0.49||| 86709|EAP|0302|HEPATITIS A ATB IgM (811)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 86709|EAP|0302|HEPATITIS A ANTIBODY (IGM)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.52||| 86709|EAP|0302|HEPATITIS A ATB IgM (811)|Medicare|MEDICARE A & B|0.49||||0.49||| 86709|EAP|0302|HEPATITIS A ANTIBODY (IGM)|Medicare|MEDICARE A & B|0.49||||1.52||| 86709|EAP|0302|HEPATITIS A ANTIBODY (IGM)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.52||| 86709|EAP|0302|HEPATITIS A ANTIBODY (IGM)|NON CONTRACTED|COMMERCIAL OTHER|1.52||||||| 86710|EAP|0302|INFLUENZA A&B VIRUS ABS ADL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.56||||||| 86710|EAP|0302|INFLUENZA A&B VIRUS ABS (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.56||||||| 86710|EAP|0302|INFLUENZA A&B VIRUS ABS ADL|Medicare|MEDICARE A & B|0.56||||0.56||| 86710|EAP|0302|INFLUENZA A&B VIRUS ABS (REF)|Medicare|MEDICARE A & B|0.56||||0.56||| 86710|EAP|0302|INFLUENZA A&B VIRUS ABS ADL|Blue Cross PPO|BLUE CROSS PPO|0.56||||||| 86710|EAP|0302|INFLUENZA A&B VIRUS ABS (REF)|Blue Cross PPO|BLUE CROSS PPO|0.56||||||| 86713|EAP|0302|LEGIONELLA TITER, SERUM (REF)|Medicare|MEDICARE A & B|1.26||||1.26||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||93.45||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Managed Medicaid|MOLINA MEDICAID|||||93.45||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGM(REF)|Managed Medicaid|SUPERIOR STAR MCD|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGM(REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||93.45||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||61.23||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Aetna|AETNA|||||93.45||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Blue Cross PPO|BLUE CROSS POS|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Blue Cross PPO|BLUE CROSS PPO|||||93.45||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGM(REF)|Blue Cross PPO|BLUE CROSS POS|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|United Healthcare|UMR|||||93.45||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.29||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY, IGG(REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.29||| 86738|EAP|0302|MYCOPLASMA PNEUM AB (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 86738|EAP|0301|MYCOPLASMA PNEUMONIAE IGM|Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 86747|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||2.18||| 86747|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.18||| 86747|EAP|0302|PARVOVIRUS, IGM (PART OF 4298)|Blue Cross PPO|BLUE CROSS PPO|||||107.65||| 86747|EAP|0302|PARVOVIRUS, IGG (PART OF 4298)|Blue Cross PPO|BLUE CROSS PPO|||||107.65||| 86757|EAP|0302|RICKETTSIA AB,IGM (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.05||| 86757|EAP|0302|RICKETTSIA AB, IGG (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.05||| 86757|EAP|0302|RICKETTSIA AB, IGG (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||15.05||| 86757|EAP|0302|RICKETTSIA AB,IGM (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||15.05||| 86757|EAP|0302|RICKETTSIA AB, IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||15.05||| 86757|EAP|0302|RICKETTSIA AB,IGM (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||15.05||| 86762|EAP|0302|RUBELLA IGM (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||87.55||| 86762|EAP|0302|RUBELLA IGM (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.72||| 86762|EAP|0302|RUBELLA IGM (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 86762|EAP|0302|RUBELLA IGM (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||103.10||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.32||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Aetna|AETNA|||||0.35||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.35||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.35||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Managed Medicaid|MOLINA MEDICAID|||||0.35||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.35||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.32||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|United Healthcare|UMR|||||0.35||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Medicaid|MEDICAID|||||0.29||| 86765|EAP|0302|RUBEOLA AB (IGG/IGM) (REF)|Medicare|MEDICARE A & B|||||0.29||| 86778|EAP|0302|TOXOPLASMA IGM ( PART OF 4390)|United Healthcare|UMR|||||0.28||| 86778|EAP|0302|TOXOPLASMA IGM ( PART OF 4390)|Blue Cross PPO|BLUE CROSS PPO|||||0.28||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO Select|BCBS UTHCT|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|ChampVA|CHAMPVA OF CO DENVER|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Cigna|CIGNA OPEN ACCESS PLUS|||||0.36||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Cigna|CIGNA BEHAVIORAL HEALTH|0.54||||0.36||| 86780|EAP|0302|MHA-TP (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.54||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.36||| 86780|EAP|0302|MHA-TP (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.54||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Managed Medicaid|FAMILY PLANNING GRANT|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.45||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Managed Medicaid|SUPERIOR STAR MCD|0.54||||0.45||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.54||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Managed Medicaid|MOLINA MEDICAID|||||0.36||| 86780|EAP|0302|MHA-TP (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.25||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Aetna|TRS COORDINATED CARE|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Aetna|AETNA EXXON MOBIL|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Aetna|AETNA|||||0.54||| 86780|EAP|0302|MHA-TP (REF)|Blue Cross PPO|BLUE CROSS PPO|0.54||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO|BLUE CROSS POS|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.54||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO|BCBS TRANE PPO|||||0.45||| 86780|EAP|0302|MHA-TP (REF)|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.19||| 86780|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|0.54||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO|BCBS WALMART|||||0.36||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO|BLUE CROSS PPO|0.54||||0.54||| 86780|EAP|0302|MHA-TP (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Medicaid|MEDICAID|||||0.54||| 86780|EAP|0302|MHA-TP (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Medicare|MEDICARE A & B|0.54||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Multiplan|WEB TPA|||||0.36||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Cigna|CIGNA OF TN CHATTANOOGA|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Multiplan|TML GRP INS|||||0.45||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|NON CONTRACTED|PPO OTHER|||||0.36||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|NON CONTRACTED|COMMERCIAL OTHER|0.54||||0.54||| 86780|EAP|0302|MHA-TP (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.54||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|NON CONTRACTED|BOONE CHAPMAN|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.54||| 86780|EAP|0302|MHA-TP (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.54||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.54||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|United Healthcare|UMR|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|United Healthcare|GOLDEN RULE INSURANCE|||||0.54||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.45||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|PHCS|WEB TPA|||||0.36||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.54||| 86780|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.54||||0.19||| 86780|EAP|0302|SYPHILIS TREPONEMA PALLADIUM|PHCS|TML GRP INS|||||0.45||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|United Healthcare|UMR|||||58.55||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.39||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Medicare|MEDICARE A & B|2.39||||||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Medicare|MEDICARE A & B|2.39||||||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Blue Cross PPO|BLUE CROSS PPO|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.39||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Blue Cross PPO|BLUE CROSS PPO|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Blue Cross PPO|BLUE CROSS PPO|||||58.55||| 86787|EAP|0302||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Blue Cross PPO|BLUE CROSS POS|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Aetna|AETNA|||||58.55||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.39||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||58.55||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|NON CONTRACTED|COMMERCIAL OTHER|||||148.78||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Managed Medicaid|MOLINA MEDICAID|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.39||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Managed Medicaid|FAMILY PLANNING GRANT|||||58.55||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Blue Cross PPO Select|BCBS UTHCT|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.39||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.39||| 86787|EAP|0302||Blue Cross PPO Select|BCBS UTHCT|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Cigna|CIGNA OPEN ACCESS PLUS|||||2.39||| 86787|EAP|0302|VARICELLA-ZOSTER AB, IGG (REF|Cigna|CIGNA OF TN CHATTANOOGA|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGM (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||58.55||| 86787|EAP|0302|V.ZOSTER AB, IGG (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||58.55||| 86790|EAP|0301|HTLV I/II W/REFLEX TO WB|Blue Cross PPO|BLUE CROSS PPO|||||1.26||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Medicaid|MEDICAID|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Medicare|MEDICARE A & B|1.08||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|United Healthcare|UMR|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Cigna|CIGNA OTHER|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||57.50||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Managed Medicaid|MOLINA MEDICAID|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Aetna|TRS COORDINATED CARE|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Aetna|AETNA EXXON MOBIL|||||57.50||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.43||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS PPO|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||57.50||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Blue Cross PPO|BCBS WALMART|||||0.72||| 86800|EAP|0302|THYROGLOBULIN ANTIBODIES (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.72||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Blue Cross PPO|BLUE CROSS PPO|0.52||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO|BCBS WALMART|||||0.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO|BCBS TRANE PPO|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO|BLUE CROSS POS|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO|BLUE CROSS PPO|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.09||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Aetna|TRS COORDINATED CARE|||||0.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Aetna|AETNA|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Managed Medicaid|MOLINA MEDICAID|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|ChampVA|CHAMPVA OF CO DENVER|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Blue Cross PPO Select|BCBS UTHCT|0.52||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO Select|BCBS UTHCT|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Cigna|CIGNA OTHER|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.48||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.52||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Managed Medicaid|SUPERIOR STAR MCD|||||0.48||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Aetna|AETNA EXXON MOBIL|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|PHCS|WEB TPA|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|PHCS|TML GRP INS|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|PHCS|PHCS OF AZ PHEONIX|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|United Healthcare|AARP OF GA ATLANTA|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|United Healthcare|UMR|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Multiplan|TML GRP INS|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Multiplan|WEB TPA|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Multiplan|PHCS OF AZ PHEONIX|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|NON CONTRACTED|PPO OTHER|||||0.48||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|NON CONTRACTED|COMMERCIAL OTHER|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|NON CONTRACTED|COMMUNITY CARE|||||0.48||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|NON CONTRACTED|BOONE CHAPMAN|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|NON CONTRACTED|COMMERCIAL OTHER|||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Medicaid|MEDICAID|||||2.09||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Medicaid|MEDICAID|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Medicare|MEDICARE A & B|0.52||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY (811)|Medicare|MEDICARE RAILROAD|||||0.52||| 86803|EAP|0302|HEPATITIS C ANTIBODY - EIA SCR|Medicare|MEDICARE A & B|2.09||||2.09||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|Medicare|MEDICARE A & B|||||3.43||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|NON CONTRACTED|COMMERCIAL OTHER|||||3.43||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|Blue Cross PPO Select|BCBS UTHCT|||||3.43||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||184.80||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.43||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|Blue Cross PPO|BCBS WALMART|||||3.43||| 86812|EAP|0302|HLA B27,FLOW CYTOMETRY;EA CELL|Blue Cross PPO|BLUE CROSS PPO|||||3.43||| 86830|EAP|0302|OH HEPATITIS C ANTIBODY|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.17||||||| 86860|EAP|0302|ANTIBODY ELUTION RBC EACH|Medicare|MEDICARE A & B|||||1.35||| 86860|EAP|0302|ANTIBODY ELUTION RBC EACH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.35||||||| 86870|EAP|0302|ANTIBODY ID (PART OF 4612) (RE|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.71||||||| 86870|EAP|0302|ANTIBODY ID (PART OF 4612) (RE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.71||||2.71||| 86870|EAP|0302|ANTIBODY ID (PART OF 4612) (RE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.71||| 86870|EAP|0302|ANTIBODY ID (PART OF 4612) (RE|Medicare|MEDICARE A & B|||||2.71||| 86880|EAP|0302|COOMBS, DIRECT FOR COMPLEMENT|Medicare|MEDICARE A & B|||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR IGG|Medicare|MEDICARE A & B|||||1.19||| 86880|EAP|0302|ANTIHUMAN GLOBULIN TEST DAT EA|Medicare|MEDICARE A & B|||||1.19||| 86880|EAP|0302|ANTIHUMAN GLOBULIN TEST DAT EA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR IGG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.19||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR COMPLEMENT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.19||||1.19||| 86880|EAP|0302|ANTIHUMAN GLOBULIN TEST DAT EA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.19||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR IGG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR COMPLEMENT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.19||| 86880|EAP|0302|ANTIHUMAN GLOBULIN TEST DAT EA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.19||| 86880|EAP|0302|ANTIHUMAN GLOBULIN TEST DAT EA|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.19||||||| 86880|EAP|0302|ANTIHUMAN GLOBULIN TEST DAT EA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR COMPLEMENT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.19||| 86880|EAP|0302|COOMBS, DIRECT FOR IGG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.19||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Managed Medicaid|SUPERIOR STAR MCD|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Managed Medicaid|MOLINA MEDICAID|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Blue Cross PPO|BLUE CROSS PPO|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Blue Cross PPO|BLUE CROSS POS|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.11||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|United Healthcare|UMR|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.11||||||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|NON CONTRACTED|COMMERCIAL OTHER|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Medicaid|MEDICAID|1.11||||||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Medicare|MEDICARE PART A|||||1.11||| 86885|EAP|0302|ANTIHUMAN GLOBULIN ( INDIRECT)|Medicare|MEDICARE A & B|1.11||||1.11||| 86900|EAP|0302|BLOOD TYPING - ABO|Medicaid|MEDICAID|0.70||||0.70||| 86900|EAP|0309|ABO RH (CARTER)|Medicare|MEDICARE A & B|||||2.07||| 86900|EAP|0302|BLOOD TYPING - ABO|Medicare|MEDICARE A & B|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Medicare|MEDICARE PART A|||||0.70||| 86900|EAP|0302||Medicare|MEDICARE A & B|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|NON CONTRACTED|COMMERCIAL OTHER|||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|United Healthcare|UMR|||||0.70||| 86900|EAP|0309|ABO RH (CARTER)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.07||| 86900|EAP|0302|BLOOD TYPING - ABO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.70||||||| 86900|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.70||||0.25||| 86900|EAP|0309|ABO RH (CARTER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.07||||2.07||| 86900|EAP|0301|ISOHEMAGGLUTIN TITER,1gG/1gM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.19||| 86900|EAP|0302|BLOOD TYPING - ABO|Aetna|AETNA EL PASO CLAIMS OFFICE|0.70||||0.70||| 86900|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Blue Cross PPO|BLUE CROSS PPO|0.70||||0.70||| 86900|EAP|0301|ISOHEMAGGLUTIN TITER,1gG/1gM|Medicare|MEDICARE A & B|||||1.19||| 86900|EAP|0302|BLOOD TYPING - ABO|Blue Cross PPO|BLUE CROSS POS|||||0.70||| 86900|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|0.70||||0.70||| 86900|EAP|0301|ISOHEMAGGLUTIN TITER,1gG/1gM|Blue Cross PPO Select|BCBS UTHCT|||||1.19||| 86900|EAP|0302|BLOOD TYPING - ABO|Managed Medicaid|FAMILY PLANNING GRANT|||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Managed Medicaid|SUPERIOR STAR MCD|||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Managed Medicaid|MOLINA MEDICAID|||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 86900|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.70||||0.25||| 86900|EAP|0302|BLOOD TYPING - ABO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|ChampVA|CHAMPVA OF CO DENVER|||||0.70||| 86900|EAP|0309|ABO RH (CARTER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.07||||||| 86900|EAP|0302|BLOOD TYPING - ABO|Blue Cross PPO Select|BCBS UTHCT|||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.70||||0.70||| 86900|EAP|0302|BLOOD TYPING - ABO|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.70||| 86901|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.67||||0.25||| 86901|EAP|0302|BLOOD TYPING - RH|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|ChampVA|CHAMPVA OF CO DENVER|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Blue Cross PPO Select|BCBS UTHCT|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 86901|EAP|0302|BLOOD TYPING - RH|Managed Medicaid|SUPERIOR STAR MCD|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Managed Medicaid|MOLINA MEDICAID|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Managed Medicaid|FAMILY PLANNING GRANT|||||0.67||| 86901|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Blue Cross PPO|BLUE CROSS POS|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Blue Cross PPO|BLUE CROSS PPO|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.67||||0.67||| 86901|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.67||||0.25||| 86901|EAP|0302|BLOOD TYPING - RH|Aetna|AETNA EL PASO CLAIMS OFFICE|0.67||||0.67||| 86901|EAP|0302||Aetna|AETNA EL PASO CLAIMS OFFICE|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|United Healthcare|UMR|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.67||||||| 86901|EAP|0302|BLOOD TYPING - RH|NON CONTRACTED|COMMERCIAL OTHER|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Medicare|MEDICARE PART A|||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Medicaid|MEDICAID|0.67||||0.67||| 86901|EAP|0302||Medicare|MEDICARE A & B|0.67||||0.67||| 86901|EAP|0302|BLOOD TYPING - RH|Medicare|MEDICARE A & B|0.67||||0.67||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Medicaid|MEDICAID|1.99||||||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Medicare|MEDICARE A & B|1.99||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|NON CONTRACTED|COMMERCIAL OTHER|||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.99||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|United Healthcare|UMR|||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.99||||||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.99||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.99||||||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Blue Cross PPO|BLUE CROSS PPO|1.99||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Blue Cross PPO|BLUE CROSS POS|||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Managed Medicaid|SUPERIOR STAR MCD|||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.99||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.99||||1.99||| 86920|EAP|0302|COMPATIBILITY TEST,EACH (IST)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.99||||1.99||| 86922|EAP|0302|COMPATIBILITY TEST EA ANTGB TN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.39||||||| 86922|EAP|0309|COMPATIBILITY TEST AHG (CARTER|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.40||||||| 86922|EAP|0302|COMPATIBILITY TEST EA ANTGB TN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.39||| 86922|EAP|0302|COMPATIBILITY TEST EA ANTGB TN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.39||||1.39||| 86922|EAP|0309|COMPATIBILITY TEST AHG (CARTER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.40||||3.40||| 86922|EAP|0302|COMPATIBILITY TEST EA ANTGB TN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.39||| 86922|EAP|0309|COMPATIBILITY TEST AHG (CARTER|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.40||| 86922|EAP|0302|COMPATIBILITY TEST EA ANTGB TN|Medicare|MEDICARE A & B|||||1.39||| 86922|EAP|0309|COMPATIBILITY TEST AHG (CARTER|Medicare|MEDICARE A & B|||||3.40||| 86941|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.60||| 86941|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.57||| 86941|EAP|0309||Blue Cross PPO Select|BCBS UTHCT|||||1.60||| 86941|EAP|0309||Blue Cross PPO Select|BCBS UTHCT|||||1.57||| 86945|EAP|0302|IRRADIATION OF BLOOD PRODUCT|Medicare|MEDICARE A & B|0.70||||0.70||| 86945|EAP|0302|IRRADIATION OF BLOOD PRODUCT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.70||| 86945|EAP|0302|IRRADIATION OF BLOOD PRODUCT|Blue Cross PPO|BLUE CROSS POS|||||0.70||| 86945|EAP|0302|IRRADIATION OF BLOOD PRODUCT|Blue Cross PPO|BLUE CROSS PPO|||||0.70||| 86945|EAP|0302|IRRADIATION OF BLOOD PRODUCT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.70||||0.70||| 870|DRG||SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS|Medicare|MEDICARE A & B|115,993.37|50635.24|50635.24|50635.24|||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.40||| 87015|EAP|0301||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||129.20||| 87015|EAP|0309|SEQ DNAP (RWL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.38||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Managed Medicaid|MEDICAID CSHCN|||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.40||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.40||||0.40||| 87015|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.40||||0.96||| 87015|EAP|0306|KINYOUN STAIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.40||||1.38||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Managed Medicaid|SUPERIOR STAR MCD|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Managed Medicaid|MOLINA MEDICAID|||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Managed Medicaid|OTHER MEDICAID|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Managed Medicaid|MOLINA MEDICAID|||||0.40||| 87015|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 87015|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.06||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||0.96||| 87015|EAP|0306|KINYOUN STAIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||1.38||| 87015|EAP|0309|SEQ DNAP (RWL)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.25||| 87015|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| 87015|EAP|0306|KINYOUN STAIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||1.38||| 87015|EAP|0306|NOCARDIA MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||3.80||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||0.96||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||1.54||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||3.47||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.38||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||1.32||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|ChampVA|CHAMPVA OF CO DENVER|||||0.25||| 87015|EAP|0309|SEQ DNAP (RWL)|Blue Cross PPO Select|BCBS UTHCT|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross PPO Select|BCBS UTHCT|||||3.54||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||3.00||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||3.00||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||2.04||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||3.00||| 87015|EAP|0410||Blue Cross PPO Select|BCBS UTHCT|||||2.20||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.96||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.54||| 87015|EAP|0309|SEQ DNAP (RWL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.25||| 87015|EAP|0306|KINYOUN STAIN|Blue Cross PPO Select|BCBS UTHCT|||||1.38||| 87015|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||3.00||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Blue Cross PPO Select|BCBS UTHCT|||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.40||| 87015|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.66||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Cigna|CIGNA OPEN ACCESS PLUS|||||0.40||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.60||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Cigna|CIGNA OPEN ACCESS PLUS|||||0.40||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||3.00||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.75||| 87015|EAP|0306|KINYOUN STAIN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.38||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||2.11||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Cigna|NALC HLTH BENEFIT|0.40||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Cigna|CIGNA OF TN CHATTANOOGA|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Cigna|CIGNA OF TN CHATTANOOGA|||||0.40||| 87015|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.38||| 87015|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||3.60||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||2.11||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||1.66||| 87015|EAP|0306|KINYOUN STAIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.38||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.40||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||2.11||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||0.40||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||1.32||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||4.50||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||1.66||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||1.09||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||0.83||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||4.50||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.54||| 87015|EAP|0309|SEQ DNAP (RWL)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Cigna|CIGNA OPEN ACCESS PLUS|||||3.54||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Cigna|CIGNA OF TN CHATTANOOGA|||||3.54||| 87015|EAP|0309|SEQ DNAP (RWL)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.25||| 87015|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| 87015|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| 87015|EAP|0510||Aetna|AETNA|||||2.64||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||3.00||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||0.40||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||1.38||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||3.60||| 87015|EAP|0306|KINYOUN STAIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||1.38||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||0.40||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||2.11||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||2.04||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||1.66||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||1.32||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||0.96||| 87015|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||0.25||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||3.47||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Aetna|AETNA|||||2.11||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||3.00||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||0.83||| 87015|EAP|0309|SEQ DNAP (RWL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.54||| 87015|EAP|0306|KINYOUN STAIN|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||1.38||| 87015|EAP|0306|KINYOUN STAIN|Aetna|AETNA|||||1.38||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||2.11||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Aetna|AETNA|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||0.40||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||2.11||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||1.66||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||1.38||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||1.32||| 87015|EAP|0306||Aetna|AETNA|||||2.04||| 87015|EAP|0306||Aetna|AETNA|||||1.32||| 87015|EAP|0306||Aetna|AETNA|||||0.96||| 87015|EAP|0309|AER ORG SUSCEPT (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.93||| 87015|EAP|0309|SEQ DNAP (RWL)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.25||| 87015|EAP|0309|SEQ DNAP (RWL)|Aetna|AETNA|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.54||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Aetna|AETNA|||||3.54||| 87015|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.44||| 87015|EAP|0301|MALDI-TOFF FUNGAL ID|Aetna|AETNA|||||129.20||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS POS|0.40||||1.38||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Blue Cross PPO|BLUE CROSS PPO|0.40||||3.00||| 87015|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.32||| 87015|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 87015|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 87015|EAP|0309|SEQ DNAP (RWL)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.54||| 87015|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|||||1.44||| 87015|EAP|0309|AER ORG SUSCEPT (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.93||| 87015|EAP|0309|SEQ DNAP (RWL)|Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross PPO|BLUE CROSS POS|||||3.54||| 87015|EAP|0309|SEQ DNAP (RWL)|Blue Cross PPO|BLUE CROSS POS|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross PPO|BLUE CROSS PPO|||||3.54||| 87015|EAP|0309|DNA SEQ FUNGAL ID (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||6.24||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Blue Cross PPO|BLUE CROSS PPO|0.40||||2.11||| 87015|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 87015|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 87015|EAP|0301|MALDI-TOFF FUNGAL ID|Blue Cross PPO|BLUE CROSS PPO|||||129.20||| 87015|EAP|0410||Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Blue Cross PPO|BLUE CROSS POS|0.40||||0.40||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||3.47||| 87015|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BLUE CROSS POS|0.40||||1.38||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||1.54||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross PPO|BLUE CROSS POS|0.40||||3.00||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS POS|0.40||||1.32||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS POS|0.40||||0.49||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Blue Cross PPO|BLUE CROSS POS|0.40||||2.11||| 87015|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BLUE CROSS PPO|0.40||||1.38||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||0.96||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||1.32||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||1.44||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||1.66||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||2.11||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Blue Cross PPO|BLUE CROSS POS|0.40||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Blue Cross PPO|BCBS TRANE PPO|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.40||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||3.06||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Blue Cross PPO|BLUE CROSS PPO|0.40||||5.40||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||3.00||| 87015|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.66||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.40||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||1.09||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Blue Cross PPO|BLUE CROSS PPO|0.40||||0.40||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||0.83||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS POS|0.40||||2.11||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Blue Cross PPO|BLUE CROSS PPO|0.40||||0.40||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||4.50||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||3.60||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.00||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||3.60||| 87015|EAP|0306|NT MAC MIC RWL (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||3.00||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.11||| 87015|EAP|0306|KINYOUN STAIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||1.38||| 87015|EAP|0306|KINYOUN STAIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||1.38||| 87015|EAP|0306|KINYOUN STAIN|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||172.50||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||2.11||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||2.11||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||0.40||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross PPO|BLUE CROSS PPO|0.40||||3.00||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||0.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||0.40||| 87015|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.40||||1.38||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.40||| 87015|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||2.04||| 87015|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||1.66||| 87015|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.40||||1.32||| 87015|EAP|0301|MYCOBACTERIAL SUSCEPTIBILITY|Blue Cross PPO|BLUE CROSS PPO|||||2.00||| 87015|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||4.50||| 87015|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.40||||3.17||| 87015|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.38||| 87015|EAP|0309|SEQ DNAP (RWL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.31||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.54||| 87015|EAP|0309|SEQ DNAP (RWL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.38||| 87015|EAP|0510||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.38||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|PHCS|WEB TPA|||||5.40||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|PHCS|WEB TPA|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|PHCS|WEB TPA|||||0.40||| 87015|EAP|0306||PHCS|WEB TPA|||||2.04||| 87015|EAP|0306||PHCS|WEB TPA|||||1.66||| 87015|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 87015|EAP|0306||PHCS|WEB TPA|||||1.32||| 87015|EAP|0306||PHCS|WEB TPA|||||0.96||| 87015|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.64||| 87015|EAP|0306|NT MAC MIC RWL (REF)|United Healthcare|UMR|||||3.00||| 87015|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.19||| 87015|EAP|0306||United Healthcare|UMR|||||1.32||| 87015|EAP|0306|KINYOUN STAIN|Tricare|TRICARE WEST UNITED HEALTH|||||1.38||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Tricare|TRICARE WEST UNITED HEALTH|||||0.40||| 87015|EAP|0309|SEQ DNAP (RWL)|PHCS|WEB TPA|||||3.38||| 87015|EAP|0309|DNA SEQ BACTERIAL ID (ARUP)|PHCS|WEB TPA|||||3.17||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|PHCS|WEB TPA|||||5.31||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.40||||0.40||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|United Healthcare|UMR|||||3.00||| 87015|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 87015|EAP|0306||United Healthcare|UMR|||||1.66||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|United Healthcare|UMR|||||0.40||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||0.96||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|United Healthcare|UMR|||||0.40||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|United Healthcare|UMR|||||2.11||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||2.04||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.40||| 87015|EAP|0306||United Healthcare|UMR|||||3.00||| 87015|EAP|0306||United Healthcare|UMR|||||1.38||| 87015|EAP|0306||United Healthcare|UMR|||||2.11||| 87015|EAP|0306|KINYOUN STAIN|United Healthcare|UMR|||||1.38||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.54||| 87015|EAP|0301|MALDI-TOFF FUNGAL ID|PHCS|WEB TPA|||||129.20||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|United Healthcare|UMR|||||3.54||| 87015|EAP|0309|SEQ DNAP (RWL)|United Healthcare|UMR|||||2.25||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.40||||||| 87015|EAP|0306|KINYOUN STAIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.40||||1.38||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.40||||3.00||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||3.60||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||3.00||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.40||||0.40||| 87015|EAP|0309|SEQ DNAP (RWL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.25||| 87015|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|0.40||||1.54||| 87015|EAP|0510||Medicare|MEDICARE A & B|||||4.38||| 87015|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 87015|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 87015|EAP|0301|MALDI-TOFF FUNGAL ID|Multiplan|WEB TPA|||||129.20||| 87015|EAP|0306||Multiplan|WEB TPA|||||0.96||| 87015|EAP|0306||Multiplan|WEB TPA|||||2.04||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||2.11||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Multiplan|WEB TPA|||||5.40||| 87015|EAP|0306||Multiplan|WEB TPA|||||1.32||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Multiplan|WEB TPA|||||0.40||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Multiplan|WEB TPA|||||5.31||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.40||||4.50||| 87015|EAP|0309|DNA SEQ BACTERIAL ID (ARUP)|Multiplan|WEB TPA|||||3.17||| 87015|EAP|0309|SEQ DNAP (RWL)|Multiplan|WEB TPA|||||3.38||| 87015|EAP|0309|SEQ DNAP (RWL)|NON CONTRACTED|BOONE CHAPMAN|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|NON CONTRACTED|COMMERCIAL OTHER|||||3.54||| 87015|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 87015|EAP|0309|SEQ DNAP (RWL)|NON CONTRACTED|COMMERCIAL OTHER|||||2.25||| 87015|EAP|0309||NON CONTRACTED|COMMERCIAL OTHER|||||3.54||| 87015|EAP|0352||Medicare|MEDICARE A & B|||||28.51||| 87015|EAP|0306||Multiplan|WEB TPA|||||1.66||| 87015|EAP|0636||Medicare|MEDICARE A & B|||||24.30||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Multiplan|WEB TPA|||||0.40||| 87015|EAP|0352||Medicare|MEDICARE A & B|||||23.22||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|NON CONTRACTED|PPO OTHER|||||0.40||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.32||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||1.38||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.60||| 87015|EAP|0306|NT MAC MIC RWL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||4.50||| 87015|EAP|0306|KINYOUN STAIN|NON CONTRACTED|COMMERCIAL OTHER|||||1.38||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|NON CONTRACTED|COMMERCIAL OTHER|||||2.11||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|NON CONTRACTED|BOONE CHAPMAN|||||2.11||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|NON CONTRACTED|COMMERCIAL OTHER|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|NON CONTRACTED|PPO OTHER|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|NON CONTRACTED|COMMERCIAL OTHER|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.40||||0.40||| 87015|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||3.00||| 87015|EAP|0306|KINYOUN STAIN|NON CONTRACTED|BOONE CHAPMAN|||||1.38||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.40||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|NON CONTRACTED|BOONE CHAPMAN|||||3.54||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||3.60||| 87015|EAP|0309||NON CONTRACTED|COMMERCIAL OTHER|||||2.25||| 87015|EAP|0410||Medicare|MEDICARE A & B|||||2.20||| 87015|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Cigna|NALC HLTH BENEFIT|0.40||||0.40||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Cigna|CIGNA OPEN ACCESS PLUS|||||2.11||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|NON CONTRACTED|BOONE CHAPMAN|||||0.40||| 87015|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||3.06||| 87015|EAP|0306||NON CONTRACTED|BOONE CHAPMAN|||||1.66||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|NON CONTRACTED|BOONE CHAPMAN|||||3.00||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Medicare|MEDICARE RAILROAD|||||0.40||| 87015|EAP|0255||Medicare|MEDICARE A & B|||||5.25||| 87015|EAP|0306|KINYOUN STAIN|Medicare|MEDICARE RAILROAD|||||1.38||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Medicare|MEDICARE A & B|0.40||||3.00||| 87015|EAP|0306|KINYOUN STAIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.38||| 87015|EAP|0251||Medicare|MEDICARE A & B|||||12.05||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Medicare|MEDICARE RAILROAD|||||0.40||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE A & B|0.40||||2.11||| 87015|EAP|0309|VNTR PRA EXTRACTION|Medicare|MEDICARE A & B|||||2.25||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Blue Cross PPO Select|BCBS UTHCT|||||0.40||| 87015|EAP|0309||Medicare|MEDICARE A & B|||||3.54||| 87015|EAP|0309|VNTR DNA SEQUENCE #2|Medicare|MEDICARE A & B|||||2.25||| 87015|EAP|0309||Medicare|MEDICARE A & B|||||2.25||| 87015|EAP|0309|VNTR PCR(PRA) (PART OF 816)|Medicare|MEDICARE A & B|||||2.25||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||4.50||| 87015|EAP|0309|AER ORG SUSCEPT (ARUP)|Medicare|MEDICARE A & B|||||0.93||| 87015|EAP|0306|NT MAC MIC RWL (REF)|Medicare|MEDICARE RAILROAD|||||3.75||| 87015|EAP|0309||Medicare|MEDICARE A & B|||||1.44||| 87015|EAP|0309|SEQ DNAP (RWL)|Medicare|MEDICARE A & B|||||2.25||| 87015|EAP|0309|SEQ DNAP (RWL)|Medicare|MEDICARE RAILROAD|||||281.50||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Medicaid|MEDICAID|0.40||||0.40||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Medicaid|MEDICAID|0.40||||0.40||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.40||||2.11||| 87015|EAP|0771|ADM OF INFLUENZA VACC (CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| 87015|EAP|0260||Medicare|MEDICARE A & B|||||213.82||| 87015|EAP|0306||Medicaid|MEDICAID|0.40||||2.07||| 87015|EAP|0306||Medicaid|MEDICAID|0.40||||1.66||| 87015|EAP|0306||Medicaid|MEDICAID|0.40||||1.64||| 87015|EAP|0306||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.66||| 87015|EAP|0306||Medicaid|MEDICAID|0.40||||1.32||| 87015|EAP|0300|ADDITIONAL CONC FOR INF AGENTS|Medicare|MEDICARE A & B|||||0.63||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Medicare|MEDICARE PART A|0.40||||||| 87015|EAP|0301||Medicare|MEDICARE A & B|||||0.92||| 87015|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Medicare|MEDICARE PART A|0.40||||||| 87015|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| 87015|EAP|0510||Medicaid|MEDICAID|||||2.64||| 87015|EAP|0309|SEQ DNA SEQF (RWL)|Medicare|MEDICARE A & B|||||2.25||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Medicare|MEDICARE RAILROAD|||||442.50||| 87015|EAP|0301|MALDI-TOFF FUNGAL ID|Medicare|MEDICARE A & B|||||129.20||| 87015|EAP|0301|MYCOBACTERIAL SUSCEPTIBILITY|Medicare|MEDICARE A & B|||||2.00||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||1.66||| 87015|EAP|0460||Managed Medicaid|MEDICAID CSHCN|||||8.25||| 87015|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.40||||1.66||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||3.00||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||1.32||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||2.04||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||0.83||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||1.38||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||2.11||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||3.47||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||3.60||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Managed Medicaid|MEDICAID CSHCN|||||0.40||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||1.09||| 87015|EAP|0306|NT MYCO SLOW MIC RWL (REF)|Medicare|MEDICARE A & B|0.40||||3.00||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.31||| 87015|EAP|0306|NT MYCO RADID MIC RWL (REF)|Medicare|MEDICARE A & B|0.40||||3.60||| 87015|EAP|0306|NOCARDIA MIC RWL (REF)|Medicare|MEDICARE A & B|0.40||||5.70||| 87015|EAP|0306|ADDITIONAL CONC FOR INF AGENTS|Medicare|MEDICARE A & B|0.40||||0.40||| 87015|EAP|0306|KINYOUN STAIN|Medicare|MEDICARE A & B|0.40||||1.38||| 87015|EAP|0306|CONCENTRATION FOR INFECTIOUS A|Medicare|MEDICARE A & B|0.40||||0.40||| 87015|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE RAILROAD|||||2.11||| 87015|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Medicare|MEDICARE A & B|0.40||||0.96||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||0.49||| 87015|EAP|0251|EPINEPHRINE, RACEMIC 2.25%, IN|Medicare|MEDICARE A & B|||||4.45||| 87015|EAP|0301||Medicaid|MEDICAID|||||129.20||| 87015|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Medicare|MEDICARE A & B|||||3.54||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||1.54||| 87015|EAP|0306||Medicare|MEDICARE A & B|0.40||||0.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Medicaid|MEDICAID|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Medicare|MEDICARE A & B|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Medicare|MEDICARE PART A|1.96||||||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|NON CONTRACTED|COMMERCIAL OTHER 2|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|NON CONTRACTED|COMMERCIAL OTHER|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Workers Compensation|WC GALLAGHER BASSETT|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|PHCS|TML GRP INS|1.96||||||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|United Healthcare|UMR|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Blue Cross PPO|BLUE CROSS PPO|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Blue Cross PPO|BLUE CROSS POS|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Blue Cross PPO|BCBS WALMART|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Blue Cross PPO|BCBS TRANE PPO|1.96||||||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Multiplan|TML GRP INS|1.96||||||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|ChampVA|CHAMPVA OF CO DENVER|1.96||||||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Blue Cross PPO Select|BCBS UTHCT|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Medicare|MEDICARE RAILROAD|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Cigna|NALC HLTH BENEFIT|1.96||||||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Cigna|CIGNA OF TN CHATTANOOGA|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.96||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Managed Medicaid|MOLINA MEDICAID|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Managed Medicaid|SUPERIOR STAR MCD|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Managed Medicaid|OTHER MEDICAID|||||1.96||| 87040|EAP|0306|BLOOD CULTURE (ADULT)|Managed Medicaid|MEDICAID CSHCN|||||1.96||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.39||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Blue Cross PPO Select|BCBS UTHCT|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|ChampVA|CHAMPVA OF CO DENVER|||||0.27||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Cigna|CIGNA OF TN CHATTANOOGA|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Cigna|CIGNA OF TN CHATTANOOGA|||||0.27||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.39||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.39||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Blue Cross PPO|BLUE CROSS PPO|1.39||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Blue Cross PPO|BLUE CROSS POS|1.39||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Blue Cross PPO|BCBS TRANE PPO|||||0.83||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Managed Medicaid|SUPERIOR STAR MCD|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.27||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|United Healthcare|UMR|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.39||||||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.83||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|NON CONTRACTED|COMMERCIAL OTHER|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.27||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Medicaid|MEDICAID|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Medicare|MEDICARE RAILROAD|||||1.39||| 87045|EAP|0306|CULTURE, SALMONELLA/SHIGELLA (|Medicare|MEDICARE A & B|1.39||||1.39||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Medicare|MEDICARE A & B|0.68||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.27||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Medicaid|MEDICAID|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.27||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.27||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Medicaid|MEDICAID|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Medicare|MEDICARE A & B|0.68||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Medicare|MEDICARE A & B|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Medicare|MEDICARE RAILROAD|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Medicare|MEDICARE RAILROAD|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|NON CONTRACTED|COMMERCIAL OTHER|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|NON CONTRACTED|COMMERCIAL OTHER|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|NON CONTRACTED|COMMERCIAL OTHER|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|United Healthcare|UMR|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||47.50||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||47.50||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||47.50||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.68||||||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.68||||||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.68||||||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|United Healthcare|UMR|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.27||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Blue Cross PPO|BLUE CROSS PPO|0.68||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Blue Cross PPO|BLUE CROSS POS|0.68||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.27||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.27||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Blue Cross PPO|BCBS TRANE PPO|||||47.50||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Blue Cross PPO|BCBS TRANE PPO|||||47.50||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Blue Cross PPO|BLUE CROSS POS|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Blue Cross PPO|BLUE CROSS PPO|0.68||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Blue Cross PPO|BLUE CROSS PPO|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Blue Cross PPO|BCBS TRANE PPO|||||47.50||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|United Healthcare|UMR|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Blue Cross PPO|BLUE CROSS POS|0.68||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.68||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.68||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|ChampVA|CHAMPVA OF CO DENVER|||||0.27||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|ChampVA|CHAMPVA OF CO DENVER|||||0.27||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Blue Cross PPO Select|BCBS UTHCT|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Blue Cross PPO Select|BCBS UTHCT|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Blue Cross PPO Select|BCBS UTHCT|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Medicare|MEDICARE RAILROAD|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|ChampVA|CHAMPVA OF CO DENVER|||||0.27||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.27||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Medicaid|MEDICAID|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.27||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.27||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.68||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Managed Medicaid|SUPERIOR STAR MCD|||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.68||||0.68||| 87046|EAP|0306|CULTURE, YERSINIA (STOOL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Managed Medicaid|SUPERIOR STAR MCD|||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.68||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.68||| 87046|EAP|0306|CULTURE, VIBRIO (STOOL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.68||||0.68||| 87046|EAP|0306|CULTURE, E.COLI 0157 (STOOL)|Managed Medicaid|SUPERIOR STAR MCD|||||0.68||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.54||||1.54||| 87070|EAP|0999||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|OTHER MEDICAID|||||1.54||| 87070|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.54||||1.66||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|MOLINA MEDICAID|||||1.54||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Managed Medicaid|SUPERIOR STAR MCD|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Managed Medicaid|MOLINA MEDICAID|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Managed Medicaid|OTHER MEDICAID|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Managed Medicaid|MEDICAID CSHCN|||||1.54||| 87070|EAP|0510||Managed Medicaid|MEDICAID CSHCN|||||2.64||| 87070|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| 87070|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.07||| 87070|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.08||| 87070|EAP|0510||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| 87070|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|||||5.18||| 87070|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||2.50||| 87070|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| 87070|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.54||||1.54||| 87070|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 87070|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 87070|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.54||||1.66||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|ChampVA|CHAMPVA OF CO DENVER|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|ChampVA|CHAMPVA OF CO DENVER|1.54||||1.54||| 87070|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.04||| 87070|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 87070|EAP|0272|SCALPEL SZ 15|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.08||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross PPO Select|BCBS UTHCT|1.54||||1.54||| 87070|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|1.54||||0.24||| 87070|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Cigna|CIGNA OTHER|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Cigna|CIGNA OPEN ACCESS PLUS|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.54||| 87070|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.54||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.54||||1.54||| 87070|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.54||||1.07||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.54||||1.54||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.54||||89.50||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.54||||1.54||| 87070|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.54||||1.32||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Aetna|AETNA EXXON MOBIL|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Aetna|AETNA EL PASO CLAIMS OFFICE|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Aetna|AETNA|||||1.54||| 87070|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|1.54||||0.25||| 87070|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 87070|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 87070|EAP|0301||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.30||| 87070|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross PPO|BLUE CROSS POS|1.54||||1.54||| 87070|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.54||||48.50||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross PPO|BCBS TRANE PPO|1.54||||1.54||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|Blue Cross PPO|BLUE CROSS PPO|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||89.50||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross PPO|BCBS WALMART|1.54||||1.54||| 87070|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO|BLUE CROSS PPO|1.54||||1.66||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross PPO|BCBS TRANE PPO|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross PPO|BLUE CROSS PPO|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross PPO|BCBS WALMART|1.54||||1.54||| 87070|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.54||||1.66||| 87070|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.54||||1.32||| 87070|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.54||||0.49||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross PPO|BLUE CROSS PPO|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Blue Cross PPO|BLUE CROSS POS|1.54||||1.54||| 87070|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.54||||0.25||| 87070|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 87070|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 87070|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 87070|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.54||||0.96||| 87070|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 87070|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 87070|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 87070|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 87070|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 87070|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.54||||1.54||| 87070|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 87070|EAP|0450|DRAINAGE SCROTAL WALL ABSCESS|Blue Cross PPO|BLUE CROSS PPO|||||22.94||| 87070|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||10.22||| 87070|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||5.18||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Workers Compensation|WC GALLAGHER BASSETT|||||1.54||| 87070|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 87070|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.54||||1.66||| 87070|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.54||||1.54||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.54||||1.54||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.54||| 87070|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.54||||1.32||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Cigna|NALC HLTH BENEFIT|1.54||||1.54||| 87070|EAP|0510||United Healthcare|UMR|||||2.64||| 87070|EAP|0510||United Healthcare|UMR|||||3.26||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Cigna|NALC HLTH BENEFIT|1.54||||0.25||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|PHCS|TML GRP INS|1.54||||0.25||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|PHCS|WEB TPA|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|PHCS|WEB TPA|||||0.25||| 87070|EAP|0981||United Healthcare|UMR|||||0.00||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|United Healthcare|UMR|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|United Healthcare|UMR|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Blue Cross PPO Select|BCBS UTHCT|1.54||||1.54||| 87070|EAP|0306||United Healthcare|UMR|1.54||||0.25||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Tricare|TRICARE WEST UNITED HEALTH|||||1.54||| 87070|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|United Healthcare|UMR|1.54||||0.25||| 87070|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.54||||0.25||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|United Healthcare|UMR|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.54||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.54||||1.54||| 87070|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 87070|EAP|0510||Medicare|MEDICARE A & B|||||2.09||| 87070|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 87070|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Multiplan|WEB TPA|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Multiplan|TML GRP INS|1.54||||0.25||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Multiplan|WEB TPA|||||0.25||| 87070|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER|||||1.30||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|NON CONTRACTED|COMMERCIAL OTHER|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|NON CONTRACTED|PPO OTHER|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|NON CONTRACTED|COMMERCIAL OTHER|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|NON CONTRACTED|BOONE CHAPMAN|||||1.54||| 87070|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.54||||1.32||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.54||| 87070|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 87070|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 87070|EAP|0306||Medicare|MEDICARE A & B|1.54||||1.32||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|FAMILY PLANNING GRANT|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.54||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Medicaid|MEDICAID|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Medicaid|MEDICAID|1.54||||1.54||| 87070|EAP|0981||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.00||| 87070|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 87070|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 87070|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Managed Medicaid|SUPERIOR STAR MCD|1.54||||1.54||| 87070|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.30||| 87070|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 87070|EAP|0306||Medicare|MEDICARE A & B|1.54||||0.40||| 87070|EAP|0306|CULTURE, THROAT/NASOPHARYNGEAL|Medicare|MEDICARE A & B|1.54||||1.54||| 87070|EAP|0306||Medicare|MEDICARE A & B|1.54||||1.66||| 87070|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 87070|EAP|0981||Medicaid|MEDICAID|||||0.00||| 87070|EAP|0306|CULTURE, NASAL STAPH AUREUS SC|Medicare|MEDICARE A & B|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Medicare|MEDICARE RAILROAD|1.54||||1.54||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Medicare|MEDICARE PART A|1.54||||||| 87070|EAP|0306|CULTURE, AEROBIC (ROUTINE)|Medicare|MEDICARE A & B|1.54||||1.54||| 87070|EAP|0306||Medicare|MEDICARE A & B|1.54||||3.47||| 87070|EAP|0306||Medicare|MEDICARE A & B|1.54||||1.38||| 87075|EAP|0306|CULTURE, ANAEROBIC|ChampVA|CHAMPVA OF CO DENVER|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Blue Cross PPO Select|BCBS UTHCT|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Managed Medicaid|SUPERIOR STAR MCD|2.14||||||| 87075|EAP|0306|CULTURE, ANAEROBIC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.14||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Blue Cross PPO|BLUE CROSS PPO|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Blue Cross PPO|BLUE CROSS POS|2.14||||||| 87075|EAP|0306|CULTURE, ANAEROBIC|Medicaid|MEDICAID|2.14||||||| 87075|EAP|0306|CULTURE, ANAEROBIC|NON CONTRACTED|COMMERCIAL OTHER|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Blue Cross PPO|BCBS WALMART|||||2.14||| 87075|EAP|0306|CULTURE, ANAEROBIC|Medicare|MEDICARE A & B|2.14||||2.14||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.07||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Blue Cross PPO|BCBS TRANE PPO|||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Managed Medicaid|SUPERIOR STAR MCD|1.07||||1.07||| 87076|EAP|0301|ANAEROBIC ORGANISM ID|Medicare|MEDICARE A & B|||||129.20||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Medicare|MEDICARE A & B|1.07||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|Blue Cross PPO|BLUE CROSS PPO|||||1.07||| 87076|EAP|0306|DEFINITIVE IDENTIFICATION, ANA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.07||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross PPO|BCBS TRANE PPO|||||1.32||| 87077|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.44||| 87077|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.32||||0.49||| 87077|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.32||||78.50||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.44||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.44||| 87077|EAP|0306||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross PPO|BLUE CROSS POS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Managed Medicaid|FAMILY PLANNING GRANT|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||1.32||| 87077|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.32||||1.66||| 87077|EAP|0306||Blue Cross PPO|BLUE CROSS POS|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Medicare|MEDICARE A & B|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.32||| 87077|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||24.50||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Cigna|NALC HLTH BENEFIT|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Managed Medicaid|SUPERIOR STAR MCD|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross PPO|BLUE CROSS PPO|1.32||||1.32||| 87077|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||1.66||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Aetna|AETNA EL PASO CLAIMS OFFICE|1.32||||1.32||| 87077|EAP|0306||Multiplan|WEB TPA|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||1.32||| 87077|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.32||||1.32||| 87077|EAP|0306||Blue Cross PPO|BCBS TRANE PPO|||||1.32||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Blue Cross PPO|BLUE CROSS PPO|1.44||||||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.32||| 87077|EAP|0306||Managed Medicaid|SUPERIOR STAR MCD|1.32||||1.32||| 87077|EAP|0306||Blue Cross PPO|BLUE CROSS POS|1.32||||1.66||| 87077|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO|BLUE CROSS PPO|1.32||||95.50||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|MEDICAID CSHCN|||||1.32||| 87077|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||1.32||| 87077|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Aetna|AETNA EL PASO CLAIMS OFFICE|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross PPO|BLUE CROSS PPO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Medicare|MEDICARE PART A|1.32||||||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|NON CONTRACTED|BOONE CHAPMAN|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|FAMILY PLANNING GRANT|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Aetna|AETNA|||||78.50||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Medicare|MEDICARE A & B|1.44||||1.44||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Aetna|AETNA US HEALTHCARE PA|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|United Healthcare|UMR|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Aetna|TRS COORDINATED CARE|||||0.25||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Managed Medicaid|OTHER MEDICAID|||||1.32||| 87077|EAP|0306||ChampVA|CHAMPVA OF CO DENVER|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Medicare|MEDICARE RAILROAD|||||1.32||| 87077|EAP|0306||Blue Cross PPO|BCBS WALMART|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross PPO|BCBS WALMART|1.32||||1.32||| 87077|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.32||||1.32||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.44||||||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Medicaid|MEDICAID|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|ChampVA|CHAMPVA OF CO DENVER|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Medicare|MEDICARE RAILROAD|||||1.32||| 87077|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.32||||1.66||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Aetna|AETNA EL PASO CLAIMS OFFICE|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Cigna|CIGNA OF TN CHATTANOOGA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Multiplan|WEB TPA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Tricare|TRICARE WEST UNITED HEALTH|||||78.50||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Cigna|CIGNA OPEN ACCESS PLUS|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Blue Cross PPO|BLUE CROSS PPO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross PPO|BLUE CROSS POS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|NON CONTRACTED|COMMERCIAL OTHER|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.32||| 87077|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||1.66||| 87077|EAP|0306||Blue Cross PPO|BLUE CROSS POS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Cigna|CIGNA OF TN CHATTANOOGA|||||1.32||| 87077|EAP|0306||PHCS|WEB TPA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Multiplan|WEB TPA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.32||||1.32||| 87077|EAP|0306||Multiplan|TML GRP INS|||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||1.32||| 87077|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Blue Cross PPO|BLUE CROSS POS|1.32||||1.32||| 87077|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|NON CONTRACTED|PPO OTHER|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Managed Medicaid|MOLINA MEDICAID|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|PHCS|WEB TPA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross PPO|BCBS WALMART|1.32||||1.32||| 87077|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicare|MEDICARE RAILROAD|||||3.96||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|MOLINA MEDICAID|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Cigna|NALC HLTH BENEFIT|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|United Healthcare|UMR|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Managed Medicaid|MOLINA MEDICAID|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Managed Medicaid|SUPERIOR STAR MCD|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|United Healthcare|GOLDEN RULE INSURANCE|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|PHCS|WEB TPA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|SUPERIOR STAR MCD|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 87077|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|ChampVA|CHAMPVA OF CO DENVER|||||1.32||| 87077|EAP|0306||United Healthcare|UMR|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|PHCS|TML GRP INS|||||0.25||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.44||| 87077|EAP|0306||Managed Medicaid|MOLINA MEDICAID|||||1.36||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.32||||1.32||| 87077|EAP|0306||Medicare|MEDICARE A & B|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Cigna|CIGNA OF TN CHATTANOOGA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.32||||1.32||| 87077|EAP|0306||PHCS|TML GRP INS|||||0.25||| 87077|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|NON CONTRACTED|COMMERCIAL OTHER|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.23||| 87077|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER 2|||||0.25||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|NON CONTRACTED|PPO OTHER|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.32||||1.32||| 87077|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.32||||1.32||| 87077|EAP|0301|ANTIMICROBIAL SUS ANAEROBES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||132.30||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Medicare|MEDICARE A & B|1.32||||1.32||| 87077|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.32||||0.25||| 87077|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Medicare|MEDICARE RAILROAD|||||1.32||| 87077|EAP|0306||Medicaid|MEDICAID|1.32||||1.32||| 87077|EAP|0306||Medicare|MEDICARE A & B|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Aetna|AETNA US HEALTHCARE PA|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|ChampVA|CHAMPVA OF CO DENVER|||||1.32||| 87077|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.32||||1.32||| 87077|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Medicare|MEDICARE A & B|1.32||||1.32||| 87077|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Medicare|MEDICARE PART A|1.32||||||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Managed Medicaid|OTHER MEDICAID|||||1.44||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|NON CONTRACTED|COMMERCIAL OTHER|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Medicare|MEDICARE PART A|1.32||||||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|United Healthcare|UMR|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Blue Cross PPO Select|BCBS UTHCT|||||78.50||| 87077|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Multiplan|TML GRP INS|||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Cigna|CIGNA OPEN ACCESS PLUS|||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION,AERO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.32||| 87077|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.32||| 87077|EAP|0306|DEFINITIVE ID PANEL, GRAM POS|Medicaid|MEDICAID|1.32||||1.32||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Managed Medicaid|OTHER MEDICAID|||||1.32||| 87077|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.44||| 87077|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 87077|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.32||||0.25||| 87077|EAP|0306|DEFINITIVE IDENTIFICATION, AER|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.32||||1.32||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|FAMILY PLANNING GRANT|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||80.50||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|MOLINA MEDICAID|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Workers Compensation|WC TX MUTUAL INS|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Cigna|CIGNA OF TN CHATTANOOGA|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Cigna|CIGNA OPEN ACCESS PLUS|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Cigna|CIGNA OF TN CHATTANOOGA|||||73.50||| 87086|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|1.36||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|MEDICAID CSHCN|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Cigna|NALC HLTH BENEFIT|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Cigna|CIGNA BEHAVIORAL HEALTH|1.36||||||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.18||| 87086|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.36||||1.36||| 87086|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Aetna|AETNA EXXON MOBIL|||||0.25||| 87086|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.36||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|ChampVA|CHAMPVA OF CO DENVER|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.36||| 87086|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.36||||1.36||| 87086|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|1.36||||1.32||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO|BCBS WALMART|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.36||||||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Aetna|AETNA EL PASO CLAIMS OFFICE|1.36||||1.36||| 87086|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.36||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO Select|BCBS UTHCT|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.36||||1.36||| 87086|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.19||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|United Healthcare|UMR|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Aetna|AETNA|||||0.25||| 87086|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.36||||0.25||| 87086|EAP|0306||Medicare|MEDICARE A & B|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO|BLUE CROSS PPO|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|United Healthcare|GOLDEN RULE INSURANCE|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Medicare|MEDICARE PART A|1.36||||||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||1.36||| 87086|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.36||||0.25||| 87086|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Aetna|AETNA US HEALTHCARE PA|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Medicare|MEDICARE RAILROAD|1.36||||1.36||| 87086|EAP|0301|ANAEROBIC ORGANISM ID|Medicare|MEDICARE A & B|||||129.20||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|NON CONTRACTED|PPO OTHER|||||0.25||| 87086|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|1.36||||1.66||| 87086|EAP|0301|ANTIMICROBIAL SUS ANAEROBES|Medicare|MEDICARE A & B|||||132.30||| 87086|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|1.36||||1.36||| 87086|EAP|0301||Medicare|MEDICARE A & B|||||33.66||| 87086|EAP|0981||Medicare|MEDICARE A & B|0.00||||||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|PHCS|TML GRP INS|||||80.50||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Medicaid|MEDICAID|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Blue Cross PPO|BLUE CROSS POS|1.36||||1.36||| 87086|EAP|0306||Medicare|MEDICARE A & B|1.36||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Multiplan|WEB TPA|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Multiplan|TML GRP INS|||||80.50||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Tricare|TRICARE WEST UNITED HEALTH|||||0.25||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|PHCS|WEB TPA|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|SUPERIOR STAR MCD|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Aetna|TRS COORDINATED CARE|||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.36||| 87086|EAP|0309|AER ORG ID MALDI-TOF (ARUP)|Medicare|MEDICARE A & B|||||1.44||| 87086|EAP|0309|AER ORG SUSCEPT (ARUP)|Medicare|MEDICARE A & B|||||0.93||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|NON CONTRACTED|COMMERCIAL OTHER|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Medicare|MEDICARE A & B|1.36||||1.36||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.36||| 87086|EAP|0730||Medicare|MEDICARE A & B|3.86||||||| 87086|EAP|0306|CULTURE, BACTERIAL; QUANT COLO|Managed Medicaid|OTHER MEDICAID|||||1.36||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross PPO|BLUE CROSS PPO|75,927.21|8618.93|14520.46|7171.74|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Medicare|MEDICARE A & B|61,252.24|14520.46|14520.46|7171.74|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Humana Medicare Advantage|HUMANA MEDICARE PPO|16,330.55|13671.54|14520.46|7171.74|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|61,781.98|9285.25|14520.46|7171.74|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|19,778.65|7171.74|14520.46|7171.74|||| 87101|EAP|0306|CULT,FUNGI;SKIN,HAIR,NAIL(REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 87101|EAP|0306|CULT,FUNGI;SKIN,HAIR,NAIL(REF)|United Healthcare|UMR|||||1.39||| 87101|EAP|0306|DEFINITIVE ID, MOL (REF)|United Healthcare|UMR|||||2.04||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Medicare|MEDICARE A & B|1.58||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|NON CONTRACTED|PPO OTHER|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Medicaid|MEDICAID|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Blue Cross PPO|BLUE CROSS PPO|1.58||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|United Healthcare|UMR|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Managed Medicaid|OTHER MEDICAID|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Managed Medicaid|MEDICAID CSHCN|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Blue Cross PPO|BLUE CROSS POS|1.58||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Blue Cross PPO|BCBS WALMART|1.58||||||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Aetna|AETNA|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.58||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Cigna|NALC HLTH BENEFIT|||||1.58||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Medicare|MEDICARE PART A|1.58||||||| 87102|EAP|0306|FUNGAL CULTURE (REF)|Managed Medicaid|MOLINA MEDICAID|||||1.58||| 87103|EAP|0306|FUNGAL CULTURE, BLOOD (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.78||||||| 87103|EAP|0306|FUNGAL CULTURE, BLOOD (REF)|Medicare|MEDICARE A & B|0.78||||||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Managed Medicaid|MEDICAID CSHCN|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Managed Medicaid|OTHER MEDICAID|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Blue Cross PPO|BLUE CROSS POS|1.09||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Managed Medicaid|MOLINA MEDICAID|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Medicaid|MEDICAID|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Medicare|MEDICARE PART A|1.09||||||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Blue Cross PPO|BLUE CROSS PPO|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Medicare|MEDICARE A & B|1.09||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.09||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.09||| 87106|EAP|0306|DEFINITIVE ID, YEAST (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.09||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross PPO Select|BCBS UTHCT|2.04||||||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Managed Medicaid|MOLINA MEDICAID|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross PPO|BLUE CROSS PPO|2.04||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|NON CONTRACTED|BOONE CHAPMAN|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Medicare|MEDICARE A & B|2.04||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.04||| 87107|EAP|0306|DEFINITIVE ID, MOL (REF)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.04||| 87110|EAP|0306|CHLAMYDIA, CULTURE (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.58||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Aetna|AETNA EL PASO CLAIMS OFFICE|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Blue Cross PPO|BLUE CROSS PPO|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Managed Medicaid|MOLINA MEDICAID|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Blue Cross PPO|BCBS TRANE PPO|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Managed Medicaid|OTHER MEDICAID|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Tricare|TRICARE WEST UNITED HEALTH|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Cigna|CIGNA OF TN CHATTANOOGA|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Multiplan|WEB TPA|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|NON CONTRACTED|BOONE CHAPMAN|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Medicaid|MEDICAID|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Medicare|MEDICARE A & B|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Medicare|MEDICARE PART A|3.47||||||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Managed Medicaid|MEDICAID CSHCN|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|NON CONTRACTED|PPO OTHER|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Cigna|NALC HLTH BENEFIT|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Cigna|CIGNA OPEN ACCESS PLUS|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Blue Cross PPO Select|BCBS UTHCT|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|PHCS|WEB TPA|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Aetna|AETNA|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|NON CONTRACTED|COMMERCIAL OTHER|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Blue Cross PPO|BLUE CROSS POS|3.47||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|Medicare|MEDICARE RAILROAD|||||3.47||| 87116|EAP|0306|AFB CULTURE & ISOLATION OF ORG|United Healthcare|UMR|||||3.47||| 87140|EAP|0302|CULTURE TYPING EA ADD (6883)|Blue Cross PPO|BLUE CROSS PPO|||||0.23||| 87140|EAP|0309|CULTURE TYPING EA (6883)|Blue Cross PPO|BLUE CROSS PPO|||||0.23||| 87147|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Multiplan|WEB TPA|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.72||| 87147|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||0.72||| 87147|EAP|0301|PBP2A SUSCEPTIBILITY (REF)|Medicare|MEDICARE A & B|||||186.76||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Tricare|TRICARE WEST UNITED HEALTH|||||0.25||| 87147|EAP|0306||Medicare|MEDICARE A & B|0.72||||0.72||| 87147|EAP|0306||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Medicare|MEDICARE A & B|0.72||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|NON CONTRACTED|COMMERCIAL OTHER|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||48.50||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|PHCS|WEB TPA|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.25||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Managed Medicaid|FAMILY PLANNING GRANT|||||0.72||| 87147|EAP|0306||Medicaid|MEDICAID|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Managed Medicaid|MOLINA MEDICAID|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Medicaid|MEDICAID|||||0.72||| 87147|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|United Healthcare|UMR|||||0.72||| 87147|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Blue Cross PPO Select|BCBS UTHCT|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.72||| 87147|EAP|0306||Managed Medicaid|SUPERIOR STAR MCD|0.72||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.72||| 87147|EAP|0306||Aetna|AETNA EXXON MOBIL|||||0.25||| 87147|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Blue Cross PPO|BLUE CROSS POS|0.72||||0.72||| 87147|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.72||||0.72||| 87147|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Medicare|MEDICARE PART A|0.72||||||| 87147|EAP|0306||Blue Cross PPO|BLUE CROSS POS|0.72||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Cigna|CIGNA OF TN CHATTANOOGA|||||0.72||| 87147|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.72||| 87147|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.72||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Blue Cross PPO|BCBS TRANE PPO|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Blue Cross PPO|BCBS WALMART|0.72||||0.72||| 87147|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Blue Cross PPO|BLUE CROSS PPO|0.72||||0.72||| 87147|EAP|0306|IMMUNOLOGIC AGGLUTINATION,EACH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.72||| 87149|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||2.11||| 87149|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||2.11||| 87149|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.11||||2.11||| 87149|EAP|0306||NON CONTRACTED|BOONE CHAPMAN|||||2.11||| 87149|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.11||| 87149|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||2.11||| 87149|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.11||||2.11||| 87149|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|2.11||||2.11||| 87149|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.11||| 87149|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.11||| 87149|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.11||| 87149|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|2.11||||2.11||| 87149|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||2.11||| 87149|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||2.11||| 87149|EAP|0306|CULTYP ID NUCLEIC ACID PROBE|Medicare|MEDICARE A & B|2.11||||2.11||| 87149|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||2.11||| 87149|EAP|0306||Medicare|MEDICARE A & B|2.11||||2.11||| 87150|EAP|0309|VNTR PCR(PRA) (PART OF 816)|Medicare|MEDICARE A & B|||||1.50||| 87150|EAP|0309|VNTR PCR(PRA) (PART OF 816)|Blue Cross PPO|BLUE CROSS PPO|||||1.50||| 87153|EAP|0309||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.54||| 87153|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.54||||3.54||| 87153|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.31||| 87153|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.54||| 87153|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.00||| 87153|EAP|0309||Blue Cross PPO|BLUE CROSS POS|||||5.31||| 87153|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.54||| 87153|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|3.54||||3.54||| 87153|EAP|0309|VNTR DNA SEQUENCE #2|Blue Cross PPO|BLUE CROSS PPO|3.54||||1.50||| 87153|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Medicare|MEDICARE PART A|3.54||||||| 87153|EAP|0309|VNTR DNA SEQUENCE #2|Medicare|MEDICARE A & B|3.54||||1.50||| 87153|EAP|0309|DNA SEQ BACTERIAL ID (ARUP)|Medicare|MEDICARE A & B|3.54||||3.17||| 87153|EAP|0309|CULT TYPING ID BY NUC ACID RWL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.54||||||| 87153|EAP|0309||Medicare|MEDICARE A & B|3.54||||3.54||| 87153|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|3.54||||3.54||| 87153|EAP|0309|CULT TYPING ID BY NUC ACID RWL|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.54||||3.54||| 87158|EAP|0309|SEQ DNAP (RWL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.25||||||| 87158|EAP|0309|VNTR PRA EXTRACTION|Medicare|MEDICARE A & B|2.25||||1.50||| 87158|EAP|0309||Medicare|MEDICARE A & B|2.25||||2.25||| 87158|EAP|0309||Blue Cross PPO|BLUE CROSS PPO|2.25||||2.25||| 87158|EAP|0309|VNTR PRA EXTRACTION|Blue Cross PPO|BLUE CROSS PPO|2.25||||1.50||| 87158|EAP|0309|SEQ DNA SEQF (RWL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.25||||2.25||| 87158|EAP|0309||Blue Cross PPO|BLUE CROSS POS|||||3.38||| 87158|EAP|0309|SEQ DNAP (RWL)|Medicare|MEDICARE PART A|2.25||||||| 87158|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||129.20||| 87158|EAP|0301|MALDI-TOFF FUNGAL ID|Blue Cross PPO|BLUE CROSS PPO|||||129.20||| 87158|EAP|0301|MALDI-TOFF FUNGAL ID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||129.20||| 87158|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|2.25||||2.25||| 87158|EAP|0301|MALDI-TOFF FUNGAL ID|Medicare|MEDICARE A & B|||||129.20||| 87158|EAP|0301|MALDI-TOFF FUNGAL ID|NON CONTRACTED|COMMERCIAL OTHER 2|||||129.20||| 87158|EAP|0309|SEQ DNAP (RWL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 87158|EAP|0301||Medicare|MEDICARE A & B|||||129.20||| 87158|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|129.20||||||| 87158|EAP|0301|MALDI-TOFF FUNGAL ID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||129.20||| 87158|EAP|0309||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.25||||2.25||| 87158|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||129.20||| 87158|EAP|0301|MALDI-TOFF FUNGAL ID|Managed Medicaid|MEDICAID CSHCN|||||129.20||| 87158|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| 87158|EAP|0309|SEQ DNAP (RWL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.38||| 87158|EAP|0309||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.25||| 87176|EAP|0306|TISSUE GRINDING (HOMOGENIZATIO|Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 87176|EAP|0306|TISSUE GRINDING (HOMOGENIZATIO|Medicare|MEDICARE A & B|||||0.55||| 87176|EAP|0306|TISSUE GRINDING (HOMOGENIZATIO|NON CONTRACTED|COMMERCIAL OTHER|||||0.55||| 87176|EAP|0306|TISSUE GRINDING (HOMOGENIZATIO|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.55||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.62||||0.25||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Blue Cross PPO|BLUE CROSS PPO|0.62||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.62||||||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Blue Cross PPO|BLUE CROSS POS|0.62||||0.25||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|NON CONTRACTED|COMMERCIAL OTHER|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|United Healthcare|UMR|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Medicaid|MEDICAID|0.62||||||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.62||||0.25||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Medicare|MEDICARE A & B|0.62||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Blue Cross PPO Select|BCBS UTHCT|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Managed Medicaid|SUPERIOR STAR MCD|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.62||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 87177|EAP|0306|O&P DIRECT CONC & ID (5952)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.62||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Medicare|MEDICARE A & B|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Medicare|MEDICARE A & B|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Medicare|MEDICARE PART A|0.96||||||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Medicare|MEDICARE PART A|0.96||||||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Multiplan|WEB TPA|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|NON CONTRACTED|PPO OTHER|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|NON CONTRACTED|COMMERCIAL OTHER|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Multiplan|WEB TPA|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|NON CONTRACTED|COMMERCIAL OTHER|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|NON CONTRACTED|COMMERCIAL OTHER|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|PHCS|WEB TPA|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Medicare|MEDICARE A & B|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|United Healthcare|UMR|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|United Healthcare|UMR|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|United Healthcare|UMR|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|United Healthcare|UMR|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Medicare|MEDICARE A & B|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|NON CONTRACTED|COMMERCIAL OTHER|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Medicare|MEDICARE A & B|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|PHCS|WEB TPA|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Blue Cross PPO|BLUE CROSS PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Blue Cross PPO|BLUE CROSS PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Blue Cross PPO|BLUE CROSS PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Managed Medicaid|SUPERIOR STAR MCD|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Managed Medicaid|MEDICAID CSHCN|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Cigna|CIGNA OF TN CHATTANOOGA|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Cigna|CIGNA OF TN CHATTANOOGA|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Cigna|CIGNA OPEN ACCESS PLUS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Managed Medicaid|MOLINA MEDICAID|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Managed Medicaid|MEDICAID CSHCN|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Managed Medicaid|OTHER MEDICAID|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Managed Medicaid|MOLINA MEDICAID|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Managed Medicaid|MOLINA MEDICAID|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Blue Cross PPO|BLUE CROSS PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Blue Cross PPO|BLUE CROSS POS|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Blue Cross PPO|BLUE CROSS PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Blue Cross PPO|BLUE CROSS POS|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Cigna|CIGNA OPEN ACCESS PLUS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Cigna|CIGNA OPEN ACCESS PLUS|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.96||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Blue Cross PPO|BLUE CROSS POS|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Medicaid|MEDICAID|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES DISK, HAEMOPHI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Cigna|CIGNA OF TN CHATTANOOGA|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Aetna|AETNA EL PASO CLAIMS OFFICE|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Aetna|AETNA EL PASO CLAIMS OFFICE|0.96||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM NEG/DISK|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Aetna|AETNA EL PASO CLAIMS OFFICE|0.96||||0.96||| 87184|EAP|0306|SUSCEP-PANEL - RES CF|Medicaid|MEDICAID|0.96||||0.96||| 87184|EAP|0306|SUSCEP PANEL - BASIC CF|Medicaid|MEDICAID|0.96||||0.96||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Aetna|AETNA EL PASO CLAIMS OFFICE|0.96||||0.96||| 87184|EAP|0301|SUSCEPTIBILITY DISK DIFF REF|Medicare|MEDICARE A & B|||||71.52||| 87184|EAP|0306|SUSCEPT STUDIES GRAM POS /DISK|Medicare|MEDICARE PART A|0.96||||||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|United Healthcare|UMR|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|PHCS|WEB TPA|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Multiplan|WEB TPA|||||0.49||| 87185|EAP|0301|ANTIMICROBIAL SUSCEPTIBILITY|Medicare|MEDICARE A & B|||||33.66||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Medicare|MEDICARE A & B|0.49||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Blue Cross PPO|BCBS TRANE PPO|||||0.49||| 87185|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|0.49||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Blue Cross PPO|BLUE CROSS PPO|0.49||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Managed Medicaid|MOLINA MEDICAID|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|NON CONTRACTED|COMMERCIAL OTHER|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.49||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Managed Medicaid|OTHER MEDICAID|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Managed Medicaid|SUPERIOR STAR MCD|0.49||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Blue Cross PPO Select|BCBS UTHCT|||||0.37||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Blue Cross PPO|BLUE CROSS POS|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.49||||||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.49||| 87185|EAP|0306|SUSCEPT STUDIES ENZYME DETECTI|Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87186|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.00||| 87186|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.66||| 87186|EAP|0309|AER ORG SUSCEPT (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.93||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|ChampVA|CHAMPVA OF CO DENVER|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Blue Cross PPO Select|BCBS UTHCT|||||1.66||| 87186|EAP|0306||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Cigna|CIGNA OPEN ACCESS PLUS|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Blue Cross PPO|BCBS WALMART|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Cigna|CIGNA OF TN CHATTANOOGA|||||1.66||| 87186|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.66||||1.66||| 87186|EAP|0306||Managed Medicaid|SUPERIOR STAR MCD|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|ChampVA|CHAMPVA OF CO DENVER|||||1.66||| 87186|EAP|0306||ChampVA|CHAMPVA OF CO DENVER|||||1.66||| 87186|EAP|0309|AER ORG SUSCEPT (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.93||||||| 87186|EAP|0306|NT MYCO RADID MIC RWL (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.66||||5.40||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|MEDICAID CSHCN|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|FAMILY PLANNING GRANT|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Managed Medicaid|MOLINA MEDICAID|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|SUPERIOR STAR MCD|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Managed Medicaid|FAMILY PLANNING GRANT|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|OTHER MEDICAID|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.66||||1.66||| 87186|EAP|0306||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.66||| 87186|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO Select|BCBS UTHCT|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO|BLUE CROSS POS|1.66||||1.66||| 87186|EAP|0306||Blue Cross PPO|BCBS WALMART|1.66||||1.66||| 87186|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Blue Cross PPO|BLUE CROSS POS|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Blue Cross PPO|BLUE CROSS PPO|1.66||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.66||| 87186|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.00||||1.66||| 87186|EAP|0309|AER ORG SUSCEPT (ARUP)|Managed Medicaid|OTHER MEDICAID|||||0.93||| 87186|EAP|0306|NT MAC MIC RWL (REF)|Blue Cross PPO|BLUE CROSS PPO|1.66||||3.00||| 87186|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.66||||3.00||| 87186|EAP|0306||Blue Cross PPO|BCBS TRANE PPO|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO|BLUE CROSS PPO|1.66||||1.66||| 87186|EAP|0306||Blue Cross PPO|BLUE CROSS POS|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO|BCBS WALMART|1.66||||1.66||| 87186|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.66||||95.50||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.66||||1.66||| 87186|EAP|0309|AER ORG SUSCEPT (ARUP)|Blue Cross PPO|BLUE CROSS PPO|0.93||||||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Cigna|NALC HLTH BENEFIT|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.66||||1.66||| 87186|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Aetna|AETNA US HEALTHCARE PA|||||1.66||| 87186|EAP|0309|AER ORG SUSCEPT (ARUP)|Medicare|MEDICARE A & B|0.93||||0.93||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Medicaid|MEDICAID|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Aetna|AETNA EL PASO CLAIMS OFFICE|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Aetna|TRS COORDINATED CARE|||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Blue Cross PPO|BLUE CROSS PPO|1.66||||95.50||| 87186|EAP|0306|NT MAC MIC RWL (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.66||||3.00||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.66||| 87186|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|3.00||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Medicaid|MEDICAID|1.66||||1.66||| 87186|EAP|0309||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicaid|MEDICAID|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Aetna|AETNA EXXON MOBIL|||||1.66||| 87186|EAP|0306||Medicaid|MEDICAID|1.66||||1.66||| 87186|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|3.80||||1.66||| 87186|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.66||| 87186|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.66||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Cigna|NALC HLTH BENEFIT|1.66||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.66||| 87186|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.66||||1.66||| 87186|EAP|0301||Medicare|MEDICARE A & B|||||2.00||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|MOLINA MEDICAID|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.66||||1.66||| 87186|EAP|0306||Medicare|MEDICARE A & B|1.66||||3.00||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Medicare|MEDICARE A & B|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Medicare|MEDICARE RAILROAD|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Managed Medicaid|OTHER MEDICAID|||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Managed Medicaid|MOLINA MEDICAID|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Medicare|MEDICARE PART A|1.66||||||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Medicare|MEDICARE A & B|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|United Healthcare|UMR|||||1.66||| 87186|EAP|0306||Medicare|MEDICARE RAILROAD|||||1.66||| 87186|EAP|0306||Medicare|MEDICARE A & B|3.00||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|NON CONTRACTED|COMMERCIAL OTHER|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Multiplan|TML GRP INS|||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|NON CONTRACTED|PPO OTHER|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Aetna|AETNA US HEALTHCARE PA|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|NON CONTRACTED|PPO OTHER|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|NON CONTRACTED|BOONE CHAPMAN|||||1.66||| 87186|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.66||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|Medicare|MEDICARE PART A|1.66||||||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicare|MEDICARE RAILROAD|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.66||||1.66||| 87186|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.00||||95.50||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Multiplan|WEB TPA|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|NON CONTRACTED|COMMERCIAL OTHER|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.66||||1.66||| 87186|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER 2|||||0.25||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|PHCS|WEB TPA|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Tricare|TRICARE WEST UNITED HEALTH|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|PHCS|TML GRP INS|||||0.25||| 87186|EAP|0306||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.66||||1.66||| 87186|EAP|0306|NT MAC MIC RWL (REF)|Medicare|MEDICARE A & B|1.66||||3.00||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|United Healthcare|GOLDEN RULE INSURANCE|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|United Healthcare|UMR|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|NON CONTRACTED|COMMERCIAL OTHER|1.66||||1.66||| 87186|EAP|0306|NT MAC MIC RWL (REF)|Medicare|MEDICARE PART A|3.00||||||| 87186|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|3.00||||0.25||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.66||||1.66||| 87186|EAP|0306|SUSCEP-MIC , PER PLATE|United Healthcare|UMR|||||1.66||| 87186|EAP|0301||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.00||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Aetna|AETNA|||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicare|MEDICARE PART A|1.66||||||| 87186|EAP|0306|NT MAC MIC RWL (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.66||||3.00||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Aetna|AETNA EL PASO CLAIMS OFFICE|1.66||||1.66||| 87186|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|1.66||||1.66||| 87186|EAP|0306||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.24||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GP|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.66||||1.66||| 87186|EAP|0306|SUSCEPT STUDIES, MIC; VITEK GN|Medicare|MEDICARE A & B|1.66||||1.66||| 87188|EAP|0306|SUSCEPTIBILITY AFB; MACROBROTH|Medicare|MEDICARE A & B|0.30||||||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|31,348.46|3721.68|10424.56|3721.68|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE A & B|15,141.39|9421.265|10424.56|3721.68|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|58,086.09|10424.56|10424.56|3721.68|||| 87205|EAP|0306|GRAM STAIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Workers Compensation|WC GALLAGHER BASSETT|||||0.83||| 87205|EAP|0306|GRAM STAIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Multiplan|TML GRP INS|0.83||||||| 87205|EAP|0306|GRAM STAIN|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.83||| 87205|EAP|0306|GRAM STAIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|PHCS|TML GRP INS|0.83||||||| 87205|EAP|0306|GRAM STAIN|PHCS|WEB TPA|||||0.83||| 87205|EAP|0306|GRAM STAIN|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.83||| 87205|EAP|0306|GRAM STAIN|United Healthcare|UMR|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Multiplan|WEB TPA|||||0.83||| 87205|EAP|0306|GRAM STAIN|NON CONTRACTED|BOONE CHAPMAN|||||0.83||| 87205|EAP|0306|GRAM STAIN|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.83||| 87205|EAP|0306|GRAM STAIN|NON CONTRACTED|COMMERCIAL OTHER|||||0.83||| 87205|EAP|0306|GRAM STAIN|Medicare|MEDICARE PART A|0.83||||||| 87205|EAP|0306|GRAM STAIN|Medicare|MEDICARE RAILROAD|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Medicaid|MEDICAID|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.83||| 87205|EAP|0306|GRAM STAIN|Medicare|MEDICARE A & B|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Managed Medicaid|MEDICAID CSHCN|||||0.83||| 87205|EAP|0306|GRAM STAIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.83||| 87205|EAP|0306|GRAM STAIN|NON CONTRACTED|PPO OTHER|||||0.83||| 87205|EAP|0306|GRAM STAIN|Managed Medicaid|SUPERIOR STAR MCD|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Managed Medicaid|OTHER MEDICAID|||||0.83||| 87205|EAP|0306|GRAM STAIN|Managed Medicaid|MOLINA MEDICAID|||||0.83||| 87205|EAP|0306|GRAM STAIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross PPO Select|BCBS UTHCT|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Tricare|TRICARE WEST UNITED HEALTH|||||0.83||| 87205|EAP|0306|GRAM STAIN|Cigna|NALC HLTH BENEFIT|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Cigna|CIGNA OPEN ACCESS PLUS|||||0.83||| 87205|EAP|0306|GRAM STAIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.83||| 87205|EAP|0306|GRAM STAIN|Cigna|CIGNA OF TN CHATTANOOGA|||||0.83||| 87205|EAP|0306|GRAM STAIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross PPO|BLUE CROSS POS|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross PPO|BCBS WALMART|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross PPO|BLUE CROSS PPO|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|ChampVA|CHAMPVA OF CO DENVER|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Aetna|AETNA EL PASO CLAIMS OFFICE|0.83||||0.83||| 87205|EAP|0306|GRAM STAIN|Aetna|AETNA|||||0.83||| 87205|EAP|0306|GRAM STAIN|Blue Cross PPO|BCBS TRANE PPO|||||0.83||| 87206|EAP|0306|FLUOROCHROME STAIN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Blue Cross PPO|BLUE CROSS PPO|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Aetna|AETNA|||||1.38||| 87206|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Aetna|AETNA|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Aetna|AETNA EL PASO CLAIMS OFFICE|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.38||||1.38||| 87206|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BLUE CROSS PPO|1.38||||1.38||| 87206|EAP|0306|ZIEHL - NEELSEN (STAIN ONLY)|Blue Cross PPO|BLUE CROSS PPO|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BLUE CROSS POS|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.38||| 87206|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|1.38||||1.38||| 87206|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Aetna|AETNA EL PASO CLAIMS OFFICE|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Cigna|NALC HLTH BENEFIT|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Cigna|CIGNA OPEN ACCESS PLUS|||||1.38||| 87206|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.38||| 87206|EAP|0306|NOCARDIA STAIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Medicaid|MEDICAID|1.38||||1.38||| 87206|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Managed Medicaid|OTHER MEDICAID|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Managed Medicaid|MEDICAID CSHCN|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.38||| 87206|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.38||| 87206|EAP|0306||United Healthcare|UMR|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Medicare|MEDICARE PART A|1.38||||||| 87206|EAP|0306||Medicare|MEDICARE A & B|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|United Healthcare|UMR|||||1.38||| 87206|EAP|0306||Medicare|MEDICARE RAILROAD|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Medicare|MEDICARE A & B|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Medicare|MEDICARE PART A|1.38||||||| 87206|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|PHCS|WEB TPA|||||1.38||| 87206|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Medicare|MEDICARE RAILROAD|||||1.38||| 87206|EAP|0306||Cigna|CIGNA OF TN CHATTANOOGA|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Multiplan|WEB TPA|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|NON CONTRACTED|BOONE CHAPMAN|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.38||||1.38||| 87206|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|NON CONTRACTED|BOONE CHAPMAN|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Blue Cross PPO|BLUE CROSS POS|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Blue Cross PPO|BCBS TRANE PPO|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|NON CONTRACTED|COMMERCIAL OTHER|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|NON CONTRACTED|COMMERCIAL OTHER|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Managed Medicaid|MOLINA MEDICAID|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Managed Medicaid|MOLINA MEDICAID|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|NON CONTRACTED|PPO OTHER|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.38||||1.38||| 87206|EAP|0306|NOCARDIA STAIN|Medicare|MEDICARE A & B|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Tricare|TRICARE WEST UNITED HEALTH|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Blue Cross PPO Select|BCBS UTHCT|||||1.38||| 87206|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.38||||1.38||| 87206|EAP|0306|ZIEHL - NEELSEN (STAIN ONLY)|Aetna|AETNA EL PASO CLAIMS OFFICE|1.38||||1.38||| 87206|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.38||||1.38||| 87206|EAP|0306||Managed Medicaid|MEDICAID CSHCN|||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Medicaid|MEDICAID|1.38||||1.38||| 87206|EAP|0306|KINYOUN STAIN|Managed Medicaid|OTHER MEDICAID|||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|Medicare|MEDICARE A & B|1.38||||1.38||| 87206|EAP|0306|FLUOROCHROME STAIN|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.38||| 87206|EAP|0306|ZIEHL - NEELSEN (STAIN ONLY)|Medicare|MEDICARE A & B|1.38||||1.38||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.27||||0.51||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.27||||||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Medicaid|MEDICAID|1.27||||||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Medicare|MEDICARE A & B|1.27||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|United Healthcare|UMR|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Managed Medicaid|SUPERIOR STAR MCD|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Blue Cross PPO|BLUE CROSS POS|1.27||||0.51||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|NON CONTRACTED|COMMERCIAL OTHER|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.27||||0.51||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Blue Cross PPO|BLUE CROSS PPO|1.27||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Blue Cross PPO|BCBS TRANE PPO|||||0.51||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Blue Cross PPO Select|BCBS UTHCT|||||1.27||| 87209|EAP|0306|O&P SMEAR SPEC STAIN (5952)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.27||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Aetna|TRS COORDINATED CARE|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.25||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.63||| 87210|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|ChampVA|CHAMPVA OF CO DENVER|||||0.25||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.63||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Aetna|AETNA|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Blue Cross PPO|BLUE CROSS PPO|||||0.63||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Blue Cross PPO|BCBS WALMART|||||0.63||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO|BCBS WALMART|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO|BLUE CROSS POS|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.86||| 87210|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Cigna|CIGNA OF TN CHATTANOOGA|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|ChampVA|CHAMPVA OF CO DENVER|||||0.86||| 87210|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Blue Cross PPO Select|BCBS UTHCT|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Blue Cross PPO Select|BCBS UTHCT|||||0.63||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Cigna|CIGNA OF TN CHATTANOOGA|||||0.86||| 87210|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Managed Medicaid|MOLINA MEDICAID|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Managed Medicaid|FAMILY PLANNING GRANT|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Managed Medicaid|SUPERIOR STAR MCD|0.86||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Multiplan|WEB TPA|||||0.63||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.63||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Multiplan|TML GRP INS|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Blue Cross PPO|BLUE CROSS POS|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Medicaid|MEDICAID|||||0.86||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Medicare|MEDICARE A & B|0.86||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||55.50||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Medicare|MEDICARE A & B|0.86||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|Medicaid|MEDICAID|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Medicaid|MEDICAID|||||0.63||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|Medicare|MEDICARE A & B|0.86||||0.63||| 87210|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|NON CONTRACTED|COMMERCIAL OTHER|0.86||||55.50||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|NON CONTRACTED|BOONE CHAPMAN|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|NON CONTRACTED|COMMERCIAL OTHER|0.86||||55.50||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.86||| 87210|EAP|0311||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.57||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.63||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.86||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|PHCS|TML GRP INS|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|PHCS|WEB TPA|||||0.63||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.25||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|United Healthcare|UMR|||||55.50||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|United Healthcare|UMR|||||0.86||| 87210|EAP|0510||NON CONTRACTED|BOONE CHAPMAN|||||2.50||| 87210|EAP|0306|KOH\WET MOUNT FOR INF AGENT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.25||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.86||| 87210|EAP|0306|SMEAR - INFECTIOUS WET MOUNT|United Healthcare|UMR|||||0.63||| 87210|EAP|0306|WET PREP; SALINE WET MOUNT|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.25||| 87220|EAP|0306|KOH EXAM OF SKIN, HAIR, OR NAI|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.12||| 87220|EAP|0306|KOH EXAM OF SKIN, HAIR, OR NAI|Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 87230|EAP|0309|C. DIFF CYTOTOXIN CELL (ARUP)|Medicare|MEDICARE A & B|||||1.36||| 87230|EAP|0309|C. DIFF CYTOTOXIN CELL (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.63||| 87252|EAP|0306|VIRAL CULTURE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.54||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.95||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.95||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.95||| 87252|EAP|0306|VIRAL CULTURE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.54||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.95||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.95||| 87252|EAP|0306|VIRAL CULTURE (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.54||| 87252|EAP|0306|VIRAL CULTURE (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.54||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.95||| 87252|EAP|0306|HERPES CULTURE (HSV) (REF)|Medicaid|MEDICAID|||||2.95||| 87252|EAP|0306|VIRAL CULTURE (REF)|Medicare|MEDICARE A & B|3.54||||||| 87252|EAP|0306|VIRAL CULTURE (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.54||| 87252|EAP|0309|VIRUS ISOLAT TISS CULT (6588)|Medicaid|MEDICAID|||||0.90||| 87252|EAP|0306|VIRAL CULTURE (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.54||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.76||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|Medicaid|MEDICAID|||||0.76||| 87253|EAP|0309|VIRUS ID CHARGE ONLY (ARUP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.85||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.76||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|Blue Cross PPO|BLUE CROSS PPO|||||0.76||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|Managed Medicaid|FAMILY PLANNING GRANT|||||0.76||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.76||| 87253|EAP|0306|VIRUS ISLTN; ADDITION STUDIES|Blue Cross PPO Select|BCBS UTHCT|||||0.76||| 87254|EAP|0309|VIRUS ISOLATION ID EA (6588)|Medicaid|MEDICAID|||||0.85||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|Medicare|MEDICARE A & B|0.20||||0.20||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|Medicaid|MEDICAID|||||0.20||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|NON CONTRACTED|COMMERCIAL OTHER|0.20||||||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|Blue Cross PPO|BLUE CROSS PPO|0.20||||||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.20||||0.20||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|Blue Cross PPO Select|BCBS UTHCT|||||0.20||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.20||||||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.20||||||| 87260|EAP|0306|ADENOVIRUS ANTIGEN (REF)|United Healthcare|UMR|0.20||||||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|Medicaid|MEDICAID|||||2.23||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|Medicare|MEDICARE A & B|2.23||||2.23||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|Blue Cross PPO|BLUE CROSS PPO|2.23||||||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.23||||2.23||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.23||||||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|NON CONTRACTED|COMMERCIAL OTHER|2.23||||||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|United Healthcare|UMR|2.23||||||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.23||||||| 87275|EAP|0306|INFLUENZA B VIRUS, FA (REF)|Blue Cross PPO Select|BCBS UTHCT|||||2.23||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|Blue Cross PPO Select|BCBS UTHCT|||||0.20||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.20||||0.20||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|Aetna|AETNA EL PASO CLAIMS OFFICE|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|Aetna|AETNA EL PASO CLAIMS OFFICE|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|United Healthcare|UMR|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|Blue Cross PPO|BLUE CROSS PPO|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|Blue Cross PPO Select|BCBS UTHCT|||||0.20||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.20||||||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|United Healthcare|UMR|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|NON CONTRACTED|COMMERCIAL OTHER|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.20||||0.20||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|NON CONTRACTED|COMMERCIAL OTHER|0.20||||||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|Medicaid|MEDICAID|||||0.20||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|Medicare|MEDICARE A & B|0.20||||0.20||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|Medicaid|MEDICAID|||||0.20||| 87279|EAP|0306|PARAINFLUENZA VIRUS,EACH TYPE|Blue Cross PPO|BLUE CROSS PPO|0.20||||||| 87279|EAP|0301|PARAINFLUENZA VIRUS ADL|Medicare|MEDICARE A & B|0.20||||0.20||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|NON CONTRACTED|COMMERCIAL OTHER|0.20||||||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|Medicare|MEDICARE A & B|0.20||||0.20||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|Aetna|AETNA EL PASO CLAIMS OFFICE|0.20||||||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|Blue Cross PPO|BLUE CROSS PPO|0.20||||||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|United Healthcare|UMR|0.20||||||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|Medicaid|MEDICAID|||||0.20||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|Blue Cross PPO Select|BCBS UTHCT|||||0.20||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.20||||||| 87280|EAP|0306|RESPIRATORY SYNCYTIAL VIRUS-RF|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.20||||0.20||| 87281|EAP|0306|PNEUMOCYSTIS CARINII DFA (REF)|Medicare|MEDICARE A & B|3.03||||||| 87281|EAP|0306|PNEUMOCYSTIS CARINII DFA (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.03||||||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|Blue Cross PPO|BLUE CROSS PPO|0.79||||||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|Aetna|AETNA EL PASO CLAIMS OFFICE|0.79||||||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|NON CONTRACTED|COMMERCIAL OTHER|0.79||||||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|Medicaid|MEDICAID|||||0.79||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.79||||0.79||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|Medicare|MEDICARE A & B|0.79||||0.79||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.79||||||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|United Healthcare|UMR|0.79||||||| 87299|EAP|0306|INFLUENZA A VIRUS, ANTIGEN-REF|Blue Cross PPO Select|BCBS UTHCT|||||0.79||| 87305|EAP|0306|ASPERGILLIS GALACTOMANNAN EIA|Medicare|MEDICARE A & B|||||1.08||| 87305|EAP|0306|ASPERGILLIS GALACTOMANNAN EIA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.08||| 87305|EAP|0306|ASPERGILLIS GALACTOMANNAN EIA|Cigna|CIGNA OF TN CHATTANOOGA|||||1.08||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Managed Medicaid|FAMILY PLANNING GRANT|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.20||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Blue Cross PPO Select|BCBS UTHCT|||||2.20||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Cigna|CIGNA OF TN CHATTANOOGA|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.20||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Blue Cross PPO|BLUE CROSS POS|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Blue Cross PPO|BCBS TRANE PPO|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.03||| 87338|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.20||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|United Healthcare|UMR|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.20||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Medicare|MEDICARE RAILROAD|||||1.03||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|NON CONTRACTED|COMMERCIAL OTHER|||||161.50||| 87338|EAP|0306|HELICOBACTER PYLORI AG, STOOL|Medicare|MEDICARE A & B|2.20||||2.20||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.49||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.49||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.49||||0.49||| 87340|EAP|0302||United Healthcare|UMR|||||0.48||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|NON CONTRACTED|COMMERCIAL OTHER|||||0.49||| 87340|EAP|0302||Medicare|MEDICARE A & B|0.49||||0.48||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Medicare|MEDICARE A & B|0.49||||0.49||| 87340|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER|||||0.48||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.49||| 87340|EAP|0302||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.48||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|United Healthcare|UMR|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Aetna|AETNA|||||0.49||| 87340|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.49||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.49||| 87340|EAP|0302||Blue Cross PPO|BLUE CROSS PPO|||||48.50||| 87340|EAP|0302||Blue Cross PPO|BLUE CROSS POS|||||0.48||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Blue Cross PPO|BLUE CROSS PPO|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Blue Cross PPO|BLUE CROSS POS|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Blue Cross PPO|BCBS TRANE PPO|0.49||||||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Blue Cross PPO Select|BCBS UTHCT|0.49||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Cigna|CIGNA OTHER|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Medicaid|MEDICAID|||||0.49||| 87340|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.48||| 87340|EAP|0302||Humana Medicare Advantage|HUMANA MEDICARE PPO|0.49||||0.49||| 87340|EAP|0306|OH HEPATITIS B SURFACE ANTIGEN|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.45||||||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.49||| 87340|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.49||| 87340|EAP|0302|HEP B SURF ANTIGEN(811)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.49||| 87341|EAP|0306|HEPATITIS B SURFACE AG CONFIRM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.55||| 87341|EAP|0306|HEPATITIS B SURFACE AG CONFIRM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.55||| 87341|EAP|0306|HEPATITIS B SURFACE AG CONFIRM|Managed Medicaid|SUPERIOR STAR MCD|0.55||||||| 87341|EAP|0306|HEPATITIS B SURFACE AG CONFIRM|Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 87341|EAP|0306|HEPATITIS B SURFACE AG CONFIRM|Medicare|MEDICARE A & B|0.55||||0.55||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.15||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.15||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|NON CONTRACTED|COMMERCIAL OTHER|2.15||||||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.15||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|Medicare|MEDICARE A & B|||||2.15||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.15||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|Blue Cross PPO|BLUE CROSS PPO|||||2.15||| 87350|EAP|0306|HEPATITIS BE ANTIGEN (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.15||| 87385|EAP|0306|HISTOPLASMA ANTIGEN, SERUM ARU|Medicare|MEDICARE A & B|2.20||||1.35||| 87385|EAP|0306|HISTOPLASMA ANTIGEN, SERUM ARU|Medicare|MEDICARE A & B|1.35||||1.35||| 87385|EAP|0306|HISTOPLAS GALACT AG QNT (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.20||| 87385|EAP|0306|HISTOPLASMA ANTIGEN, SERUM ARU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.35||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|United Healthcare|UMR|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|NON CONTRACTED|BOONE CHAPMAN|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Medicaid|MEDICAID|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Medicare|MEDICARE PART A|0.99||||||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Cigna|CIGNA OTHER|||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Managed Medicaid|SUPERIOR STAR MCD|0.99||||82.50||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO|BCBS WALMART|||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Aetna|AETNA EL PASO CLAIMS OFFICE|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.99||||0.99||| 87389|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Aetna|AETNA|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO|BLUE CROSS PPO|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO|BLUE CROSS POS|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO|BLUE CROSS SECONDARY|||||0.99||| 87389|EAP|0302||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO|BCBS TRANE PPO|0.99||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Managed Medicaid|MOLINA MEDICAID|||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Managed Medicaid|FAMILY PLANNING GRANT|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|ChampVA|CHAMPVA OF CO DENVER|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Aetna|TRS COORDINATED CARE|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Cigna|CIGNA OF TN CHATTANOOGA|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Cigna|CIGNA OPEN ACCESS PLUS|||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Cigna|CIGNA OF TN CHATTANOOGA|||||82.50||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Blue Cross PPO Select|BCBS UTHCT|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Cigna|CIGNA BEHAVIORAL HEALTH|0.99||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Medicare|MEDICARE A & B|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Medicare|MEDICARE PART B|||||0.99||| 87389|EAP|0302||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|NON CONTRACTED|COMMERCIAL OTHER|0.99||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|NON CONTRACTED|PPO OTHER|||||0.66||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Multiplan|TML GRP INS|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.99||||82.50||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|United Healthcare|GOLDEN RULE INSURANCE|||||82.50||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|Aetna|AETNA EXXON MOBIL|||||0.99||| 87389|EAP|0302|HIV AG/AB 1,2 COMBO|PHCS|TML GRP INS|||||0.99||| 87420|EAP|0306|RSV ANTIGEN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.19||| 87420|EAP|0306|RSV ANTIGEN|Blue Cross PPO|BLUE CROSS PPO|||||2.19||| 87420|EAP|0306|RSV ANTIGEN|Blue Cross PPO|BCBS TRANE PPO|2.19||||||| 87420|EAP|0306|RSV ANTIGEN|Managed Medicaid|SUPERIOR STAR MCD|||||2.19||| 87420|EAP|0306|RSV ANTIGEN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.19||| 87420|EAP|0306|RSV ANTIGEN|Medicaid|MEDICAID|||||2.19||| 87420|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 87420|EAP|0306|RSV ANTIGEN|Medicare|MEDICARE A & B|2.19||||||| 87420|EAP|0306|RSV ANTIGEN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.19||| 87420|EAP|0306|RSV ANTIGEN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.19||||||| 87425|EAP|0306|ROTAVIRUS ANTIGEN DETECTION (Q|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.25||| 87425|EAP|0306|ROTAVIRUS ANTIGEN DETECTION (Q|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.34||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.73||||||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|United Healthcare|UMR|0.73||||||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|NON CONTRACTED|COMMERCIAL OTHER|0.73||||||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Medicare|MEDICARE A & B|1.38||||0.73||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Medicare|MEDICARE PART A|0.73||||||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Medicare|MEDICARE A & B|0.73||||0.73||| 87449|EAP|0306|FUNGITELL IA BY EIA MULTI STP|Blue Cross PPO|BLUE CROSS POS|||||1.38||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.73||||||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.73||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||0.73||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Blue Cross PPO Select|BCBS UTHCT|0.73||||0.73||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Blue Cross PPO|BLUE CROSS PPO|0.73||||||| 87449|EAP|0306|LEGIONELLA AG, URINE (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|0.73||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Blue Cross PPO Select|BCBS UTHCT|1.04||||1.04||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.04||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Cigna|CIGNA OPEN ACCESS PLUS|||||1.04||| 87450|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.04||||||| 87450|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Aetna|AETNA EL PASO CLAIMS OFFICE|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Blue Cross PPO|BLUE CROSS PPO|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Blue Cross PPO|BLUE CROSS POS|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Medicare|MEDICARE A & B|1.04||||||| 87450|EAP|0306||Medicare|MEDICARE A & B|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|NON CONTRACTED|COMMERCIAL OTHER|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|United Healthcare|UMR|1.04||||||| 87450|EAP|0306|PNEUMOCOC AG - SS METHOD|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.04||||||| 87476|EAP|0302|B. BURGDORFERI BY PCR (LYME DI|Blue Cross PPO|BLUE CROSS PPO|||||1.23||| 87483|EAP|0306|MENINGITIS ENCEPHALITIS PAN BY|Medicare|MEDICARE A & B|5.85||||||| 87483|EAP|0306|MENINGITIS ENCEPHALITIS PAN BY|Blue Cross PPO|BLUE CROSS PPO|||||5.85||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.97||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.39||| 87491|EAP|0306||Managed Medicaid|SUPERIOR STAR MCD|2.39||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO Select|BCBS UTHCT|||||2.39||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 87491|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Cigna|CIGNA OTHER|||||0.00||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.68||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.39||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|ChampVA|CHAMPVA OF CO DENVER|||||2.39||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 87491|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.39||| 87491|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.16||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Aetna|AETNA EXXON MOBIL|||||0.00||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 87491|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Aetna|TRS COORDINATED CARE|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Aetna|AETNA|||||2.39||| 87491|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 87491|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 87491|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO|BLUE CROSS POS|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO|BCBS WALMART|||||2.39||| 87491|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.39||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.39||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO|BCBS TRANE PPO|||||1.68||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|2.39||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|2.39||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Blue Cross PPO|BLUE CROSS SECONDARY|||||2.39||| 87491|EAP|0311||Blue Cross PPO|BLUE CROSS POS|||||0.60||| 87491|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||2.39||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.39||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.39||| 87491|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.63||| 87491|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.05||| 87491|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.30||| 87491|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.39||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.39||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|PHCS|WEB TPA|||||0.97||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|PHCS|TML GRP INS|||||0.97||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Tricare|TRICARE WEST UNITED HEALTH|||||0.97||| 87491|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.12||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|United Healthcare|UMR|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Cigna|CIGNA OTHER|||||1.68||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|United Healthcare|GOLDEN RULE INSURANCE|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|United Healthcare|UMR|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|United Healthcare|GOLDEN RULE INSURANCE|||||0.97||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.68||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Cigna|CIGNA BEHAVIORAL HEALTH|2.39||||0.97||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|NON CONTRACTED|PPO OTHER|||||0.97||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER|2.39||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER|2.39||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Managed Medicaid|FAMILY PLANNING GRANT|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Managed Medicaid|SUPERIOR STAR MCD|2.39||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Medicaid|MEDICAID|||||2.39||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Medicaid|MEDICAID|||||0.00||| 87491|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Managed Medicaid|MOLINA MEDICAID|||||2.39||| 87491|EAP|0311||Medicare|MEDICARE A & B|||||0.57||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 87491|EAP|0306|NO CHG CHLAMYDIA AMP PROBE|Medicare|MEDICARE A & B|||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Medicare|MEDICARE A & B|||||2.39||| 87491|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|2.39||||0.00||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|NON CONTRACTED|BOONE CHAPMAN|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.39||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Multiplan|WEB TPA|||||0.97||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Multiplan|TML GRP INS|||||0.97||| 87491|EAP|0306|CHLAMYDIA AMP PROBE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.39||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.87||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Medicaid|MEDICAID|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.87||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Medicaid|MEDICAID|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Medicare|MEDICARE A & B|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Medicare|MEDICARE RAILROAD|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Medicare|MEDICARE RAILROAD|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Medicare|MEDICARE PART A|1.30||||||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|NON CONTRACTED|COMMERCIAL OTHER|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|NON CONTRACTED|COMMERCIAL OTHER|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.30||||||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.30||||||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Blue Cross PPO|BLUE CROSS PPO|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Blue Cross PPO|BLUE CROSS PPO|1.30||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.87||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Blue Cross PPO|BLUE CROSS POS|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Blue Cross PPO|BCBS TRANE PPO|||||1.30||| 87493|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Blue Cross PPO|BLUE CROSS POS|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.87||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|United Healthcare|UMR|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Blue Cross PPO|BCBS TRANE PPO|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|United Healthcare|UMR|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Blue Cross PPO Select|BCBS UTHCT|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Blue Cross PPO Select|BCBS UTHCT|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Medicare|MEDICARE A & B|1.30||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.87||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.87||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Medicare|MEDICARE PART A|1.30||||||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.30||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.30||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|ChampVA|CHAMPVA OF CO DENVER|||||0.87||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|ChampVA|CHAMPVA OF CO DENVER|||||0.87||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.30||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.30||||1.30||| 87493|EAP|0306|INF AGT DET C. DIFF ADDL (855)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.30||| 87493|EAP|0306|INF AGENT DETECT C. DIFF (855)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.30||| 87496|EAP|0306|CMV BY PCR (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.21||| 87496|EAP|0306|CMV BY PCR (REF)|Medicare|MEDICARE A & B|1.21||||||| 87497|EAP|0306|CYTOMEGALOVIRUS QUAN PCR ARUP|Blue Cross PPO|BLUE CROSS PPO|||||4.76||| 87497|EAP|0306|CYTOMEGALOVIRUS QUAN PCR ARUP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.76||| 87498|EAP|0306|ENTEROVIRUS,AMPL PROBE (REF)|Medicare|MEDICARE A & B|2.74||||||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|SUPERIOR STAR MCD|||||3.15||| 87502|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 87502|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||3.15||| 87502|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.99||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Cigna|NALC HLTH BENEFIT|||||2.10||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Cigna|CIGNA OPEN ACCESS PLUS|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross PPO Select|BCBS UTHCT|3.15||||3.15||| 87502|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.10||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.10||| 87502|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|ChampVA|CHAMPVA OF CO DENVER|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Cigna|NALC HLTH BENEFIT|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|OTHER MEDICAID|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Cigna|CIGNA OPEN ACCESS PLUS|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|ChampVA|CHAMPVA OF CO DENVER|||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Cigna|CIGNA OF TN CHATTANOOGA|||||2.10||| 87502|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 87502|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.82||| 87502|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 87502|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.25||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Aetna|AETNA EL PASO CLAIMS OFFICE|3.15||||3.15||| 87502|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.09||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Aetna|AETNA EXXON MOBIL|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Aetna|AETNA|||||3.15||| 87502|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| 87502|EAP|0949||Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 87502|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 87502|EAP|0300|POC FLU TEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.10||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.10||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Blue Cross PPO|BLUE CROSS PPO|2.10||||2.10||| 87502|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Blue Cross PPO|BLUE CROSS POS|||||2.10||| 87502|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.30||| 87502|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 87502|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 87502|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 87502|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 87502|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross PPO|BLUE CROSS PPO|3.15||||3.15||| 87502|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 87502|EAP|0300|POC FLU TEST|Blue Cross PPO|BLUE CROSS PPO|2.10||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross PPO|BLUE CROSS POS|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross PPO|BCBS TRANE PPO|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross PPO|BCBS WALMART|||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Blue Cross PPO|BCBS WALMART|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.15||| 87502|EAP|0301||Blue Cross PPO|BCBS TRANE PPO|||||1.30||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Blue Cross PPO Select|BCBS UTHCT|||||2.10||| 87502|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.30||| 87502|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 87502|EAP|0949||Blue Cross PPO|BCBS TRANE PPO|||||213.82||| 87502|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 87502|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 87502|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 87502|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 87502|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 87502|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 87502|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.30||| 87502|EAP|0510||United Healthcare|GOLDEN RULE INSURANCE|||||2.50||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||3.15||| 87502|EAP|0510||PHCS|PHCS OF AZ PHEONIX|||||2.50||| 87502|EAP|0981||United Healthcare|UMR|||||0.00||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|PHCS|WEB TPA OF GRAND PRAIRIE|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|PHCS|WEB TPA|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|PHCS|PHCS OF AZ PHEONIX|||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.10||| 87502|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|United Healthcare|GOLDEN RULE INSURANCE|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|MOLINA MEDICAID|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Cigna|CIGNA OF TN CHATTANOOGA|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.15||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|United Healthcare|UMR|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Managed Medicaid|MEDICAID CSHCN|||||3.15||| 87502|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 87502|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 87502|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.10||| 87502|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 87502|EAP|0306||Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| 87502|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Multiplan|PHCS OF AZ PHEONIX|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Multiplan|WEB TPA|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Multiplan|WEB TPA OF GRAND PRAIRIE|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|United Healthcare|UMR|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Multiplan|GILSBAR INC|||||3.15||| 87502|EAP|0510||Multiplan|PHCS OF AZ PHEONIX|||||2.50||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|NON CONTRACTED|COMMERCIAL OTHER|||||2.10||| 87502|EAP|0300|POC FLU TEST|NON CONTRACTED|COMMERCIAL OTHER|||||2.10||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|NON CONTRACTED|COMMERCIAL OTHER|3.15||||3.15||| 87502|EAP|0949||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 87502|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 87502|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Medicaid|MEDICAID|3.15||||3.15||| 87502|EAP|0300|POC FLU TEST|Medicare|MEDICARE A & B|2.10||||2.10||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Medicare|MEDICARE RAILROAD|||||2.10||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Medicare|MEDICARE A & B|2.10||||2.10||| 87502|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 87502|EAP|0981||Managed Medicaid|OTHER MEDICAID|||||0.00||| 87502|EAP|0300|INFLUENZA VIRUS MULT TYPES|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.10||| 87502|EAP|0981||Medicaid|MEDICAID|||||0.00||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Medicare|MEDICARE A & B|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Medicare|MEDICARE PART A|3.15||||3.15||| 87502|EAP|0306|CEPHEID XPERT XPRESS FLU|Medicare|MEDICARE RAILROAD|3.15||||3.15||| 87502|EAP|0306||Medicare|MEDICARE A & B|3.15||||3.15||| 87502|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 87502|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 87517|EAP|0306|HEPATITIS B DNA BY PCR, QUANT|Medicare|MEDICARE A & B|||||3.21||| 87517|EAP|0306|HEPATITIS B DNA BY PCR, QUANT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.21||| 87517|EAP|0306|HEPATITIS B DNA BY PCR, QUANT|Blue Cross PPO|BLUE CROSS PPO|||||3.21||| 87517|EAP|0306|HEPATITIS B DNA BY PCR, QUANT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.21||| 87517|EAP|0306|HEPATITIS B DNA BY PCR, QUANT|Managed Medicaid|SUPERIOR STAR MCD|3.21||||||| 87517|EAP|0306|HEPATITIS B DNA BY PCR, QUANT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.21||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Cigna|CIGNA OPEN ACCESS PLUS|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.86||| 87522|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.86||||251.50||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.17||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Managed Medicaid|SUPERIOR STAR MCD|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Blue Cross PPO|BCBS WALMART|||||1.17||| 87522|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|United Healthcare|UMR|||||251.50||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Medicaid|MEDICAID|||||3.86||| 87522|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.86||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.86||| 87522|EAP|0306||Medicare|MEDICARE A & B|3.86||||3.86||| 87522|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.86||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Medicare|MEDICARE A & B|3.86||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Medicare|MEDICARE RAILROAD|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Medicare|MEDICARE PART B|||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.86||||3.86||| 87522|EAP|0306|HEP C RNA, QNT NAAT (REF)|Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 87522|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||251.50||| 87522|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.86||| 87522|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 87529|EAP|0306|HERPES SIMPLEX VIRUS BY PCR|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||251.35||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|NON CONTRACTED|COMMERCIAL OTHER|||||1.58||| 87529|EAP|0306|HERPES SIMPLEX VIRUS BY PCR|Blue Cross PPO|BLUE CROSS PPO|||||3.19||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|Blue Cross PPO|BLUE CROSS PPO|||||1.58||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.58||| 87529|EAP|0306|HERPES SIMPLEX VIRUS BY PCR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.19||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|United Healthcare|GOLDEN RULE INSURANCE|||||1.58||| 87529|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.19||| 87529|EAP|0306|HERPES SIMPLEX VIRUS BY PCR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.19||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.58||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|Medicaid|MEDICAID|||||1.58||| 87529|EAP|0306|HERPES SIMPLX AMP PROBE (6491)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.58||| 87535|EAP|0306|HIV-1 DNA BY PCR, QUALITATIVE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.68||| 87535|EAP|0306|HIV-1 DNA BY PCR, QUALITATIVE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.68||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Cigna|CIGNA OF TN CHATTANOOGA|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Blue Cross PPO|BLUE CROSS PPO|||||5.43||| 87536|EAP|0306||Blue Cross PPO|BCBS WALMART|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|Medicare|MEDICARE A & B|5.43||||5.43||| 87536|EAP|0306||Medicare|MEDICARE A & B|5.43||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||5.43||| 87536|EAP|0306|HIV VIR LOAD + REFLEX GEN2 (RE|United Healthcare|GOLDEN RULE INSURANCE|||||5.43||| 87556|EAP|0300|CEPHEID XPERT MTB/RIF|Medicare|MEDICARE A & B|||||7.30||| 87556|EAP|0306|MYCOBACTERIUM TB AMP PR (6487)|Medicare|MEDICARE A & B|2.08||||||| 87556|EAP|0300|CEPHEID XPERT MTB/RIF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.30||| 87581|EAP|0306|MYCOPLASMA PNEUMONIAE BY PCR (|Blue Cross PPO|BLUE CROSS PPO|||||1.12||| 87581|EAP|0306|MYCOPLASMA PNEUMONIAE BY PCR (|Medicare|MEDICARE A & B|1.12||||||| 87591|EAP|0306|GONORRHEA AMP PROBE|Medicaid|MEDICAID|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER|2.39||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|United Healthcare|UMR|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|PHCS|TML GRP INS|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|PHCS|WEB TPA|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|Tricare|TRICARE WEST UNITED HEALTH|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.68||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|United Healthcare|GOLDEN RULE INSURANCE|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|United Healthcare|UMR|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|United Healthcare|GOLDEN RULE INSURANCE|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|NON CONTRACTED|BOONE CHAPMAN|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Multiplan|TML GRP INS|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|Multiplan|WEB TPA|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER|2.39||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|NON CONTRACTED|PPO OTHER|||||0.97||| 87591|EAP|0306|GONORRHEA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Medicaid|MEDICAID|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.39||| 87591|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Medicare|MEDICARE A & B|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Medicare|MEDICARE A & B|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Managed Medicaid|MOLINA MEDICAID|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.97||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Managed Medicaid|FAMILY PLANNING GRANT|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Managed Medicaid|SUPERIOR STAR MCD|2.39||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO Select|BCBS UTHCT|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Cigna|CIGNA OTHER|||||0.00||| 87591|EAP|0306||NON CONTRACTED|COMMERCIAL OTHER|2.39||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Cigna|CIGNA OTHER|||||1.68||| 87591|EAP|0306|GONORRHEA AMP PROBE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.68||| 87591|EAP|0306|GONORRHEA AMP PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Cigna|CIGNA BEHAVIORAL HEALTH|2.39||||0.97||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.39||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.39||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|ChampVA|CHAMPVA OF CO DENVER|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Aetna|AETNA EXXON MOBIL|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Aetna|AETNA|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Aetna|TRS COORDINATED CARE|||||2.39||| 87591|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO|BCBS WALMART|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO|BLUE CROSS POS|||||2.39||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 87591|EAP|0306|NO CHARGE GONORRHEA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|2.39||||0.00||| 87591|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.39||||0.00||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.39||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO|BCBS TRANE PPO|||||1.68||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO|BLUE CROSS SECONDARY|||||2.39||| 87591|EAP|0306|GONORRHEA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|2.39||||2.39||| 87624|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 87624|EAP|0306|HPV THINPREP|Blue Cross PPO|BLUE CROSS PPO|||||1.16||| 87624|EAP|0306|HPV THINPREP|Blue Cross PPO|BLUE CROSS POS|||||1.16||| 87624|EAP|0306|HPV THINPREP|Blue Cross PPO|BCBS WALMART|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||1.82||| 87624|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.77||| 87624|EAP|0306|HPV THINPREP|Blue Cross PPO|BCBS TRANE PPO|||||0.77||| 87624|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|||||0.60||| 87624|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 87624|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| 87624|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.82||| 87624|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.77||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.82||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.82||| 87624|EAP|0306||Blue Cross PPO Select|BCBS UTHCT|||||1.82||| 87624|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||227.50||| 87624|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||9.50||| 87624|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.82||| 87624|EAP|0306|HPV THINPREP|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.82||| 87624|EAP|0306|HPV HIGH RISK PCR THIN P(ARUP)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.15||| 87624|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.82||| 87624|EAP|0306||Blue Cross PPO|BLUE CROSS POS|||||1.82||| 87624|EAP|0306|HPV THINPREP|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Medicaid|MEDICAID|||||1.82||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Medicare|MEDICARE A & B|||||1.82||| 87624|EAP|0306|HPV THINPREP|Multiplan|WEB TPA|||||1.16||| 87624|EAP|0770||Medicare|MEDICARE A & B|||||0.94||| 87624|EAP|0306|HPV THINPREP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.16||| 87624|EAP|0306|HPV THINPREP|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.82||| 87624|EAP|0306|HPV THINPREP|PHCS|WEB TPA|||||1.16||| 87624|EAP|0306|HPV THINPREP|PHCS|TML GRP INS|||||1.16||| 87624|EAP|0306||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.82||| 87624|EAP|0306|HPV THINPREP|United Healthcare|UMR|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||1.82||| 87624|EAP|0306|HPV THINPREP|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.77||| 87624|EAP|0306|HPV THINPREP|United Healthcare|GOLDEN RULE INSURANCE|||||1.16||| 87624|EAP|0306|HPV THINPREP|Multiplan|TML GRP INS|||||1.16||| 87624|EAP|0306|HPV THINPREP|Medicare|MEDICARE A & B|||||1.16||| 87624|EAP|0306|HPV THINPREP|NON CONTRACTED|COMMERCIAL OTHER|||||1.16||| 87624|EAP|0306||Medicare|MEDICARE A & B|||||1.16||| 87624|EAP|0306||Medicare|MEDICARE A & B|||||1.82||| 87624|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.77||| 87624|EAP|0306||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.82||| 87624|EAP|0306|HPV THINPREP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.82||| 87624|EAP|0306|HPV HIGH RISK PCR THIN P(ARUP)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.15||| 87624|EAP|0306|HPV THINPREP|Medicaid|MEDICAID|||||1.16||| 87624|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.16||| 87624|EAP|0306|HPV THINPREP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.16||| 87624|EAP|0306|HPV THINPREP|Managed Medicaid|SUPERIOR STAR MCD|||||0.77||| 87624|EAP|0306|HPV THINPREP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.16||| 87624|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||1.82||| 87624|EAP|0306|HPV THINPREP|Managed Medicaid|FAMILY PLANNING GRANT|||||1.16||| 87624|EAP|0306|HPV HIGH RISK PCR THIN P(ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.15||| 87624|EAP|0306|HPV HIGH RISK PCR (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.82||| 87624|EAP|0306|HPV THINPREP|Cigna|CIGNA OF TN CHATTANOOGA|||||1.16||| 87624|EAP|0306|HPV THINPREP|Cigna|CIGNA OPEN ACCESS PLUS|||||96.50||| 87624|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 87624|EAP|0306|HPV THINPREP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.77||| 87624|EAP|0306||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.77||| 87624|EAP|0306|HPV THINPREP|Blue Cross PPO Select|BCBS UTHCT|||||1.16||| 87624|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 87624|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.82||| 87624|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 87624|EAP|0306|HPV THINPREP|Aetna|TRS COORDINATED CARE|||||1.16||| 87624|EAP|0306|HPV THINPREP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.16||| 87624|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.82||| 87624|EAP|0306|HPV THINPREP|Aetna|AETNA EXXON MOBIL|||||1.16||| 87651|EAP|0301|POC STREP TESTING|United Healthcare|UMR|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|55.36||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||55.36||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.30||| 87651|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Multiplan|GILSBAR INC|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|NON CONTRACTED|COMMERCIAL OTHER|||||55.36||| 87651|EAP|0450||Medicare|MEDICARE A & B|||||213.82||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER|||||1.30||| 87651|EAP|0301|POC STREP TESTING|NON CONTRACTED|COMMERCIAL OTHER|||||1.30||| 87651|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 87651|EAP|0949||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Medicare|MEDICARE A & B|55.36||||55.36||| 87651|EAP|0301|POC STREP TESTING|Medicare|MEDICARE A & B|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Medicare|MEDICARE A & B|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Medicaid|MEDICAID|||||55.36||| 87651|EAP|0301|POC STREP TESTING|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Managed Medicaid|MOLINA MEDICAID|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|SUPERIOR STAR MCD|||||55.36||| 87651|EAP|0301|POC STREP TESTING|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|OTHER MEDICAID|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||55.36||| 87651|EAP|0301|POC STREP TESTING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Cigna|CIGNA OF TN CHATTANOOGA|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Humana Medicare Advantage|HUMANA MEDICARE PPO|55.36||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Cigna|CIGNA OPEN ACCESS PLUS|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|55.36||||||| 87651|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 87651|EAP|0301|POC STREP TESTING|Cigna|CIGNA OF TN CHATTANOOGA|||||1.30||| 87651|EAP|0301|POC STREP TESTING|Cigna|CIGNA OPEN ACCESS PLUS|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|MOLINA MEDICAID|||||55.36||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Medicaid|MEDICAID|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||55.36||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Cigna|CIGNA OF TN CHATTANOOGA|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|ChampVA|CHAMPVA OF CO DENVER|||||55.36||| 87651|EAP|0301|POC STREP TESTING|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.30||| 87651|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 87651|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Aetna|AETNA EL PASO CLAIMS OFFICE|||||55.36||| 87651|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.30||| 87651|EAP|0301|POC STREP TESTING|Aetna|AETNA|||||1.30||| 87651|EAP|0301|POC STREP TESTING|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|55.36||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Blue Cross PPO|BCBS WALMART|||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Blue Cross PPO|BCBS TRANE PPO|55.36||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Blue Cross PPO|BLUE CROSS POS|55.36||||55.36||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Blue Cross PPO|BLUE CROSS PPO|55.36||||55.36||| 87651|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.30||| 87651|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 87651|EAP|0949||Blue Cross PPO|BLUE CROSS POS|||||213.82||| 87651|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 87651|EAP|0301|POC STREP TESTING|Blue Cross PPO|BLUE CROSS POS|||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|United Healthcare|UMR|55.36||||55.36||| 87651|EAP|0301|POC STREP TESTING|Blue Cross PPO|BLUE CROSS PPO|1.30||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Blue Cross PPO|BLUE CROSS PPO|1.30||||1.30||| 87651|EAP|0300|CEPHOID XPRESS STREP A|Blue Cross PPO Select|BCBS UTHCT|55.36||||55.36||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Blue Cross PPO|BLUE CROSS POS|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Blue Cross PPO|BCBS TRANE PPO|||||1.30||| 87651|EAP|0301|POC STREP TESTING|Blue Cross PPO Select|BCBS UTHCT|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Blue Cross PPO Select|BCBS UTHCT|||||1.30||| 87651|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 87651|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 87651|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 87651|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.30||| 87651|EAP|0301|POC STREP TESTING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.30||| 87651|EAP|0301|POC STREP A DNA AMP PROBE|Blue Cross PPO|BCBS WALMART|||||1.30||| 87798|EAP|0306|MUMPS VIRUS QUANT RNA PCR (ARU|Blue Cross PPO|BLUE CROSS PPO|||||6.56||| 87798|EAP|0306|HUMAN PARVOVIRUS BY DNA (REF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.35||| 87798|EAP|0306|MUMPS VIRUS QUANT RNA PCR (ARU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.56||| 87798|EAP|0306|INF AGT AMP PROBE EA. (REF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.35||| 87798|EAP|0306|PARA PERTUSSIS ARUP(PART 5090)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.19||| 87798|EAP|0306|BORDETELLA ARUP (PART OF 5090)|Medicare|MEDICARE A & B|2.08||||1.19||| 87798|EAP|0306|INF AGT AMP PROBE EA. (REF)|Medicare|MEDICARE A & B|2.35||||2.35||| 87798|EAP|0306|MUMPS VIRUS QUANT RNA PCR (ARU|Managed Medicaid|SUPERIOR STAR MCD|||||6.56||| 87798|EAP|0306|PARA PERTUSSIS ARUP(PART 5090)|Medicare|MEDICARE A & B|2.35||||1.19||| 87798|EAP|0306|BORDETELLA ARUP (PART OF 5090)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.19||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.73||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.73||||||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Medicare|MEDICARE A & B|2.73||||2.73||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Medicare|MEDICARE PART A|2.73||||||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.73||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.73||||153.50||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.73||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Blue Cross PPO|BLUE CROSS POS|||||2.73||| 87803|EAP|0306|CLOSTRIDIUM DIFFICLE TOXIN(S)|Blue Cross PPO|BLUE CROSS PPO|||||2.73||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.91||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Blue Cross PPO|BLUE CROSS POS|0.91||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.34||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Blue Cross PPO|BLUE CROSS PPO|0.91||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Blue Cross PPO|BCBS TRANE PPO|||||62.50||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.91||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Managed Medicaid|SUPERIOR STAR MCD|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Blue Cross PPO Select|BCBS UTHCT|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Cigna|CIGNA OF TN CHATTANOOGA|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Cigna|CIGNA OF TN CHATTANOOGA|||||0.34||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.91||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|ChampVA|CHAMPVA OF CO DENVER|||||0.34||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|NON CONTRACTED|COMMERCIAL OTHER|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.34||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Medicaid|MEDICAID|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Medicare|MEDICARE A & B|0.91||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Medicare|MEDICARE RAILROAD|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|United Healthcare|UMR|||||0.91||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||62.50||| 87899|EAP|0306|INFECT AGENT OP OBS NOS|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.91||||||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||10.59||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|United Healthcare|UMR|||||10.59||| 87902|EAP|0306|HEPATITIS C GENOTYPING BY PCR|Medicaid|MEDICAID|||||7.07||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Medicare|MEDICARE A & B|7.07||||10.59||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||10.59||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||10.59||| 87902|EAP|0306|HEPATITIS C GENOTYPING BY PCR|Blue Cross PPO|BLUE CROSS PPO|||||712.50||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.59||| 87902|EAP|0306||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.59||| 87902|EAP|0306|HEPATITIS C GENOTYPING BY PCR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.07||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||10.59||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|NON CONTRACTED|COMMERCIAL OTHER|||||10.59||| 87902|EAP|0306|HCV HIGH RES GENOTYPE (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.59||| 880|DRG||ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION|Medicare|MEDICARE A & B|11,988.80|7780.34|7780.34|7780.34|||| 881|DRG||DEPRESSIVE NEUROSES|NON CONTRACTED|COMMERCIAL OTHER 2|2,237.60|2237.6|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7,184.65|5390.535|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Blue Cross PPO|BCBS WALMART|12,930.75|8146.37|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21,825.05|7913.76|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Blue Cross PPO|BLUE CROSS PPO|4,272.55|2691.71|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Managed Medicaid|SUPERIOR STAR MCD|12,628.40|4579.06|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Humana Medicare Advantage|HUMANA MEDICARE PPO|9,484.20|6263.86|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Veterans Affairs|VETERANS CHOICE - TRI WEST|7,536.70|2829.42|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|14,242.65|4780.485|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|NON CONTRACTED|COMMERCIAL OTHER|7,157.05|7157.05|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Medicaid|MEDICAID|25,559.12|9267.74|9267.74|2237.6|||| 881|DRG||DEPRESSIVE NEUROSES|Medicare|MEDICARE A & B|11,495.95|4987.29|9267.74|2237.6|||| 88112|EAP|0311|CYTO, NON-GYN LIQUID BASED|Blue Cross PPO Select|BCBS UTHCT|||||2.56||| 88112|EAP|0311|CYTO, NON-GYN LIQUID BASED|ChampVA|CHAMPVA OF CO DENVER|||||2.56||| 88112|EAP|0311|CYTO, NON-GYN LIQUID BASED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.56||| 88112|EAP|0311||Blue Cross PPO|BLUE CROSS PPO|2.56||||2.56||| 88112|EAP|0311|CYTO, NON-GYN LIQUID BASED|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.56||||||| 88112|EAP|0311||Medicare|MEDICARE A & B|2.56||||2.56||| 88142|EAP|0306||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.16||| 88142|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Aetna|AETNA EXXON MOBIL|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Aetna|AETNA|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.60||| 88142|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 88142|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross PPO|BCBS WALMART|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross PPO|BCBS TRANE PPO|||||0.57||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross PPO|BLUE CROSS POS|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross PPO|BLUE CROSS PPO|||||0.60||| 88142|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Managed Medicaid|FAMILY PLANNING GRANT|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Managed Medicaid|SUPERIOR STAR MCD|||||0.57||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Blue Cross PPO Select|BCBS UTHCT|||||0.60||| 88142|EAP|0301||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 88142|EAP|0306||Cigna|CIGNA OPEN ACCESS PLUS|||||1.82||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Cigna|CIGNA OTHER|||||0.57||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Cigna|CIGNA OF TN CHATTANOOGA|||||0.60||| 88142|EAP|0306||Blue Cross PPO|BLUE CROSS PPO|||||0.77||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Cigna|CIGNA OPEN ACCESS PLUS|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|ChampVA|CHAMPVA OF CO DENVER|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Aetna|TRS COORDINATED CARE|||||0.57||| 88142|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 88142|EAP|0311|PAP SMEAR PRES FLUID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|PHCS|WEB TPA|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|PHCS|TML GRP INS|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|United Healthcare|UMR|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|United Healthcare|GOLDEN RULE INSURANCE|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.57||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Multiplan|WEB TPA|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Multiplan|TML GRP INS|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|NON CONTRACTED|COMMERCIAL OTHER|||||0.60||| 88142|EAP|0306||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.16||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.60||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Medicaid|MEDICAID|||||0.60||| 88142|EAP|0301||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.19||| 88142|EAP|0311|PAP SMEAR PRES FLUID|Medicare|MEDICARE A & B|||||0.60||| 88173|EAP|0311|CYTO, FNA INT & REPORT|Medicare|MEDICARE A & B|||||3.81||| 88173|EAP|0311|CYTO, FNA INT & REPORT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.81||| 88173|EAP|0311||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.81||| 88173|EAP|0311||Medicare|MEDICARE A & B|||||3.81||| 88173|EAP|0311|CYTO, FNA INT & REPORT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.81||| 88173|EAP|0311|CYTO, FNA INT & REPORT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.81||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||178.50||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Aetna|AETNA EXXON MOBIL|||||1.89||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.89||| 88184|EAP|0311||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 88184|EAP|0311|FLOW CYTO TC 1ST (PATH ASSOC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.68||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Medicare|MEDICARE A & B|1.68||||1.89||| 88184|EAP|0311||Medicare|MEDICARE A & B|2.52||||1.68||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|NON CONTRACTED|COMMERCIAL OTHER|||||1.89||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|United Healthcare|UMR|||||1.68||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.89||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Cigna|CIGNA OPEN ACCESS PLUS|||||178.50||| 88184|EAP|0311|FLOW CYTO TC 1ST (PATH ASSOC)|Medicare|MEDICARE A & B|1.68||||1.68||| 88184|EAP|0311|FLOW CYTO CELL 1 MARKER - REF|Blue Cross PPO Select|BCBS UTHCT|||||1.68||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Blue Cross PPO|BLUE CROSS POS|||||1.89||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Blue Cross PPO|BLUE CROSS PPO|||||1.89||| 88184|EAP|0311|FLOW CYTO TC 1ST MARKER (6207)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Cigna|CIGNA OPEN ACCESS PLUS|||||0.96||| 88185|EAP|0311||Medicare|MEDICARE A & B|0.99||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Medicare|MEDICARE A & B|1.80||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADD (PATH aSSOC)|Medicare|MEDICARE A & B|1.80||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|NON CONTRACTED|COMMERCIAL OTHER|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADD (PATH aSSOC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|United Healthcare|UMR|||||0.93||| 88185|EAP|0311|FLOW CYTO;EA CELL SURF - REF|Blue Cross PPO Select|BCBS UTHCT|||||1.20||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.99||| 88185|EAP|0311||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.93||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Aetna|AETNA EXXON MOBIL|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Blue Cross PPO|BLUE CROSS POS|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Blue Cross PPO|BLUE CROSS PPO|||||0.99||| 88185|EAP|0311|FLOW CYTO TC ADDL MARKER (6207|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.96||| 882|DRG||NEUROSES EXCEPT DEPRESSIVE|Medicare|MEDICARE A & B|10,941.50|6929.18|6958.675|2179.315|||| 882|DRG||NEUROSES EXCEPT DEPRESSIVE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|6,010.25|2179.315|6958.675|2179.315|||| 882|DRG||NEUROSES EXCEPT DEPRESSIVE|Humana Medicare Advantage|HUMANA MEDICARE PPO|8,200.30|4781.37|6958.675|2179.315|||| 882|DRG||NEUROSES EXCEPT DEPRESSIVE|NON CONTRACTED|COMMERCIAL OTHER|6,958.68|6958.675|6958.675|2179.315|||| 882|DRG||NEUROSES EXCEPT DEPRESSIVE|Blue Cross PPO|BLUE CROSS PPO|6,771.03|4265.75|6958.675|2179.315|||| 88230|EAP|0311|TISSUE CULTURE - REF|Blue Cross PPO|BLUE CROSS PPO|||||2.40||| 88237|EAP|0311|TISSUE CULT MARROW (6072)|Medicare|MEDICARE A & B|||||2.09||| 88262|EAP|0311|CHROMOSOME ANAL - REF|Blue Cross PPO|BLUE CROSS PPO|||||4.48||| 88264|EAP|0311|CHROMOSOME ANALYS 20-25 (6072)|Medicare|MEDICARE A & B|||||2.22||| 88271|EAP|0311|MOLECULAR CYTOGEN FISH (6798)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.80||| 88271|EAP|0311|MOLECULAR CYTOGEN FISH (6798)|Medicare|MEDICARE A & B|||||3.80||| 883|DRG||DISORDERS OF PERSONALITY & IMPULSE CONTROL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|13,991.45|7402.705|7402.705|2915.16|||| 883|DRG||DISORDERS OF PERSONALITY & IMPULSE CONTROL|Humana Medicare Advantage|HUMANA MEDICARE PPO|12,874.05|4813.53|7402.705|2915.16|||| 883|DRG||DISORDERS OF PERSONALITY & IMPULSE CONTROL|Veterans Affairs|VETERANS CHOICE - TRI WEST|9,932.75|2915.16|7402.705|2915.16|||| 88300|EAP|0312|SURG PATH - LEVEL I|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.08||| 88304|EAP|0360||Medicare|MEDICARE A & B|||||35.10||| 88304|EAP|0360||Medicare|MEDICARE A & B|||||7.43||| 88304|EAP|0312||Medicare|MEDICARE A & B|||||3.36||| 88304|EAP|0258||Medicare|MEDICARE A & B|||||0.05||| 88304|EAP|0270|DURA PREP REMOVER #8610|Medicare|MEDICARE A & B|||||4.90||| 88304|EAP|0270|DURA PREP|Medicare|MEDICARE A & B|||||14.50||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||3.50||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||1.55||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||17.50||| 88304|EAP|0270||Medicare|MEDICARE A & B|||||23.08||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||0.16||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 88304|EAP|0270||Medicare|MEDICARE A & B|||||0.21||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||0.20||| 88304|EAP|0312|SURG PATH - LEVEL III|Medicare|MEDICARE A & B|||||3.36||| 88304|EAP|0272||Medicare|MEDICARE A & B|||||2.70||| 88304|EAP|0312|SURG PATH - LEVEL III|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.36||| 88304|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.36||| 88304|EAP|0510|EXC SHOULDER LES SC 3 CM/>|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||24.73||| 88304|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.25||| 88304|EAP|0312|SURG PATH - LEVEL III|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.36||| 88304|EAP|0272|SCALPEL SZ 15|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.08||| 88304|EAP|0272|XEROFORM 5 X 9 STRIP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| 88304|EAP|0272|ACU-DYNE SWAB STICKS (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 88304|EAP|0272|6.5 STERILE GLOVES (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| 88304|EAP|0272|7.5 TRIFLEX STERILE GLOVES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| 88304|EAP|0272|ADAPTIC 3 X 3 (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| 88304|EAP|0312|SURG PATH - LEVEL III|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.36||| 88304|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.25||| 88304|EAP|0999|TOWEL SURGICAL (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 88304|EAP|0312|SURG PATH - LEVEL III|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.36||| 88304|EAP|0999|COTTON TIP APP STERILE (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicaid|MEDICAID|3.96||||||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||1.55||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Blue Cross PPO|BLUE CROSS PPO|3.96||||3.96||| 88305|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.68||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|ChampVA|CHAMPVA OF CO DENVER|||||3.96||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.96||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.96||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.96||| 88305|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.96||||0.73||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|United Healthcare|UMR|||||3.96||| 88305|EAP|0258||Medicare|MEDICARE A & B|||||0.05||| 88305|EAP|0270|OPTHALMIC DRAPE #8475|Medicare|MEDICARE A & B|||||25.50||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Blue Cross PPO Select|BCBS UTHCT|||||3.96||| 88305|EAP|0270|TEGADERM - SMALL 1624W|Medicare|MEDICARE A & B|||||4.90||| 88305|EAP|0270||Medicare|MEDICARE A & B|||||23.08||| 88305|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.03||| 88305|EAP|0270|BOVIE TIP 0113M|Medicare|MEDICARE A & B|||||0.18||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.96||| 88305|EAP|0270||Medicare|MEDICARE A & B|||||0.21||| 88305|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||26.35||| 88305|EAP|0270||Medicare|MEDICARE A & B|||||4.90||| 88305|EAP|0270||Medicare|MEDICARE A & B|||||14.50||| 88305|EAP|0272|BLADE, CLIPPER SURGICAL|Medicare|MEDICARE A & B|||||12.62||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||0.16||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||3.50||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||2.70||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||0.06||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.96||||3.96||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||6.50||| 88305|EAP|0272||Medicare|MEDICARE A & B|||||0.20||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.96||| 88305|EAP|0510||Medicare|MEDICARE A & B|||||8.43||| 88305|EAP|0510||Medicare|MEDICARE A & B|||||5.24||| 88305|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|NON CONTRACTED|COMMERCIAL OTHER|||||3.96||| 88305|EAP|0360||Medicare|MEDICARE A & B|||||35.10||| 88305|EAP|0360||Medicare|MEDICARE A & B|||||7.43||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicare|MEDICARE RAILROAD|||||3.96||| 88305|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Medicare|MEDICARE A & B|3.96||||3.96||| 88305|EAP|0312||Medicare|MEDICARE A & B|3.96||||3.96||| 88307|EAP|0312|LEVEL V-SURG PATH, GROSS & MIC|Medicare|MEDICARE A & B|||||5.97||| 88307|EAP|0312|LEVEL V-SURG PATH, GROSS & MIC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.97||| 88311|EAP|0312|DECALCIFICATION PROCEDURE|Medicare|MEDICARE A & B|||||0.98||| 88312|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.40||| 88312|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.40||| 88312|EAP|0312||Medicare|MEDICARE A & B|2.40||||2.40||| 88312|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.40||| 88341|EAP|0312|IMMUNO PER SPEC EACH ADDITIONA|Blue Cross PPO|BLUE CROSS PPO|||||1.25||| 88341|EAP|0312|IMMUNO PER SPEC EACH ADDITIONA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.25||| 88341|EAP|0312|IMMUNO PER SPEC EACH ADDITIONA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.25||| 88341|EAP|0312|IMMUNO PER SPEC EACH ADDITIONA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.25||| 88341|EAP|0312|IMMUNO PER SPEC EACH ADDITIONA|NON CONTRACTED|COMMERCIAL OTHER|||||1.25||| 88341|EAP|0312|IMMUNO PER SPEC EACH ADDITIONA|Medicare|MEDICARE A & B|||||1.25||| 88342|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.99||| 88342|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.99||| 88342|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.99||| 88342|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Blue Cross PPO|BLUE CROSS PPO|||||4.99||| 88342|EAP|0312|IMMUNO, PER INITAL SINGLE AB|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.99||| 88342|EAP|0312||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.99||| 88342|EAP|0312||NON CONTRACTED|COMMERCIAL OTHER|||||4.99||| 88342|EAP|0312||Medicare|MEDICARE A & B|||||4.99||| 88342|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Medicare|MEDICARE A & B|||||4.99||| 88342|EAP|0312|IMMUNO, PER INITAL SINGLE AB|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.99||| 88360|EAP|0310|TUMOR IMMUNOHISTOCHEM|NON CONTRACTED|COMMERCIAL OTHER|||||127.72||| 88361|EAP|0312|MORPHOMTRIC ANALY;TUMOR (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 88361|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 88361|EAP|0312||Medicare|MEDICARE A & B|||||1.68||| 88361|EAP|0312|MORPHOMTRIC ANALY;TUMOR (REF)|Medicare|MEDICARE A & B|||||1.68||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Veterans Affairs|VETERANS CHOICE - TRI WEST|9,299.90|5746.07|24170.5|3100.55|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Medicare|MEDICARE A & B|18,492.40|10643.04|24170.5|3100.55|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Blue Cross PPO|BLUE CROSS PPO|23,354.75|14713.49|24170.5|3100.55|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Humana Medicare Advantage|HUMANA MEDICARE PPO|16,511.20|11517.765|24170.5|3100.55|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|NON CONTRACTED|COMMERCIAL OTHER|24,170.50|24170.5|24170.5|3100.55|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Medicare|MEDICARE PART A|9,458.70|3100.55|24170.5|3100.55|||| 885|DRG||PSYCHOSES|Cigna|CIGNA BEHAVIORAL HEALTH|12,795.15||||||| 885|DRG||PSYCHOSES|Cigna|CIGNA OF TN CHATTANOOGA|5,196.98||||||| 885|DRG||PSYCHOSES|Cigna|CIGNA OPEN ACCESS PLUS|8,378.25||||||| 885|DRG||PSYCHOSES|United Healthcare|UMR|6,278.43||||||| 885|DRG||PSYCHOSES|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|7,245.53|40.5|8605.14|40.5|||| 885|DRG||PSYCHOSES|Managed Medicaid|MOLINA MEDICAID|14,671.37|5319.84|8605.14|40.5|||| 885|DRG||PSYCHOSES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|10,821.23|3923.78|8605.14|40.5|||| 885|DRG||PSYCHOSES|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|8,288.30|7312.78|8605.14|40.5|||| 885|DRG||PSYCHOSES|Humana Medicare Advantage|HUMANA MEDICARE PPO|12,956.65|6574.84|8605.14|40.5|||| 885|DRG||PSYCHOSES|Blue Cross PPO Select|BCBS UTHCT|13,358.70|8415.98|8605.14|40.5|||| 885|DRG||PSYCHOSES|Aetna|AETNA EL PASO CLAIMS OFFICE|8,615.71|72|8605.14|40.5|||| 885|DRG||PSYCHOSES|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|8,232.08|5186.21|8605.14|40.5|||| 885|DRG||PSYCHOSES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|10,851.30|5425.65|8605.14|40.5|||| 885|DRG||PSYCHOSES|Managed Medicaid|SUPERIOR STAR MCD|65.33|2368.865|8605.14|40.5|||| 885|DRG||PSYCHOSES|Blue Cross PPO|BLUE CROSS PPO|11,232.75|7076.63|8605.14|40.5|||| 885|DRG||PSYCHOSES|Blue Cross PPO|BCBS TRANE PPO|13,658.95|8605.14|8605.14|40.5|||| 885|DRG||PSYCHOSES|Optum Behavioral Health|OPTUM|12,867.28||||||| 885|DRG||PSYCHOSES|Blue Cross PPO|BLUE CROSS POS|14,243.30|7735.05|8605.14|40.5|||| 885|DRG||PSYCHOSES|Blue Cross PPO|BCBS WALMART|9,146.75|5584.84|8605.14|40.5|||| 885|DRG||PSYCHOSES|Multiplan|TML GRP INS|3,999.80|3999.8|8605.14|40.5|||| 885|DRG||PSYCHOSES|NON CONTRACTED|COMMERCIAL OTHER 2|8,468.45|8468.45|8605.14|40.5|||| 885|DRG||PSYCHOSES|NON CONTRACTED|COMMERCIAL OTHER|8,501.13|8501.125|8605.14|40.5|||| 885|DRG||PSYCHOSES|PHCS|TML GRP INS|3,999.80|3999.8|8605.14|40.5|||| 885|DRG||PSYCHOSES|Medicaid|MEDICAID|12,135.25|4400.24|8605.14|40.5|||| 885|DRG||PSYCHOSES|Medicare|MEDICARE RAILROAD|11,952.40|7115.83|8605.14|40.5|||| 885|DRG||PSYCHOSES|Medicare|MEDICARE PART A|116.11|7927.81|8605.14|40.5|||| 885|DRG||PSYCHOSES|Medicare|MEDICARE A & B|14,823.55|7131.87|8605.14|40.5|||| 885|DRG||PSYCHOSES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|12,823.15|5922.38|8605.14|40.5|||| 885|DRG||PSYCHOSES|Veterans Affairs|VETERANS CHOICE - TRI WEST|110.81|5806.25|8605.14|40.5|||| 885|DRG||PSYCHOSES|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|11.30|1036.75|8605.14|40.5|||| 89051|EAP|0309|EOSINOPHILS, MISC BODY FLS NO|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Medicare|MEDICARE PART A|1.16||||||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Medicare|MEDICARE A & B|1.16||||1.16||| 89051|EAP|0309|EOSINOPHILS, MISC BODY FLS NO|Medicare|MEDICARE A & B|1.16||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|NON CONTRACTED|COMMERCIAL OTHER|||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.16||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Workers Compensation|WC GALLAGHER BASSETT|||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Blue Cross PPO|BLUE CROSS PPO|1.16||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Blue Cross PPO|BLUE CROSS POS|1.16||||||| 89051|EAP|0309|CELL COUNT, BRONCH ALVEOLAR|Blue Cross PPO|BLUE CROSS POS|1.16||||||| 89051|EAP|0309|CELL COUNT, CSF|Blue Cross PPO Select|BCBS UTHCT|||||0.25||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Cigna|NALC HLTH BENEFIT|1.16||||1.16||| 89051|EAP|0309|EOSINOPHILS, MISC BODY FLS NO|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.16||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.16||||1.16||| 89051|EAP|0309|CELL COUNT, MISC. BODY FLUID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.16||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Managed Medicaid|SUPERIOR STAR MCD|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Blue Cross PPO Select|BCBS UTHCT|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Blue Cross PPO|BLUE CROSS PPO|0.73||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Blue Cross PPO|BLUE CROSS POS|0.73||||0.49||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Blue Cross PPO|BCBS TRANE PPO|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.73||||0.49||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|NON CONTRACTED|COMMERCIAL OTHER|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Medicare|MEDICARE A & B|0.73||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Medicare|MEDICARE RAILROAD|||||0.25||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|United Healthcare|UMR|||||0.73||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.73||||||| 89055|EAP|0309|LEUKOCYTES, STOOL (FECAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.25||| 89060|EAP|0309|CRYSTAL ID , NOT URINE**|Workers Compensation|WC GALLAGHER BASSETT|||||1.16||| 89060|EAP|0309|CRYSTAL ID , NOT URINE**|Medicare|MEDICARE A & B|||||1.16||| 89060|EAP|0309|CRYSTAL ID , NOT URINE**|Blue Cross PPO Select|BCBS UTHCT|||||1.16||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Blue Cross PPO|BLUE CROSS POS|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Blue Cross PPO|BLUE CROSS PPO|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Cigna|CIGNA OF TN CHATTANOOGA|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|NON CONTRACTED|COMMERCIAL OTHER|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Medicare|MEDICARE A & B|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|Medicaid|MEDICAID|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.04||| 89230|EAP|0309|SWEAT COLLECTION-IONTOPHORSIS|United Healthcare|UMR|||||1.04||| 894|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA|Medicare|MEDICARE A & B|20,832.85|2054.23|2054.23|2054.23|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18,199.18|6599.02|8196.36|43.01|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9,648.50|4824.25|8196.36|43.01|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Blue Cross PPO|BLUE CROSS PPO|13,010.10|8196.36|8196.36|43.01|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|62.67|2444.52|8196.36|43.01|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|NON CONTRACTED|COMMERCIAL OTHER|43.01|43.01|8196.36|43.01|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Medicare|MEDICARE A & B|11,350.75|5009.45|8196.36|43.01|||| 90375|EAP|0636|RABIES IG,150 IU/ML 10ML, IM|Medicare|MEDICARE A & B|||||10,062.90||| 90375|EAP|0636|RABIES IG,150 IU/ML 10ML, IM|Workers Compensation|WC TX MUTUAL INS|||||10,062.90||| 90375|EAP|0636|RABIES IG,300 IU/2ML, IM VIAL|Blue Cross PPO|BLUE CROSS PPO|||||1,342.15||| 90375|EAP|0636|RABIES IG,150 IU/ML 10ML, IM|Blue Cross PPO|BLUE CROSS PPO|||||6,126.20||| 90375|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90375|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 90375|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 90375|EAP|0636|RABIES IG,300 IU/2ML, IM VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||17.57||| 90375|EAP|0636|RABIES IG,150 IU/ML 10ML, IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10,062.90||| 90471|EAP|0510||Cigna|CIGNA OTHER|||||2.50||| 90471|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Cigna|CIGNA OTHER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Cigna|NALC HLTH BENEFIT|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| 90471|EAP|0771||Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90471|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90471|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 90471|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||69.31||| 90471|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 90471|EAP|0771|ADMIN OF SINGLE VACC (CARDC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Aetna|AETNA EXXON MOBIL|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Aetna|AETNA|||||160.36||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 90471|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| 90471|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 90471|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 90471|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| 90471|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| 90471|EAP|0771|ADMIN VAC/TOX EA ADD'L (ADOL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0250||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||408.85||| 90471|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 90471|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 90471|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 90471|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 90471|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||3.26||| 90471|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 90471|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.50||| 90471|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 90471|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||160.36||| 90471|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| 90471|EAP|0771||Blue Cross PPO|BCBS TRANE PPO|||||160.36||| 90471|EAP|0771|ADMIN VAC/TOX EA ADD'L (ADOL)|Blue Cross PPO|BLUE CROSS POS|||||0.86||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(GIC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Blue Cross PPO|BCBS WALMART|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross PPO|BCBS WALMART|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Blue Cross PPO|BCBS TRANE PPO|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 90471|EAP|0771||Blue Cross PPO|BLUE CROSS POS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross PPO|BCBS TRANE PPO|||||160.36||| 90471|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| 90471|EAP|0510||United Healthcare|UMR|||||2.64||| 90471|EAP|0510||United Healthcare|UMR|||||2.50||| 90471|EAP|0510||PHCS|WEB TPA|||||2.50||| 90471|EAP|0510||PHCS|PHCS OF TX ARLINGTON|||||2.64||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|United Healthcare|UMR|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|United Healthcare|UMR|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|United Healthcare|UMR|||||160.36||| 90471|EAP|0940|**ADMINISTRATION OF SINGLE VAC|United Healthcare|UMR|||||160.36||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Blue Cross PPO|BCBS WALMART|||||160.36||| 90471|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|PHCS|WEB TPA|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|PHCS|TML GRP INS|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|PHCS|PHCS OF TX ARLINGTON|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|PHCS|WEB TPA|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||160.36||| 90471|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADMIN VAC/TOX EA ADD'L (ADOL)|Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90471|EAP|0636||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||45.15||| 90471|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||2.64||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| 90471|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||4.15||| 90471|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||0.01||| 90471|EAP|0981||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 90471|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 90471|EAP|0771||Workers Compensation|WC OTHER|||||160.36||| 90471|EAP|0270||Workers Compensation|WC TX MUTUAL INS|||||0.42||| 90471|EAP|0271||Workers Compensation|WC TX MUTUAL INS|||||4.90||| 90471|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 90471|EAP|0272||Workers Compensation|WC TX MUTUAL INS|||||4.90||| 90471|EAP|0301||Workers Compensation|WC TX MUTUAL INS|||||0.19||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||160.36||| 90471|EAP|0305||Workers Compensation|WC TX MUTUAL INS|||||1.68||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771||Workers Compensation|WC TX MUTUAL INS|||||160.36||| 90471|EAP|0771||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||160.36||| 90471|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (WWC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Medicaid|MEDICAID|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Medicaid|MEDICAID|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(PUL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0949||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||213.82||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Managed Medicaid|SUPERIOR STAR MCD|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Managed Medicaid|MOLINA MEDICAID|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Managed Medicaid|MOLINA MEDICAID|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771||Managed Medicaid|SUPERIOR STAR MCD|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90471|EAP|0771||Managed Medicaid|FAMILY PLANNING GRANT|||||160.36||| 90471|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Multiplan|WEB TPA|||||160.36||| 90471|EAP|0510||Multiplan|WEB TPA|||||2.50||| 90471|EAP|0510||Multiplan|PHCS OF TX ARLINGTON|||||2.64||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Multiplan|WEB TPA|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Multiplan|PHCS OF TX ARLINGTON|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Multiplan|TML GRP INS|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90471|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 90471|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Cigna|CIGNA OPEN ACCESS PLUS|||||160.36||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (INFDC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACC (FPC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADM IMMUNIZATION,1ST VAC (ONC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE(GIC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADMIN VAC/TOX EA ADD'L (ADOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.86||| 90471|EAP|0771||NON CONTRACTED|MRAMVA|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 90471|EAP|0771|ADM OF SINGLE VACC/TOXOID (CF)|NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||160.36||| 90471|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (IMC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADMIN OF SINGLE VACCINE (FPC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771||Medicare|MEDICARE PART A|160.36||||||| 90471|EAP|0771||Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771||Medicare|MEDICARE A & B|160.36||||0.86||| 90471|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Medicare|MEDICARE A & B|160.36||||160.36||| 90471|EAP|0771|ADM OF INFLUENZA VACC (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 90471|EAP|0940|**ADMINISTRATION OF SINGLE VAC|Medicare|MEDICARE A & B|||||160.36||| 90472|EAP|0771||Medicare|MEDICARE A & B|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Medicare|MEDICARE A & B|||||0.86||| 90472|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.86||| 90472|EAP|0771||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Managed Medicaid|SUPERIOR STAR MCD|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Managed Medicaid|FAMILY PLANNING GRANT|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.86||| 90472|EAP|0771||Managed Medicaid|FAMILY PLANNING GRANT|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Workers Compensation|WC TX MUTUAL INS|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|United Healthcare|UMR|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.86||| 90472|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.86||| 90472|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.86||| 90472|EAP|0771||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.86||| 90472|EAP|0771||Blue Cross PPO|BLUE CROSS POS|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Blue Cross PPO|BCBS WALMART|||||0.86||| 90472|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90472|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 90472|EAP|0771||Aetna|AETNA EXXON MOBIL|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 90472|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.86||| 90472|EAP|0771|ADMIN VAC/TOX EA ADD'L (ADOL)|Medicare|MEDICARE A & B|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.86||| 90472|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.86||| 90472|EAP|0771||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|ChampVA|CHAMPVA OF CO DENVER|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Cigna|CIGNA OPEN ACCESS PLUS|||||0.86||| 90472|EAP|0771||Cigna|CIGNA OF TN CHATTANOOGA|||||0.86||| 90472|EAP|0771|ADMIN VACCINE/TOXOID EA ADD'L|Blue Cross PPO Select|BCBS UTHCT|||||0.86||| 90472|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||0.86||| 90632|EAP|0636|HEPATITIS A VAC ADULT 1440U|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||208.10||| 90633|EAP|0636|HEPATITIS A VAC 720U PED/90633|Blue Cross PPO Select|BCBS UTHCT|||||100.10||| 90633|EAP|0636|HEPATITIS A VAC 720U PED/90633|Blue Cross PPO|BLUE CROSS PPO|||||100.10||| 90633|EAP|0636|HEPATITIS A VAC 720U PED/90633|NON CONTRACTED|COMMERCIAL OTHER|||||100.10||| 90636|EAP|0636|HEPATITIS A/HEPATITIS B/ 90636|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||325.45||| 90636|EAP|0636|HEPATITIS A/HEPATITIS B/ 90636|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||309.95||| 90636|EAP|0306||Medicare|MEDICARE A & B|||||3.86||| 90636|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 90636|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 90636|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 90636|EAP|0636|HEPATITIS A/HEPATITIS B/ 90636|Medicare|MEDICARE A & B|||||325.45||| 90636|EAP|0636|HEPATITIS A/HEPATITIS B/ 90636|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||309.95||| 90636|EAP|0250||Blue Cross PPO Select|BCBS UTHCT|||||408.85||| 90636|EAP|0636|HEPATITIS A/HEPATITIS B/ 90636|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||309.95||| 90636|EAP|0636|HEPATITIS A/HEPATITIS B/ 90636|Blue Cross PPO Select|BCBS UTHCT|||||309.95||| 90648|EAP|0636|HEMOPHILUS B CONJ 0.5ML /90645|Blue Cross PPO|BLUE CROSS PPO|||||57.20||| 90648|EAP|0636|HEMOPHILUS B CONJ 0.5ML /90645|Medicare|MEDICARE A & B|||||57.20||| 90648|EAP|0636|HEMOPHILUS B CONJ 0.5ML /90645|NON CONTRACTED|COMMERCIAL OTHER|||||57.20||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|United Healthcare|UMR|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Medicare|MEDICARE A & B|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Multiplan|WEB TPA|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|PHCS|WEB TPA|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Cigna|CIGNA OF TN CHATTANOOGA|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Cigna|CIGNA OPEN ACCESS PLUS|||||686.95||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Managed Medicaid|FAMILY PLANNING GRANT|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Blue Cross PPO|BLUE CROSS PPO|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Blue Cross PPO|BLUE CROSS POS|||||9.72||| 90651|EAP|0250|HPV GARDASIL 9 SYRINGE|Blue Cross PPO Select|BCBS UTHCT|||||9.72||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross PPO|BLUE CROSS POS|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross PPO|BCBS WALMART|||||0.55||| 90662|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||0.55||| 90662|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.55||| 90662|EAP|0731||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.15||| 90662|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 90662|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90662|EAP|0920||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.89||| 90662|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.55||| 90662|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.14||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Cigna|NALC HLTH BENEFIT|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Cigna|CIGNA OTHER|||||0.55||| 90662|EAP|0771||Cigna|NALC HLTH BENEFIT|||||160.36||| 90662|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 90662|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 90662|EAP|0312||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| 90662|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross PPO Select|BCBS UTHCT|||||0.55||| 90662|EAP|0510||Medicare|MEDICARE A & B|||||2.09||| 90662|EAP|0320||Medicare|MEDICARE A & B|||||2.35||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Medicare|MEDICARE RAILROAD|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Medicare|MEDICARE PART B|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Medicare|MEDICARE PART A|0.55||||||| 90662|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Medicare|MEDICARE A & B|0.55||||0.55||| 90662|EAP|0636||Medicare|MEDICARE A & B|0.55||||0.55||| 90662|EAP|0636||Medicare|MEDICARE A & B|0.55||||45.15||| 90662|EAP|0403||Medicare|MEDICARE A & B|||||4.83||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.55||| 90662|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 90662|EAP|0403||Medicare|MEDICARE A & B|||||0.82||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|NON CONTRACTED|COMMERCIAL OTHER|||||0.55||| 90662|EAP|0419||Medicare|MEDICARE A & B|||||7.09||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross PPO|BCBS TRANE PPO|||||0.55||| 90662|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 90662|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.55||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|United Healthcare|UMR|||||0.55||| 90662|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 90662|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.55||||0.55||| 90662|EAP|0636|FLU VAC(65YR UP)/PF 180MCG/0.5|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.55||| 90662|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.55||||0.55||| 90662|EAP|0636||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.55||| 90662|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|United Healthcare|UMR|||||452.45||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||407.15||| 90670|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||497.75||| 90670|EAP|0636||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||497.75||| 90670|EAP|0636||Managed Medicaid|FAMILY PLANNING GRANT|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Medicare|MEDICARE RAILROAD|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Medicare|MEDICARE A & B|497.75||||497.75||| 90670|EAP|0636||Medicare|MEDICARE A & B|497.75||||497.75||| 90670|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||452.45||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Cigna|CIGNA OPEN ACCESS PLUS|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Veterans Affairs|VETERANS CHOICE - TRI WEST|497.75||||||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Cigna|CIGNA OF TN CHATTANOOGA|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Blue Cross PPO Select|BCBS UTHCT|||||497.75||| 90670|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||407.15||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Humana Medicare Advantage|HUMANA MEDICARE PPO|497.75||||497.75||| 90670|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|497.75||||497.75||| 90670|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||452.45||| 90670|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||497.75||| 90670|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Blue Cross PPO|BCBS WALMART|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Blue Cross PPO|BLUE CROSS PPO|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Blue Cross PPO|BLUE CROSS POS|||||497.75||| 90670|EAP|0636|PNEUMOCOCCAL 13-VAL CONJUGATE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||497.75||| 90674|EAP|0636|FLU VACCINE EGG FREE|Blue Cross PPO|BLUE CROSS PPO|||||0.54||| 90674|EAP|0636|FLU VACCINE EGG FREE|Medicare|MEDICARE A & B|||||0.54||| 90674|EAP|0636|FLU VACCINE EGG FREE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.54||| 90675|EAP|0771||Workers Compensation|WC TX MUTUAL INS|||||160.36||| 90675|EAP|0636|RABIES VAC, 2.5U KIT /90675|Workers Compensation|WC TX MUTUAL INS|||||1,571.10||| 90675|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||4.15||| 90675|EAP|0450||Medicare|MEDICARE A & B|||||4.15||| 90675|EAP|0450||Medicare|MEDICARE A & B|||||2.34||| 90675|EAP|0636|RABIES VAC, 2.5U KIT /90675|Medicare|MEDICARE A & B|||||1,571.10||| 90675|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 90675|EAP|0636|RABIES VAC, 2.5U KIT /90675|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1,571.10||| 90675|EAP|0636|RABIES VAC, 2.5U KIT /90675|Cigna|CIGNA OF TN CHATTANOOGA|||||1,571.10||| 90675|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.15||| 90675|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 90675|EAP|0636|RABIES VAC, 2.5U KIT /90675|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,571.10||| 90675|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 90675|EAP|0636|RABIES VAC, 2.5U KIT /90675|Blue Cross PPO|BLUE CROSS PPO|||||1,571.10||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross PPO|BLUE CROSS PPO|45.15||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross PPO|BCBS WALMART|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross PPO|BCBS TRANE PPO|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Aetna|AETNA|||||45.15||| 90686|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|45.15||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|ChampVA|CHAMPVA OF CO DENVER|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Cigna|CIGNA OPEN ACCESS PLUS|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Cigna|CIGNA OF TN CHATTANOOGA|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.18||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||45.15||| 90686|EAP|0636|INFLUENZA VIRUS VAC,ADULT .5ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.18||||69.31||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||57.23||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Managed Medicaid|SUPERIOR STAR MCD|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Medicaid|MEDICAID|45.15||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Managed Medicaid|MOLINA MEDICAID|||||69.31||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Managed Medicaid|MEDICAID CSHCN|||||69.31||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Managed Medicaid|FAMILY PLANNING GRANT|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.18||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross PPO Select|BCBS UTHCT|||||45.15||| 90686|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.18||||69.31||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Multiplan|PHCS OF TX ARLINGTON|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Multiplan|WEB TPA|||||45.15||| 90686|EAP|0636|INFLUENZA VIRUS VAC,ADULT .5ML|Medicare|MEDICARE A & B|45.15||||69.31||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Medicare|MEDICARE RAILROAD|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Medicare|MEDICARE PART A|45.15||||||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Aetna|AETNA EXXON MOBIL|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Medicare|MEDICARE A & B|45.15||||45.15||| 90686|EAP|0636||Medicare|MEDICARE A & B|45.15||||69.31||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Blue Cross PPO|BLUE CROSS POS|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Multiplan|TML GRP INS|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|NON CONTRACTED|COMMERCIAL OTHER|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|United Healthcare|GOLDEN RULE INSURANCE|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|United Healthcare|UMR|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|PHCS|WEB TPA|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|PHCS|TML GRP INS|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|PHCS|PHCS OF TX ARLINGTON|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|45.15||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||69.31||| 90686|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|45.15||||69.31||| 90686|EAP|0636||Tricare|TRICARE WEST UNITED HEALTH|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||45.15||| 90686|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.18||||45.15||| 90696|EAP|0636|KINRIX (DIPH PERTUS TET POLIO|NON CONTRACTED|COMMERCIAL OTHER|||||179.25||| 90696|EAP|0636|KINRIX (DIPH PERTUS TET POLIO|Cigna|CIGNA OF TN CHATTANOOGA|||||179.25||| 90696|EAP|0636|KINRIX (DIPH PERTUS TET POLIO|Blue Cross PPO|BLUE CROSS PPO|||||179.25||| 90698|EAP|0636|PENTACEL DTAP P H|Blue Cross PPO|BLUE CROSS PPO|||||290.55||| 90707|EAP|0636|MEASLES/MUMPS/RUBELLA /90707|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||243.25||| 90707|EAP|0636|MEASLES/MUMPS/RUBELLA /90707|NON CONTRACTED|COMMERCIAL OTHER|||||243.25||| 90707|EAP|0636|MEASLES/MUMPS/RUBELLA /90707|Blue Cross PPO Select|BCBS UTHCT|||||243.25||| 90707|EAP|0636|MEASLES/MUMPS/RUBELLA /90707|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||243.25||| 90707|EAP|0636|MEASLES/MUMPS/RUBELLA /90707|Blue Cross PPO|BLUE CROSS PPO|||||243.25||| 90710|EAP|0636|MMRV VAC, PROQUAD /90710|Blue Cross PPO|BLUE CROSS PPO|||||742.75||| 90710|EAP|0636|MMRV VAC, PROQUAD /90710|Blue Cross PPO|BLUE CROSS POS|||||814.40||| 90710|EAP|0636|MMRV VAC, PROQUAD /90710|Cigna|CIGNA OF TN CHATTANOOGA|||||814.40||| 90710|EAP|0636|MMRV VAC, PROQUAD /90710|NON CONTRACTED|COMMERCIAL OTHER|||||814.40||| 90713|EAP|0636|POLIOMYELITIS VAC,KILLED/90713|NON CONTRACTED|COMMERCIAL OTHER|||||104.10||| 90713|EAP|0636|POLIOMYELITIS VAC,KILLED/90713|Blue Cross PPO Select|BCBS UTHCT|||||99.15||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Blue Cross PPO|BLUE CROSS PPO|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||77.15||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Cigna|NALC HLTH BENEFIT|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Blue Cross PPO|BLUE CROSS POS|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.76||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Cigna|CIGNA OF TN CHATTANOOGA|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Blue Cross PPO Select|BCBS UTHCT|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|PHCS|WEB TPA|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Managed Medicaid|SUPERIOR STAR MCD|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.76||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|NON CONTRACTED|MRAMVA|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Multiplan|WEB TPA|||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|Medicare|MEDICARE A & B|78.30||||78.30||| 90714|EAP|0636|TETANUS/DIP TOX 0.5 ML ADULT|NON CONTRACTED|COMMERCIAL OTHER|||||78.30||| 90715|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 90715|EAP|0981||NON CONTRACTED|BOONE CHAPMAN|||||0.00||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Multiplan|WEB TPA|||||206.30||| 90715|EAP|0450||Medicare|MEDICARE A & B|||||4.12||| 90715|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Medicare|MEDICARE PART A|206.30||||||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|NON CONTRACTED|BOONE CHAPMAN|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|NON CONTRACTED|COMMERCIAL OTHER 2|||||206.30||| 90715|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| 90715|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 90715|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|NON CONTRACTED|COMMERCIAL OTHER|||||206.30||| 90715|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Medicaid|MEDICAID|||||206.30||| 90715|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Managed Medicaid|SUPERIOR STAR MCD|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||206.30||| 90715|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.12||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|United Healthcare|UMR|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|PHCS|WEB TPA|||||206.30||| 90715|EAP|0771||United Healthcare|UMR|||||160.36||| 90715|EAP|0981||United Healthcare|UMR|||||0.00||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||206.30||| 90715|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| 90715|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 90715|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 90715|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Workers Compensation|DO NOT USE----ENABLE COMP|||||206.30||| 90715|EAP|0771||Workers Compensation|WC OTHER|||||160.36||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||206.30||| 90715|EAP|0771||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||160.36||| 90715|EAP|0450||Workers Compensation|WC OTHER|||||4.12||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Workers Compensation|WC TX MUTUAL INS|||||206.30||| 90715|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||4.36||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|ChampVA|CHAMPVA OF CO DENVER|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Cigna|NALC HLTH BENEFIT|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Cigna|CIGNA OPEN ACCESS PLUS|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Cigna|CIGNA OF TN CHATTANOOGA|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Blue Cross PPO Select|BCBS UTHCT|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Workers Compensation|WC OTHER|||||206.30||| 90715|EAP|0771||Cigna|CIGNA OPEN ACCESS PLUS|||||160.36||| 90715|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 90715|EAP|0271||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| 90715|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.17||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||171.75||| 90715|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 90715|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||4.36||| 90715|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 90715|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Managed Medicaid|FAMILY PLANNING GRANT|||||206.30||| 90715|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 90715|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| 90715|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 90715|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||206.30||| 90715|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Medicare|MEDICARE A & B|206.30||||206.30||| 90715|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 90715|EAP|0510||Blue Cross PPO|BCBS WALMART|||||3.79||| 90715|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 90715|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 90715|EAP|0771||NON CONTRACTED|BOONE CHAPMAN|||||160.36||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Blue Cross PPO|BLUE CROSS PPO|206.30||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Blue Cross PPO|BLUE CROSS POS|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Blue Cross PPO|BCBS WALMART|||||206.30||| 90715|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 90715|EAP|0771||Blue Cross PPO|BCBS WALMART|||||160.36||| 90715|EAP|0771||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||160.36||| 90715|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||5.18||| 90715|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.12||| 90715|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.36||| 90715|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.19||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Aetna|AETNA|||||206.30||| 90715|EAP|0636|TDAP (BOOSTRIX) 0.5ML IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||206.30||| 90716|EAP|0636|VARICELLA VIRUS VAC /90716|Blue Cross PPO|BLUE CROSS POS|||||138.20||| 90716|EAP|0636|VARICELLA VIRUS VAC /90716|Blue Cross PPO|BLUE CROSS PPO|||||138.20||| 90716|EAP|0636|VARICELLA VIRUS VAC /90716|Cigna|CIGNA OF TN CHATTANOOGA|||||138.20||| 90716|EAP|0636|VARICELLA VIRUS VAC /90716|Blue Cross PPO Select|BCBS UTHCT|||||138.20||| 90716|EAP|0636|VARICELLA VIRUS VAC /90716|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||138.20||| 90723|EAP|0636|DIPH,PER,TET,HEPB,POL .5/90723|Blue Cross PPO|BLUE CROSS PPO|||||256.65||| 90732|EAP|0510||United Healthcare|UMR|||||2.50||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|United Healthcare|UMR|||||457.25||| 90732|EAP|0771||United Healthcare|UMR|||||160.36||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||363.55||| 90732|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|NON CONTRACTED|COMMERCIAL OTHER|457.25||||457.25||| 90732|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 90732|EAP|0771||Medicare|MEDICARE A & B|||||0.47||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Managed Medicaid|FAMILY PLANNING GRANT|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|410.40||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Medicare|MEDICARE A & B|457.25||||457.25||| 90732|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|ChampVA|CHAMPVA OF CO DENVER|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Cigna|CIGNA OTHER|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Cigna|CIGNA OPEN ACCESS PLUS|||||410.40||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Cigna|CIGNA OF TN CHATTANOOGA|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Veterans Affairs|VETERANS CHOICE - TRI WEST|457.25||||||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross PPO Select|BCBS UTHCT|||||457.25||| 90732|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.08||| 90732|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.63||| 90732|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Aetna|AETNA EL PASO CLAIMS OFFICE|457.25||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|457.25||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross PPO|BLUE CROSS PPO|457.25||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross PPO|BLUE CROSS POS|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross PPO|BCBS WALMART|||||457.25||| 90732|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Blue Cross PPO|BCBS TRANE PPO|||||457.25||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Blue Cross PPO|BLUE CROSS PPO|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Blue Cross PPO|BLUE CROSS POS|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|ChampVA|CHAMPVA OF CO DENVER|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Blue Cross PPO Select|BCBS UTHCT|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Multiplan|WEB TPA|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|Medicare|MEDICARE A & B|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|NON CONTRACTED|COMMERCIAL OTHER|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|United Healthcare|UMR|||||460.65||| 90734|EAP|0636|MENVEO MENINGOCOCCAL VAC VIAL|PHCS|WEB TPA|||||460.65||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||211.20||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Medicare|MEDICARE A & B|||||211.20||| 90746|EAP|0771||Medicare|MEDICARE A & B|||||101.67||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||211.20||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||211.20||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Cigna|CIGNA OF TN CHATTANOOGA|||||211.20||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Blue Cross PPO Select|BCBS UTHCT|||||211.20||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Aetna|AETNA EXXON MOBIL|||||211.20||| 90746|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||211.20||| 90746|EAP|0636|HEPATITIS B VAC, ADL /90746|Blue Cross PPO|BLUE CROSS POS|||||211.20||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross PPO Select|BCBS UTHCT|||||408.85||| 90750|EAP|0250||Blue Cross PPO Select|BCBS UTHCT|||||399.10||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||389.35||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||334.48||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross PPO|BCBS WALMART|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross PPO|BLUE CROSS PPO|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross PPO|BLUE CROSS POS|||||399.10||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Blue Cross PPO|BCBS TRANE PPO|||||408.85||| 90750|EAP|0250||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Managed Medicaid|FAMILY PLANNING GRANT|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Cigna|CIGNA OPEN ACCESS PLUS|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Cigna|CIGNA OTHER|||||389.35||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Aetna|AETNA EXXON MOBIL|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Cigna|CIGNA OF TN CHATTANOOGA|||||334.48||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||399.10||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|ChampVA|CHAMPVA OF CO DENVER|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Medicaid|MEDICAID|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Medicare|MEDICARE A & B|389.35||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Multiplan|TML GRP INS|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|PHCS|TML GRP INS|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||408.85||| 90750|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||408.85||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|United Healthcare|UMR|||||389.35||| 90750|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||389.35||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|United Healthcare|UMR|||||3.39||| 90791|EAP|0900|PSYCH DX INTERVIEW|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Multiplan|GILSBAR INC|||||3.39||| 90791|EAP|0900|PSYCH DX INTERVIEW|Medicare|MEDICARE A & B|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Medicare|MEDICARE A & B|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Medicaid|MEDICAID|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.39||| 90791|EAP|0900|PSYCH DX INTERVIEW|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.39||| 90791|EAP|0900|PSYCH DX INTERVIEW|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Cigna|CIGNA OPEN ACCESS PLUS|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Cigna|CIGNA OF TN CHATTANOOGA|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Blue Cross PPO Select|BCBS UTHCT|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.39||| 90791|EAP|0900|PSYCH DX INTERVIEW|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.39||| 90791|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.39||| 90791|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Blue Cross PPO|BLUE CROSS PPO|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Blue Cross PPO|BLUE CROSS POS|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Blue Cross PPO|BCBS WALMART|||||3.39||| 90791|EAP|0900|PSYCHIATRIC DIAGNOTIC EVAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.39||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Blue Cross PPO|BLUE CROSS PPO|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Blue Cross PPO|BCBS WALMART|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Cigna|CIGNA OF TN CHATTANOOGA|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|Medicare|MEDICARE A & B|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|NON CONTRACTED|COMMERCIAL OTHER|||||2.01||| 90792|EAP|0900|PSYCH DIAG EVAL W/MED SRVCS|Optum Behavioral Health|OPTUM|||||2.01||| 90792|EAP|0900|PSYCH DIAGNOSTIC EVAL W/MS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.01||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|United Healthcare|UMR|||||1.55||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.55||| 90832|EAP|0914|PSYCHOTHERAPY, 30MIN W/PT, FM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.33||| 90832|EAP|0915||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Medicare|MEDICARE A & B|2.33||||1.55||| 90832|EAP|0914|INDIV,PTHERP O/P 30MIN|Medicare|MEDICARE A & B|2.33||||1.51||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Optum Behavioral Health|OPTUM|||||1.55||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|NON CONTRACTED|COMMERCIAL OTHER|2.33||||1.55||| 90832|EAP|0915||Optum Behavioral Health|OPTUM|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30MIN W/PT, FM|Medicare|MEDICARE A & B|2.33||||2.33||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Medicare|MEDICARE RAILROAD|||||1.55||| 90832|EAP|0915||Medicare|MEDICARE A & B|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30MIN W/PT, FM|Managed Medicaid|MOLINA MEDICAID|||||2.33||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.55||| 90832|EAP|0915||NON CONTRACTED|COMMERCIAL OTHER|||||1.28||| 90832|EAP|0914|INDIV,PTHERP O/P 30MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.51||| 90832|EAP|0915||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Cigna|CIGNA BEHAVIORAL HEALTH|||||1.55||| 90832|EAP|0915||Cigna|CIGNA BEHAVIORAL HEALTH|||||1.28||| 90832|EAP|0914||Medicare|MEDICARE A & B|2.33||||2.12||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Humana Behavioral Health|HUMANA BEHAVIORAL HEALTH|||||1.55||| 90832|EAP|0915||Humana Behavioral Health|HUMANA BEHAVIORAL HEALTH|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Blue Cross PPO Select|BCBS UTHCT|||||1.55||| 90832|EAP|0915||Blue Cross PPO Select|BCBS UTHCT|||||1.28||| 90832|EAP|0915||United Healthcare|UMR|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.55||| 90832|EAP|0914||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.63||| 90832|EAP|0915||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||1.55||| 90832|EAP|0914|PSYCHOTHERAPY, 30MIN W/PT, FM|Aetna|AETNA EL PASO CLAIMS OFFICE|2.33||||2.33||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Aetna|AETNA EL PASO CLAIMS OFFICE|2.33||||1.55||| 90832|EAP|0915||Blue Cross PPO|BLUE CROSS PPO|||||1.28||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Blue Cross PPO|BCBS WALMART|||||1.55||| 90832|EAP|0914|PSYCHOTHERAPY, 30 MIN IOP|Blue Cross PPO|BLUE CROSS PPO|2.33||||1.55||| 90832|EAP|0914||Blue Cross PPO|BCBS WALMART|||||5.63||| 90833|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 90833|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 90833|EAP|0513||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Blue Cross PPO|BCBS TRANE PPO|||||0.25||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Blue Cross PPO|BLUE CROSS PPO|||||0.25||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Blue Cross PPO|BLUE CROSS POS|||||0.25||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.25||| 90833|EAP|0301|IMMUNOGLOBULIN IGA PART OF 770|Medicare|MEDICARE A & B|||||1.35||| 90833|EAP|0301|IGE, TOTAL|Medicare|MEDICARE A & B|||||2.35||| 90833|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 90833|EAP|0301|IMMUNOGLOBULIN IGG|Medicare|MEDICARE A & B|||||1.35||| 90833|EAP|0301|IMMUNOGLOBULIN IGM PART OF 770|Medicare|MEDICARE A & B|||||1.35||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Medicaid|MEDICAID|||||0.25||| 90833|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 90833|EAP|0513||Blue Cross PPO|BCBS TRANE PPO|||||2.64||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.25||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Managed Medicaid|SUPERIOR STAR MCD|||||0.25||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.25||| 90833|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE A & B|||||2.50||| 90833|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 90833|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Medicare|MEDICARE A & B|||||2.50||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|Medicare|MEDICARE A & B|||||0.25||| 90833|EAP|0636|PNEUMOCOCCAL 23-VAL ADU /90732|Medicare|MEDICARE A & B|||||363.55||| 90833|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 90833|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| 90833|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Medicare|MEDICARE A & B|||||160.36||| 90833|EAP|0771|ADM, PNEUMOCOCCAL VACC (IMC)|Medicare|MEDICARE A & B|||||160.36||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.25||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|NON CONTRACTED|COMMERCIAL OTHER|||||0.25||| 90833|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Medicare|MEDICARE A & B|||||1.05||| 90833|EAP|0914|PSYCH 30MIN WITH E/M SERVICES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.25||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|United Healthcare|UMR|||||5.63||| 90834|EAP|0914||United Healthcare|UMR|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|United Healthcare|UMR|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.12||| 90834|EAP|0914||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|United Healthcare|UMR|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Multiplan|GILSBAR INC|||||3.17||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Optum Behavioral Health|OPTUM|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Medicare|MEDICARE A & B|4.30||||2.12||| 90834|EAP|0914||Medicare|MEDICARE RAILROAD|||||2.12||| 90834|EAP|0914||Medicare|MEDICARE A & B|4.30||||2.12||| 90834|EAP|0915||Medicare|MEDICARE A & B|||||1.28||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|NON CONTRACTED|COMMERCIAL OTHER|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|NON CONTRACTED|COMMERCIAL OTHER|4.30||||2.12||| 90834|EAP|0914||NON CONTRACTED|COMMERCIAL OTHER|4.30||||2.12||| 90834|EAP|0914||Optum Behavioral Health|OPTUM|||||2.12||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Managed Medicaid|MOLINA MEDICAID|||||5.63||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.12||| 90834|EAP|0914||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.12||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.12||| 90834|EAP|0914||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.12||| 90834|EAP|0915||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||1.28||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.12||| 90834|EAP|0905||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Cigna|CIGNA OPEN ACCESS PLUS|4.30||||||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Cigna|CIGNA OF TN CHATTANOOGA|4.30||||||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Cigna|CIGNA BEHAVIORAL HEALTH|||||2.12||| 90834|EAP|0914||Cigna|CIGNA BEHAVIORAL HEALTH|||||2.12||| 90834|EAP|0915||NON CONTRACTED|COMMERCIAL OTHER|||||1.28||| 90834|EAP|0915||Cigna|CIGNA BEHAVIORAL HEALTH|||||1.28||| 90834|EAP|0914||Humana Behavioral Health|HUMANA BEHAVIORAL HEALTH|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Humana Behavioral Health|HUMANA BEHAVIORAL HEALTH|||||2.12||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Blue Cross PPO Select|BCBS UTHCT|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Blue Cross PPO Select|BCBS UTHCT|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Blue Cross PPO Select|BCBS UTHCT|||||2.12||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Aetna|AETNA EXXON MOBIL|||||3.17||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Medicare|MEDICARE A & B|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.12||| 90834|EAP|0914||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.12||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Medicare|MEDICARE A & B|4.30||||373.50||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||496.50||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.12||| 90834|EAP|0915||Blue Cross PPO|BCBS WALMART|||||1.28||| 90834|EAP|0914||Blue Cross PPO|BLUE CROSS PPO|4.30||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Blue Cross PPO|BLUE CROSS POS|4.30||||2.12||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Blue Cross PPO|BLUE CROSS PPO|||||5.63||| 90834|EAP|0905|INDIV PTHER, PSYCHO O/P 45MIM|Blue Cross PPO|BCBS WALMART|||||5.63||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Blue Cross PPO|BCBS TRANE PPO|4.30||||||| 90834|EAP|0914|PSYCHOTHERAPY, 45MIN W/P, FM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|4.30||||3.17||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Blue Cross PPO|BLUE CROSS PPO|4.30||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Blue Cross PPO|BCBS WALMART|||||2.12||| 90834|EAP|0914|PSYCHOTHERAPY, 45 MIN IOP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|4.30||||2.12||| 90834|EAP|0914||Blue Cross PPO|BLUE CROSS PPO|4.30||||5.63||| 90834|EAP|0914||Blue Cross PPO|BCBS WALMART|||||2.12||| 90834|EAP|0915||Blue Cross PPO|BLUE CROSS PPO|||||1.28||| 90834|EAP|0915||Blue Cross PPO|BLUE CROSS POS|||||1.28||| 90837|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Blue Cross PPO|BLUE CROSS PPO|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Blue Cross PPO|BCBS WALMART|5.63||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Blue Cross PPO|BLUE CROSS PPO|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.63||| 90837|EAP|0915||Blue Cross PPO|BLUE CROSS PPO|||||1.28||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Aetna|AETNA EXXON MOBIL|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.63||| 90837|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.63||| 90837|EAP|0513||ChampVA|CHAMPVA OF CO DENVER|||||2.50||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|ChampVA|CHAMPVA OF CO DENVER|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Cigna|CIGNA BEHAVIORAL HEALTH|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Humana Behavioral Health|HUMANA BEHAVIORAL HEALTH|||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|Blue Cross PPO Select|BCBS UTHCT|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Blue Cross PPO Select|BCBS UTHCT|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.63||| 90837|EAP|0915||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.28||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Cigna|CIGNA OPEN ACCESS PLUS|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||5.63||| 90837|EAP|0915||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||1.28||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Medicaid|MEDICAID|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Managed Medicaid|MOLINA MEDICAID|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Aetna|AETNA|||||5.63||| 90837|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicare|MEDICARE A & B|||||2.50||| 90837|EAP|0513||Medicare|MEDICARE A & B|||||2.50||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Multiplan|GILSBAR INC|||||5.63||| 90837|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Medicare|MEDICARE A & B|||||0.82||| 90837|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Medicare|MEDICARE A & B|||||4.83||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|NON CONTRACTED|COMMERCIAL OTHER|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Medicare|MEDICARE A & B|5.63||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|Medicare|MEDICARE A & B|5.63||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|Blue Cross PPO|BLUE CROSS PPO|||||5.63||| 90837|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|Medicare|MEDICARE A & B|5.63||||5.63||| 90837|EAP|0915||Medicare|MEDICARE A & B|||||1.28||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|NON CONTRACTED|COMMERCIAL OTHER|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|NON CONTRACTED|COMMERCIAL OTHER|||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.63||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|Optum Behavioral Health|OPTUM|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|United Healthcare|UMR|||||5.63||| 90837|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 90837|EAP|0914|PSYTX W PT 60 MINUTES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.63||| 90837|EAP|0914|INDIV PTHER, PSYCHO 60MIN W/PT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||5.63||| 90837|EAP|0914|INDIV PTHER,O/P PSYCHO 60MIN|United Healthcare|UMR|||||5.63||| 90846|EAP|0916|FAMILY PSYTX W/O PATIENT|Medicare|MEDICARE A & B|||||2.30||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PATIENT|Blue Cross PPO Select|BCBS UTHCT|3.57||||||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PATIENT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.57||||||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PATIENT|Blue Cross PPO|BCBS WALMART|3.57||||||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PATIENT|Blue Cross PPO|BLUE CROSS PPO|3.57||||||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PATIENT|United Healthcare|UMR|3.57||||||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PT IOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.38||| 90847|EAP|0916|FAMILY PSYCHOTHERAPY W/PATIENT|NON CONTRACTED|COMMERCIAL OTHER|3.57||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Medicare|MEDICARE RAILROAD|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Medicare|MEDICARE A & B|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Medicare|MEDICARE A & B|1.28||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Medicare|MEDICARE PART A|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|NON CONTRACTED|COMMERCIAL OTHER|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|NON CONTRACTED|COMMERCIAL OTHER 2|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Optum Behavioral Health|OPTUM|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Managed Medicaid|MOLINA MEDICAID|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Managed Medicaid|SUPERIOR STAR MCD|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Medicaid|MEDICAID|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|United Healthcare|UMR|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|PHCS|TML GRP INS|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.92||||1.92||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO|BCBS WALMART|1.28||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO|BLUE CROSS SECONDARY|||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO|BLUE CROSS PPO|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO|BLUE CROSS POS|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO|BCBS WALMART|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Multiplan|TML GRP INS|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Blue Cross PPO|BCBS TRANE PPO|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Aetna|AETNA EL PASO CLAIMS OFFICE|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.28||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Cigna|CIGNA BEHAVIORAL HEALTH|1.92||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Cigna|CIGNA OPEN ACCESS PLUS|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY (INPT)|Cigna|CIGNA OF TN CHATTANOOGA|1.92||||||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Humana Behavioral Health|HUMANA BEHAVIORAL HEALTH|||||1.28||| 90853|EAP|0915|GROUP PSYCHOTHERAPY IOP|Blue Cross PPO Select|BCBS UTHCT|1.92||||1.28||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Medicaid|MEDICAID|14,622.25|5302.03|5302.03|5302.03|||| 91110|EAP|0750|GI TRACT CAPSULE ENDOSCOPY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.98||| 91110|EAP|0750|GI TRACT CAPSULE ENDOSCOPY|Multiplan|TML GRP INS|||||19.98||| 91110|EAP|0636||Medicare|MEDICARE A & B|||||4.60||| 91110|EAP|0750|GI TRACT CAPSULE ENDOSCOPY|PHCS|TML GRP INS|||||19.98||| 91110|EAP|0636||Medicare|MEDICARE A & B|||||2.08||| 91110|EAP|0750|GI TRACT CAPSULE ENDOSCOPY|Medicare|MEDICARE A & B|||||19.98||| 91110|EAP|0258||Medicare|MEDICARE A & B|||||33.50||| 91110|EAP|0260||Medicare|MEDICARE A & B|||||669.83||| 91110|EAP|0260||Medicare|MEDICARE A & B|||||5.69||| 91110|EAP|0270||Medicare|MEDICARE A & B|||||6.30||| 91110|EAP|0270||Medicare|MEDICARE A & B|||||50.40||| 91110|EAP|0272|CATHETER; IV SHIELDED,22 GA X1|Medicare|MEDICARE A & B|||||14.70||| 91110|EAP|0272||Medicare|MEDICARE A & B|||||1,235.85||| 91110|EAP|0272||Medicare|MEDICARE A & B|||||12.60||| 91110|EAP|0251||Medicare|MEDICARE A & B|||||15.75||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Blue Cross PPO|BLUE CROSS PPO|29,321.25|29321.25|29321.25|7741.61|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Medicare|MEDICARE A & B|16,626.60|7741.61|29321.25|7741.61|||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.98||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Medicare|MEDICARE RAILROAD|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Medicare|MEDICARE A & B|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|NON CONTRACTED|COMMERCIAL OTHER|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Managed Medicaid|FAMILY PLANNING GRANT|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.98||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Managed Medicaid|FAMILY PLANNING GRANT|||||0.00||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Medicare|MEDICARE A & B|||||0.00||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Cigna|CIGNA OF TN CHATTANOOGA|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Blue Cross PPO Select|BCBS UTHCT|||||0.98||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.98||| 92227|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 92227|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Blue Cross PPO|BLUE CROSS PPO|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Blue Cross PPO|BLUE CROSS POS|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Blue Cross PPO|BCBS WALMART|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Aetna|AETNA EXXON MOBIL|||||0.98||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.98||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 92227|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 92227|EAP|0920|RETINA/FUNDUS SCREENING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.98||| 92227|EAP|0920|NO CHG RETINA/FUNDUS SCREENING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 92506|EAP|0440||Medicare|MEDICARE A & B|||||3.65||| 92506|EAP|0444|SPEECH/LANGUAGE EVALUATAION|Medicare|MEDICARE A & B|||||4.99||| 92507|EAP|0440|SPEECH THERAPY|Blue Cross PPO|BLUE CROSS PPO|||||3.47||| 92507|EAP|0440|SPEECH THERAPY|Blue Cross PPO|BLUE CROSS POS|||||3.47||| 92507|EAP|0440||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.65||| 92507|EAP|0440|SPEECH THERAPY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.47||| 92507|EAP|0440|SPEECH THERAPY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.47||| 92507|EAP|0440|SPEECH THERAPY|Medicare|MEDICARE A & B|3.47||||3.47||| 92507|EAP|0440|SPEECH THERAPY|NON CONTRACTED|COMMERCIAL OTHER|||||3.47||| 92522|EAP|0440|EVALUATION SPEECH SOUND|NON CONTRACTED|COMMERCIAL OTHER|||||2.14||| 92522|EAP|0440|EVALUATION SPEECH SOUND|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.14||| 92523|EAP|0440|EVAL SPEEC SOUND W/LAN CMP/EX|Medicaid|MEDICAID|||||4.43||| 92523|EAP|0440|EVAL SPEEC SOUND W/LAN CMP/EX|Medicare|MEDICARE A & B|||||4.43||| 92524|EAP|0440|BEH AND QUAL ANALYSIS VOICE/RE|Blue Cross PPO|BLUE CROSS PPO|||||2.10||| 92524|EAP|0440|BEH AND QUAL ANALYSIS VOICE/RE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.10||| 92524|EAP|0440|BEH AND QUAL ANALYSIS VOICE/RE|Medicare|MEDICARE A & B|2.10||||2.10||| 92526|EAP|0440|SWALLOWING THERAPY, ST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.19||| 92526|EAP|0440|SWALLOWING THERAPY, ST|Medicare|MEDICARE A & B|||||2.19||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.46||||||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.46||||||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.46||||3.46||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.46||||||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Blue Cross PPO|BLUE CROSS PPO|3.46||||3.46||| 92610|EAP|0430||Medicare|MEDICARE A & B|||||1.32||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Medicare|MEDICARE A & B|3.46||||3.46||| 92610|EAP|0440|SPEECH SOUND LANG COMPREHEN|Medicare|MEDICARE A & B|3.46||||3.65||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.46||||3.46||| 92610|EAP|0440|SWALLOWING FUNCTION EVALUATION|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.46||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Medicare|MEDICARE A & B|5.00||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Blue Cross PPO|BLUE CROSS PPO|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Blue Cross PPO|BLUE CROSS POS|5.00||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Blue Cross PPO|BCBS WALMART|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.00||| 92611|EAP|0444|MOTION FLOURO/SWALLOW, CINE OR|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.00||| 92950|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 92950|EAP|0450|CPR/CODE 44|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.82||| 92950|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 92950|EAP|0450|CPR/CODE 44|Medicare|MEDICARE A & B|||||14.82||| 92950|EAP|0450||Medicare|MEDICARE A & B|||||7.69||| 92950|EAP|0450|CPR/CODE 44|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||14.82||| 92960|EAP|0480|CARDIOVERSION ELECTRIC EXXT|Medicare|MEDICARE A & B|3.29||||||| 92960|EAP|0480|CARDIOVERSION ELECTRIC EXXT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.29||| 92960|EAP|0480|CARDIOVERSION ELECTRIC EXXT|Humana Medicare Advantage|HUMANA MEDICARE PPO|12.93||||3.29||| 93000|EAP|0730|EKG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.80||||||| 93005|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|ChampVA|CHAMPVA OF CO DENVER|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Cigna|NALC HLTH BENEFIT|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Cigna|CIGNA OTHER|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Cigna|CIGNA OPEN ACCESS PLUS|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Cigna|CIGNA OF TN CHATTANOOGA|||||3.86||| 93005|EAP|0730|ECG - 12 LEAD|Cigna|CIGNA OPEN ACCESS PLUS|||||3.86||| 93005|EAP|0730||Cigna|CIGNA OF TN CHATTANOOGA|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross PPO Select|BCBS UTHCT|3.86||||3.86||| 93005|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| 93005|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 93005|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 93005|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.86||||3.86||| 93005|EAP|0730|ECG - 12 LEAD|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.86||||3.86||| 93005|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.86||||3.86||| 93005|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 93005|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| 93005|EAP|0771||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||160.36||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|3.86||||||| 93005|EAP|0730|ECG - 12 LEAD|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|3.86||||||| 93005|EAP|0636||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.55||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.99||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 93005|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.50||| 93005|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.09||| 93005|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.38||| 93005|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 93005|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 93005|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 93005|EAP|0921||Blue Cross PPO|BLUE CROSS PPO|||||4.26||| 93005|EAP|0370||Blue Cross PPO|BLUE CROSS PPO|||||7.02||| 93005|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||21.30||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross PPO|BLUE CROSS PPO|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross PPO|BLUE CROSS POS|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross PPO|BCBS TRANE PPO|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|3.86||||3.86||| 93005|EAP|0730|ECG - 12 LEAD|Blue Cross PPO|BLUE CROSS PPO|3.86||||3.86||| 93005|EAP|0730||Blue Cross PPO|BLUE CROSS POS|3.86||||3.86||| 93005|EAP|0750||Blue Cross PPO|BLUE CROSS PPO|||||20.18||| 93005|EAP|0999||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 93005|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 93005|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 93005|EAP|0510||Aetna|AETNA|||||2.50||| 93005|EAP|0730|ECG - 12 LEAD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Aetna|AETNA EXXON MOBIL|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Aetna|AETNA EL PASO CLAIMS OFFICE|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Aetna|AETNA|||||3.86||| 93005|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 93005|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| 93005|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| 93005|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 93005|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.86||||3.86||| 93005|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 93005|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 93005|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.06||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Workers Compensation|WC OTHER|||||3.86||| 93005|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.86||||3.86||| 93005|EAP|0510||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.99||| 93005|EAP|0510||United Healthcare|UMR|||||2.50||| 93005|EAP|0350||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.79||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|United Healthcare|UMR|3.86||||3.86||| 93005|EAP|0730||United Healthcare|UMR|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|United Healthcare|GOLDEN RULE INSURANCE|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|PHCS|WEB TPA|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|PHCS|TML GRP INS|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|3.86||||3.86||| 93005|EAP|0730|ECG - 12 LEAD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.86||||3.86||| 93005|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.86||||3.86||| 93005|EAP|0981||United Healthcare|GOLDEN RULE INSURANCE|||||0.00||| 93005|EAP|0981|ER VISIT; LEVEL IV|Medicare|MEDICARE RAILROAD|||||0.00||| 93005|EAP|0981||Medicare|MEDICARE PART A|||||0.00||| 93005|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Medicare|MEDICARE A & B|||||0.70||| 93005|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 93005|EAP|0510||Medicare|MEDICARE RAILROAD|||||3.26||| 93005|EAP|0510||Medicare|MEDICARE A & B|||||3.79||| 93005|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 93005|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 93005|EAP|0730|ECG - 12 LEAD|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.86||||3.86||| 93005|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| 93005|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 93005|EAP|0510||Medicare|MEDICARE A & B|||||2.09||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|NON CONTRACTED|BOONE CHAPMAN|||||3.86||| 93005|EAP|0320||Medicare|MEDICARE RAILROAD|||||3.69||| 93005|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||11.55||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Multiplan|WEB TPA|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Multiplan|TML GRP INS|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Multiplan|GILSBAR INC|||||3.86||| 93005|EAP|0730|ECG - 12 LEAD|Optum Behavioral Health|OPTUM|3.86||||||| 93005|EAP|0450||Medicare|MEDICARE A & B|||||4.15||| 93005|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE RAILROAD|||||2.10||| 93005|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE RAILROAD|||||669.83||| 93005|EAP|0450|ACUITY POINT 10|Medicare|MEDICARE RAILROAD|||||0.00||| 93005|EAP|0450|IV INFUSION THER,EA ADD'L HR|Medicare|MEDICARE RAILROAD|||||3.45||| 93005|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Medicare|MEDICARE RAILROAD|||||11.19||| 93005|EAP|0450|ACUITY POINT 7|Medicare|MEDICARE RAILROAD|||||0.00||| 93005|EAP|0450|ACUITY POINT 5|Medicare|MEDICARE RAILROAD|||||0.00||| 93005|EAP|0730|ECG - 12 LEAD|Aetna|AETNA EL PASO CLAIMS OFFICE|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Aetna|TRS COORDINATED CARE|||||3.86||| 93005|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| 93005|EAP|0450|ACUITY POINT 15|Medicare|MEDICARE RAILROAD|||||0.00||| 93005|EAP|0450||Medicare|MEDICARE A & B|||||5.69||| 93005|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Medicare|MEDICARE RAILROAD|||||47.45||| 93005|EAP|0636||Medicare|MEDICARE A & B|||||11.50||| 93005|EAP|0730|ECG RYTHM STRIP|Medicare|MEDICARE RAILROAD|3.86||||1.82||| 93005|EAP|0730|ECG - 12 LEAD|Medicare|MEDICARE A & B|3.86||||3.86||| 93005|EAP|0730||Medicare|MEDICARE A & B|3.86||||3.86||| 93005|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Blue Cross PPO|BCBS WALMART|3.86||||3.86||| 93005|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 93005|EAP|0459||Medicare|MEDICARE A & B|||||3.00||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicare|MEDICARE RAILROAD|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicare|MEDICARE PART B|||||3.86||| 93005|EAP|0370||Blue Cross PPO|BLUE CROSS PPO|||||1.76||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicare|MEDICARE PART A|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicare|MEDICARE A & B|3.86||||3.86||| 93005|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.86||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|NON CONTRACTED|MRAMVA|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|NON CONTRACTED|PPO OTHER|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|NON CONTRACTED|COMMERCIAL OTHER|3.86||||3.86||| 93005|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|||||213.82||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 93005|EAP|0257|ASPIRIN 81mg TAB PO|Medicare|MEDICARE RAILROAD|||||0.65||| 93005|EAP|0307||Medicare|MEDICARE RAILROAD|||||0.69||| 93005|EAP|0272|IMED NITRO TUBING (ER)|Medicare|MEDICARE RAILROAD|||||17.85||| 93005|EAP|0272|IV CATH 18 GA X 1.25 (ER)|Medicare|MEDICARE RAILROAD|||||5.25||| 93005|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 93005|EAP|0272|EXTENSION MICROBORE (JLOOP)|Medicare|MEDICARE RAILROAD|||||0.07||| 93005|EAP|0272|IV START KIT (ER)|Medicare|MEDICARE RAILROAD|||||5.25||| 93005|EAP|0300||Medicare|MEDICARE A & B|||||0.09||| 93005|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 93005|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 93005|EAP|0305||Medicare|MEDICARE RAILROAD|||||1.22||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||3.51||| 93005|EAP|0301||Medicare|MEDICARE RAILROAD|||||2.21||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||1.22||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|SUPERIOR STAR MCD|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.86||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|MOLINA MEDICAID|||||3.86||| 93005|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.26||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|FAMILY PLANNING GRANT|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.86||||3.86||| 93005|EAP|0730||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.86||||3.86||| 93005|EAP|0305||Medicare|MEDICARE A & B|||||0.78||| 93005|EAP|0730||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||1.29||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| 93005|EAP|0301||Medicare|MEDICARE RAILROAD|||||3.14||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||1.75||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||2.36||| 93005|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 93005|EAP|0301||Medicare|MEDICARE RAILROAD|||||3.51||| 93005|EAP|0301||Medicare|MEDICARE RAILROAD|||||1.68||| 93005|EAP|0301||Medicare|MEDICARE RAILROAD|||||2.59||| 93005|EAP|0301||Medicare|MEDICARE RAILROAD|||||0.19||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.86||| 93005|EAP|0730|ECG, ROUTINE, 12-LEAD|Medicaid|MEDICAID|3.86||||3.86||| 93005|EAP|0981||Medicaid|MEDICAID|||||0.00||| 93005|EAP|0305||Medicare|MEDICARE RAILROAD|||||1.68||| 93005|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| 93005|EAP|0305||Medicare|MEDICARE A & B|||||1.55||| 93005|EAP|0250|NITROGLYCERIN COMP SYR 1000MCG|Medicare|MEDICARE RAILROAD|||||74.90||| 93005|EAP|0251||Medicare|MEDICARE RAILROAD|||||3.15||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Medicare|MEDICARE A & B|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|NON CONTRACTED|COMMERCIAL OTHER|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|United Healthcare|UMR|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Veterans Affairs|VETERANS CHOICE - TRI WEST|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Aetna|AETNA EL PASO CLAIMS OFFICE|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Blue Cross PPO|BLUE CROSS PPO|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Blue Cross PPO|BCBS WALMART|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Medicaid|MEDICAID|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Blue Cross PPO|BLUE CROSS POS|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Humana Medicare Advantage|HUMANA MEDICARE PPO|13.03||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|ChampVA|CHAMPVA OF CO DENVER|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Cigna|CIGNA OF TN CHATTANOOGA|||||13.03||| 93017|EAP|0482|STRESS GRADED EX TEST - CARDIO|Blue Cross PPO Select|BCBS UTHCT|||||13.03||| 93041|EAP|0730|ECG RYTHM STRIP|Cigna|CIGNA OPEN ACCESS PLUS|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Cigna|CIGNA OF TN CHATTANOOGA|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross PPO Select|BCBS UTHCT|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.82||| 93041|EAP|0730|ECG RHYTHM STRIP|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.82||||1.52||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross PPO|BLUE CROSS PPO|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross PPO|BLUE CROSS POS|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross PPO|BCBS WALMART|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross PPO|BCBS TRANE PPO|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Aetna|AETNA US HEALTHCARE PA|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Aetna|AETNA EL PASO CLAIMS OFFICE|1.82||||1.82||| 93041|EAP|0730|ECG RHYTHM STRIP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.82||||1.52||| 93041|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 93041|EAP|0730|ECG RYTHM STRIP|Workers Compensation|WC OTHER|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|United Healthcare|UMR|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|United Healthcare|GOLDEN RULE INSURANCE|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|PHCS|WEB TPA|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|PHCS|TML GRP INS|1.82||||||| 93041|EAP|0730|ECG RYTHM STRIP|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.82||| 93041|EAP|0730|ECG RHYTHM STRIP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.82||||1.52||| 93041|EAP|0730|ECG RYTHM STRIP|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.82||||1.82||| 93041|EAP|0981||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.00||| 93041|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 93041|EAP|0730|ECG RYTHM STRIP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Medicare|MEDICARE PART A|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Multiplan|TML GRP INS|1.82||||||| 93041|EAP|0730|ECG RYTHM STRIP|Multiplan|WEB TPA|||||1.82||| 93041|EAP|0450||Medicare|MEDICARE A & B|||||5.51||| 93041|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 93041|EAP|0450||Medicare|MEDICARE A & B|||||181.41||| 93041|EAP|0450||Medicare|MEDICARE A & B|||||1.14||| 93041|EAP|0730|ECG RYTHM STRIP|Medicare|MEDICARE A & B|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Medicare|MEDICARE RAILROAD|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|ChampVA|CHAMPVA OF CO DENVER|1.82||||1.82||| 93041|EAP|0730|ECG RHYTHM STRIP|Medicare|MEDICARE A & B|1.52||||1.52||| 93041|EAP|0730|ECG RYTHM STRIP|NON CONTRACTED|MRAMVA|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|NON CONTRACTED|COMMERCIAL OTHER 2|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|NON CONTRACTED|COMMERCIAL OTHER|1.82||||1.82||| 93041|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 93041|EAP|0730|ECG RYTHM STRIP|Managed Medicaid|SUPERIOR STAR MCD|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Managed Medicaid|OTHER MEDICAID|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Managed Medicaid|MOLINA MEDICAID|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Managed Medicaid|MEDICAID CSHCN|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.82||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.82||| 93041|EAP|0730|ECG RYTHM STRIP|Medicaid|MEDICAID|1.82||||1.82||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Medicaid|MEDICAID|||||9.15||| 93225|EAP|0402||Medicare|MEDICARE A & B|||||4.59||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Medicare|MEDICARE A & B|||||9.15||| 93225|EAP|0730||Medicare|MEDICARE A & B|||||1.65||| 93225|EAP|0731|AMB ECG UP TO HR48 MONITOR-DY|Medicare|MEDICARE A & B|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|NON CONTRACTED|COMMERCIAL OTHER|||||9.15||| 93225|EAP|0320||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.06||| 93225|EAP|0731|AMB ECG UP TO HR48 MONITOR-DY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.15||| 93225|EAP|0730||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.65||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.15||| 93225|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.65||| 93225|EAP|0731|AMB ECG UP TO HR48 MONITOR-DY|Blue Cross PPO|BLUE CROSS PPO|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Blue Cross PPO|BLUE CROSS PPO|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Blue Cross PPO|BLUE CROSS POS|||||9.15||| 93225|EAP|0731|AMB ECG UP TO HR48 MONITOR-DY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.15||| 93225|EAP|0731|AMB ECG MONITOR - 48 HOURS|Blue Cross PPO Select|BCBS UTHCT|||||9.15||| 93279|EAP|0480|PMDEVICE PROGR EVAL SNGL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.67||| 93279|EAP|0480|PMDEVICE PROGR EVAL SNGL|Medicare|MEDICARE A & B|||||0.67||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|PHCS|WEB TPA|||||3.22||| 93280|EAP|0510||PHCS|WEB TPA|||||2.50||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Medicaid|MEDICAID|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Multiplan|WEB TPA|||||3.22||| 93280|EAP|0510||Multiplan|WEB TPA|||||2.50||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Medicare|MEDICARE A & B|||||3.22||| 93280|EAP|0480||Medicare|MEDICARE A & B|||||3.22||| 93280|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.22||| 93280|EAP|0480|PACER, DUAL W/PROGRAMMING|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.22||| 93282|EAP|0480|ICD DEVICE PROG EVAL, 1 SNGL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.40||| 93283|EAP|0480|ICD DEVICE PROGR EVAL DUAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.40||| 93283|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| 93283|EAP|0480|ICD DEVICE PROGR EVAL DUAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.40||| 93283|EAP|0480|ICD DEVICE PROGR EVAL DUAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.40||| 93283|EAP|0480|ICD DEVICE PROGR EVAL DUAL|Medicare|MEDICARE A & B|||||0.40||| 93283|EAP|0480|ICD DEVICE PROGR EVAL DUAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.40||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Veterans Affairs|VETERANS CHOICE - TRI WEST|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|United Healthcare|UMR|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|PHCS|TML GRP INS|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||14.21||| 93306|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Multiplan|TML GRP INS|||||14.21||| 93306|EAP|0636||Medicare|MEDICARE A & B|||||0.55||| 93306|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Medicare|MEDICARE RAILROAD|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Medicare|MEDICARE PART A|14.21||||||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Medicare|MEDICARE A & B|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|NON CONTRACTED|COMMERCIAL OTHER|14.21||||14.21||| 93306|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|ChampVA|CHAMPVA OF CO DENVER|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Cigna|NALC HLTH BENEFIT|14.21||||||| 93306|EAP|0402||Medicare|MEDICARE A & B|||||8.48||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Cigna|CIGNA OPEN ACCESS PLUS|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Cigna|CIGNA OF TN CHATTANOOGA|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Medicaid|MEDICAID|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross PPO Select|BCBS UTHCT|||||14.21||| 93306|EAP|0921||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.22||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||14.21||| 93306|EAP|0921||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.26||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Managed Medicaid|MOLINA MEDICAID|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross PPO|BCBS WALMART|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross PPO|BLUE CROSS POS|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross PPO|BLUE CROSS PPO|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross PPO|BCBS TRANE PPO|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|14.21||||14.21||| 93306|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Aetna|AETNA EXXON MOBIL|||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Aetna|AETNA EL PASO CLAIMS OFFICE|14.21||||14.21||| 93306|EAP|0483|TTE W/DOPPLER, COMPLETE|Aetna|AETNA|||||14.21||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.33||| 93308|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Blue Cross PPO|BLUE CROSS PPO|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Cigna|CIGNA OF TN CHATTANOOGA|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Blue Cross PPO Select|BCBS UTHCT|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Medicare|MEDICARE A & B|8.33||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|NON CONTRACTED|COMMERCIAL OTHER|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||8.33||| 93308|EAP|0480|ECHOCARDIOGRAPHY, LIMIT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||8.33||| 93312|EAP|0483|ECHO; W/WO MODE TRANSESOPHAGEA|Medicare|MEDICARE A & B|22.29||||||| 93312|EAP|0483|ECHO; W/WO MODE TRANSESOPHAGEA|Humana Medicare Advantage|HUMANA MEDICARE PPO|22.29||||||| 93312|EAP|0483|ECHO; W/WO MODE TRANSESOPHAGEA|Blue Cross PPO|BLUE CROSS PPO|22.29||||||| 93312|EAP|0483|ECHO; W/WO MODE TRANSESOPHAGEA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||22.29||| 93350|EAP|0480|STRESS ECHO; EXERCISE|Medicare|MEDICARE A & B|||||17.30||| 93351|EAP|0483|STRESS TTE COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||12.06||| 93351|EAP|0483|STRESS TTE COMPLETE|Medicare|MEDICARE A & B|||||12.06||| 93880|EAP|0402|CAROTID DOPPLER BIL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.59||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|United Healthcare|UMR|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.58||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||18.58||| 93880|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 93880|EAP|0402|CAROTID DOPPLER BIL|Medicare|MEDICARE A & B|||||4.59||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Medicare|MEDICARE A & B|18.58||||18.58||| 93880|EAP|0402|CAROTID DOPPLER BIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.59||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Blue Cross PPO|BLUE CROSS PPO|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||18.58||| 93880|EAP|0402|CAROTID DOPPLER BIL|Blue Cross PPO|BLUE CROSS POS|||||4.59||| 93880|EAP|0402|CAROTID DOPPLER BIL|Blue Cross PPO|BLUE CROSS PPO|||||4.59||| 93880|EAP|0402|CAROTID DOPPLER BIL|Blue Cross PPO Select|BCBS UTHCT|||||4.59||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Cigna|CIGNA OF TN CHATTANOOGA|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Blue Cross PPO Select|BCBS UTHCT|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||18.58||| 93880|EAP|0921|US DOPPLER CAROTIDS, BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|18.58||||18.58||| 93880|EAP|0402|CAROTID DOPPLER BIL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.59||| 93880|EAP|0402|CAROTID DOPPLER BIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.59||| 93880|EAP|0402|CAROTID DOPPLER BIL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.59||| 93880|EAP|0402|CAROTID DOPPLER BIL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.59||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|ChampVA|CHAMPVA OF CO DENVER|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Cigna|CIGNA OF TN CHATTANOOGA|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Cigna|CIGNA OPEN ACCESS PLUS|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Blue Cross PPO Select|BCBS UTHCT|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Blue Cross PPO|BLUE CROSS PPO|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Blue Cross PPO|BLUE CROSS POS|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.26||| 93922|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.26||| 93922|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|NON CONTRACTED|COMMERCIAL OTHER|4.26||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Medicare|MEDICARE A & B|4.26||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|United Healthcare|UMR|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.26||| 93922|EAP|0921|PVD, ANKLE/BRACH INDEX, TCP02|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.26||| 93923|EAP|0921|PVD ASMT UPPER OR LOWER WITHOU|Medicare|MEDICARE A & B|||||6.22||| 93923|EAP|0921|PVD ASMT UPPER OR LOWER WITHOU|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.22||| 93925|EAP|0921|DUPLEX LOWR EXT ART/BYP;COMP B|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||26.76||| 93925|EAP|0920||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.89||| 93925|EAP|0921|DUPLEX LOWR EXT ART/BYP;COMP B|Aetna|AETNA EL PASO CLAIMS OFFICE|||||26.76||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.32||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|ChampVA|CHAMPVA OF CO DENVER|||||9.32||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|Cigna|CIGNA OTHER|||||9.32||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.32||| 93925|EAP|0921|DUPLEX LOWR EXT ART/BYP;COMP B|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||26.76||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.32||| 93925|EAP|0921|DUPLEX LOWR EXT ART/BYP;COMP B|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||26.76||| 93925|EAP|0921|DUPLEX LOWR EXT ART/BYP;COMP B|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||26.76||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|NON CONTRACTED|COMMERCIAL OTHER|||||9.32||| 93925|EAP|0920|US ARTERIAL DUP LWR EXT BIL|Medicare|MEDICARE A & B|||||9.32||| 93925|EAP|0921|DUPLEX LOWR EXT ART/BYP;COMP B|Medicare|MEDICARE A & B|26.76||||26.76||| 93926|EAP|0402|US ARTERIAL DUP LWR DVT UNILAT|Medicare|MEDICARE A & B|||||5.42||| 93926|EAP|0921|DUPLEX LOWR EXT ART/BYP;UNI/L|NON CONTRACTED|COMMERCIAL OTHER|||||16.76||| 93926|EAP|0921|DUPLEX LOWR EXT ART/BYP;UNI/L|Medicare|MEDICARE A & B|||||16.76||| 93926|EAP|0300||Medicare|MEDICARE A & B|||||0.09||| 93926|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 93926|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| 93926|EAP|0921|DUPLEX LOWR EXT ART/BYP;UNI/L|Managed Medicaid|SUPERIOR STAR MCD|||||16.76||| 93926|EAP|0921|DUPLEX LOWR EXT ART/BYP;UNI/L|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||16.76||| 93926|EAP|0402|US ARTERIAL DUP LWR DVT UNILAT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.42||| 93926|EAP|0402|US ARTERIAL DUP LWR DVT UNILAT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.42||| 93926|EAP|0921|DUPLEX LOWR EXT ART/BYP;UNI/L|Blue Cross PPO|BLUE CROSS PPO|||||16.76||| 93926|EAP|0402|US ARTERIAL DUP LWR DVT UNILAT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.42||| 93926|EAP|0921|DUPLEX LOWR EXT ART/BYP;UNI/L|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||16.76||| 93926|EAP|0402|US ARTERIAL DUP LWR DVT UNILAT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.42||| 93931|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 93970|EAP|0402|EXT VEN LOWER DVT BIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|27.00||||27.00||| 93970|EAP|0920|VENOUS REFLUX BIL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.89||| 93970|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 93970|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Blue Cross PPO|BCBS TRANE PPO|||||27.00||| 93970|EAP|0920|VENOUS REFLUX BIL|Blue Cross PPO|BLUE CROSS PPO|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|Blue Cross PPO|BLUE CROSS POS|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Blue Cross PPO|BLUE CROSS PPO|27.00||||27.00||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Blue Cross PPO|BCBS WALMART|||||27.00||| 93970|EAP|0921||Blue Cross PPO|BLUE CROSS PPO|27.00||||27.00||| 93970|EAP|0402|EXT VEN LOWER DVT BIL|Cigna|CIGNA OTHER|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|ChampVA|CHAMPVA OF CO DENVER|||||27.00||| 93970|EAP|0920|VENOUS REFLUX BIL|Cigna|CIGNA OF TN CHATTANOOGA|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|Blue Cross PPO Select|BCBS UTHCT|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|27.00||||27.00||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Blue Cross PPO Select|BCBS UTHCT|||||27.00||| 93970|EAP|0402|EXT VEN LOWER DVT BIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|United Healthcare|UMR|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|United Healthcare|UMR|27.00||||27.00||| 93970|EAP|0920|VENOUS REFLUX BIL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||27.00||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|27.00||||27.00||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|27.00||||||| 93970|EAP|0920|VENOUS REFLUX BIL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||6.89||| 93970|EAP|0301||Medicare|MEDICARE A & B|||||0.38||| 93970|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 93970|EAP|0301||Medicare|MEDICARE A & B|||||0.00||| 93970|EAP|0920|VENOUS REFLUX BIL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||6.89||| 93970|EAP|0921||Blue Cross PPO|BLUE CROSS POS|||||27.00||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Aetna|AETNA EL PASO CLAIMS OFFICE|27.00||||27.00||| 93970|EAP|0301||Medicare|MEDICARE A & B|||||0.30||| 93970|EAP|0301||Medicare|MEDICARE A & B|||||0.96||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Medicaid|MEDICAID|27.00||||27.00||| 93970|EAP|0920|VENOUS REFLUX BIL|Managed Medicaid|FAMILY PLANNING GRANT|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.00||| 93970|EAP|0921||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.00||| 93970|EAP|0402|EXT VEN LOWER DVT BIL|Medicare|MEDICARE A & B|||||6.89||| 93970|EAP|0920|VENOUS REFLUX BIL|NON CONTRACTED|COMMERCIAL OTHER|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|NON CONTRACTED|BOONE CHAPMAN|||||27.00||| 93970|EAP|0920|VENOUS REFLUX BIL|Medicare|MEDICARE A & B|||||6.89||| 93970|EAP|0920||Medicare|MEDICARE A & B|||||6.89||| 93970|EAP|0921|US EXTREMITY VENOUS, BILATERAL|Medicare|MEDICARE A & B|27.00||||27.00||| 93970|EAP|0921||Medicare|MEDICARE A & B|27.00||||27.00||| 93971|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Medicare|MEDICARE A & B|18.54||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Medicare|MEDICARE PART A|18.54||||||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|NON CONTRACTED|COMMERCIAL OTHER|||||18.54||| 93971|EAP|0921|EXT DVT US|Medicare|MEDICARE A & B|18.54||||4.16||| 93971|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Medicaid|MEDICAID|||||18.54||| 93971|EAP|0981||Medicaid|MEDICAID|||||0.00||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Managed Medicaid|SUPERIOR STAR MCD|||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||18.54||| 93971|EAP|0921|EXT DVT US|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.16||| 93971|EAP|0510||Workers Compensation|WC OTHER|||||2.50||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Workers Compensation|WC OTHER|||||18.54||| 93971|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 93971|EAP|0921|EXT DVT US|United Healthcare|UMR|||||4.16||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.54||||18.54||| 93971|EAP|0921|EXT DVT US|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.16||| 93971|EAP|0921|EXT DVT US|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.54||||4.16||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Humana Medicare Advantage|HUMANA MEDICARE PPO|18.54||||18.54||| 93971|EAP|0921|EXT DVT US|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.16||| 93971|EAP|0921|EXT DVT US|Humana Medicare Advantage|HUMANA MEDICARE PPO|18.54||||4.16||| 93971|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 93971|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 93971|EAP|0921|EXT DVT US|ChampVA|CHAMPVA OF CO DENVER|||||4.16||| 93971|EAP|0921|EXT DVT US|Cigna|CIGNA OF TN CHATTANOOGA|||||4.16||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Blue Cross PPO Select|BCBS UTHCT|||||18.54||| 93971|EAP|0402|EXT DVT US|Medicare|MEDICARE A & B|||||4.16||| 93971|EAP|0921|EXT DVT US|Blue Cross PPO Select|BCBS UTHCT|||||4.16||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Blue Cross PPO|BLUE CROSS PPO|18.54||||18.54||| 93971|EAP|0921|EXT DVT US|Blue Cross PPO|BLUE CROSS PPO|18.54||||4.16||| 93971|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 93971|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 93971|EAP|0921|EXT DVT US|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|18.54||||4.16||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Aetna|AETNA EL PASO CLAIMS OFFICE|||||18.54||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Aetna|AETNA|||||18.54||| 93971|EAP|0921|EXT DVT US|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.16||| 93971|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 93971|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 93971|EAP|0921|US EXTREMITY VENOUS, UNILATERA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|18.54||||18.54||| 93971|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 93971|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.33||| 93971|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 93975|EAP|0920|VASCULAR STUDY, INTERP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.18||| 93975|EAP|0920|VASCULAR STUDY, INTERP|Blue Cross PPO|BLUE CROSS PPO|||||6.18||| 93975|EAP|0402|RENAL ART DOPPLER; COMPLETE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.99||| 93975|EAP|0402|RENAL ART DOPPLER; COMPLETE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.99||| 93975|EAP|0920|VASCULAR STUDY, INTERP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.18||| 93975|EAP|0920|VASCULAR STUDY, INTERP|Medicare|MEDICARE A & B|||||6.18||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|Managed Medicaid|MOLINA MEDICAID|||||16.53||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||16.53||| 93976|EAP|0402|RENAL ART DOPPLER|Medicare|MEDICARE A & B|||||3.74||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|NON CONTRACTED|COMMERCIAL OTHER|||||16.53||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|Medicare|MEDICARE A & B|16.53||||16.53||| 93976|EAP|0402|RENAL ART DOPPLER|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.74||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||16.53||| 93976|EAP|0402|RENAL ART DOPPLER|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.74||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||16.53||| 93976|EAP|0402|RENAL ART DOPPLER|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.74||| 93976|EAP|0402|RENAL ART DOPPLER|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.74||| 93976|EAP|0402|RENAL ART DOPPLER|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.74||| 93976|EAP|0402|RENAL ART DOPPLER|Blue Cross PPO|BLUE CROSS PPO|||||3.74||| 93976|EAP|0402|RENAL ART DOPPLER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.74||| 93976|EAP|0921|RENAL ARTERY DOPPLER ULTRASOUN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||16.53||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.41||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||6.41||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|ChampVA|CHAMPVA OF CO DENVER|||||6.41||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.41||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6.41||| 93978|EAP|0402|AORTIC ILIAC/ARTER DUPLEX|Medicare|MEDICARE A & B|||||6.41||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|Medicare|MEDICARE A & B|||||6.41||| 93978|EAP|0402||Medicare|MEDICARE A & B|||||6.41||| 93978|EAP|0402|AORTA/ILIAC/IVC/BYPASS COMPL|NON CONTRACTED|COMMERCIAL OTHER|||||6.41||| 93978|EAP|0921|US ABDOMINAL DOPPLER/BYPASS GR|Medicare|MEDICARE A & B|||||15.00||| 94002|EAP|0410||NON CONTRACTED|COMMERCIAL OTHER|||||21.68||| 94002|EAP|0410|VENT SUPPORT INITATION|Medicare|MEDICARE PART A|21.68||||||| 94002|EAP|0410||Medicare|MEDICARE A & B|21.68||||21.68||| 94002|EAP|0410||Managed Medicaid|MOLINA MEDICAID|||||21.68||| 94002|EAP|0410||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21.68||||21.68||| 94002|EAP|0410||Humana Medicare Advantage|HUMANA MEDICARE PPO|21.68||||21.68||| 94002|EAP|0410|VENT SUPPORT INITATION|Blue Cross PPO|BLUE CROSS PPO|21.68||||||| 94002|EAP|0410|VENT SUPPORT INITATION|Aetna|AETNA EL PASO CLAIMS OFFICE|21.68||||||| 94003|EAP|0410|VENTILATION PER DAY|Aetna|AETNA EL PASO CLAIMS OFFICE|16.64||||||| 94003|EAP|0410|VENTILATION PER DAY|Blue Cross PPO|BLUE CROSS PPO|16.64||||||| 94003|EAP|0410|VENTILATION PER DAY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|16.64||||||| 94003|EAP|0410|VENTILATION PER DAY|Managed Medicaid|MOLINA MEDICAID|||||16.64||| 94003|EAP|0410|VENTILATION PER DAY|Humana Medicare Advantage|HUMANA MEDICARE PPO|16.64||||16.64||| 94003|EAP|0410|VENTILATION PER DAY|Medicare|MEDICARE PART A|16.64||||||| 94003|EAP|0410||Medicare|MEDICARE A & B|16.64||||16.64||| 94010|EAP|0460|SPIROMETRY|Workers Compensation|WC OTHER|||||4.74||| 94010|EAP|0460|SPIROMETRY BREATHING CAPACITY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.65||| 94010|EAP|0460|SPIROMETRY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.74||| 94010|EAP|0460|SPIROMETRY|United Healthcare|UMR|||||4.74||| 94010|EAP|0460|SPIROMETRY|PHCS|WEB TPA|||||4.74||| 94010|EAP|0510||United Healthcare|UMR|||||2.64||| 94010|EAP|0460|SPIROMETRY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.74||| 94010|EAP|0460|SPIROMETRY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.74||| 94010|EAP|0460||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.74||| 94010|EAP|0460|SPIROMETRY|Medicaid|MEDICAID|4.74||||4.74||| 94010|EAP|0510||Medicaid|MEDICAID|||||2.64||| 94010|EAP|0510||Medicare|MEDICARE A & B|||||3.79||| 94010|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 94010|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 94010|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 94010|EAP|0460|SPIROMETRY|Multiplan|WEB TPA|||||4.74||| 94010|EAP|0460|SPIROMETRY|NON CONTRACTED|COMMERCIAL OTHER|||||4.74||| 94010|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 94010|EAP|0460|SPIROMETRY BREATHING CAPACITY|Medicare|MEDICARE RAILROAD|||||3.65||| 94010|EAP|0460|SPIROMETRY|Medicare|MEDICARE RAILROAD|||||4.74||| 94010|EAP|0460|SPIROMETRY|Medicare|MEDICARE PART A|4.74||||4.74||| 94010|EAP|0460|SPIROMETRY|Medicare|MEDICARE A & B|4.74||||4.74||| 94010|EAP|0460|SPIROMETRY|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.74||| 94010|EAP|0460|SPIROMETRY|NON CONTRACTED|PPO OTHER|||||4.74||| 94010|EAP|0460|SPIROMETRY|ChampVA|CHAMPVA OF CO DENVER|||||4.74||| 94010|EAP|0460|SPIROMETRY|Cigna|NALC HLTH BENEFIT|||||4.74||| 94010|EAP|0460|SPIROMETRY|Cigna|CIGNA OPEN ACCESS PLUS|||||4.74||| 94010|EAP|0460|SPIROMETRY|Cigna|CIGNA OF TN CHATTANOOGA|||||4.74||| 94010|EAP|0460|SPIROMETRY|Cigna|CIGNA BEHAVIORAL HEALTH|||||4.74||| 94010|EAP|0510||Cigna|CIGNA BEHAVIORAL HEALTH|||||2.64||| 94010|EAP|0460|SPIROMETRY|Blue Cross PPO Select|BCBS UTHCT|||||4.74||| 94010|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 94010|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 94010|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| 94010|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| 94010|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 94010|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| 94010|EAP|0460|SPIROMETRY|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||4.74||| 94010|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 94010|EAP|0460|SPIROMETRY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.74||| 94010|EAP|0460|SPIROMETRY|Managed Medicaid|OTHER MEDICAID|||||4.74||| 94010|EAP|0460|SPIROMETRY BREATHING CAPACITY|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.74||||3.65||| 94010|EAP|0460|SPIROMETRY|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.74||||4.74||| 94010|EAP|0460|SPIROMETRY|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.74||| 94010|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|4.74||||4.74||| 94010|EAP|0460||Medicare|MEDICARE A & B|4.74||||4.74||| 94010|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|4.74||||2.82||| 94010|EAP|0460||Humana Medicare Advantage|HUMANA MEDICARE PPO|4.74||||2.35||| 94010|EAP|0460|SPIROMETRY BREATHING CAPACITY|Managed Medicaid|MOLINA MEDICAID|||||3.65||| 94010|EAP|0460|SPIROMETRY|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.74||| 94010|EAP|0460|SPIROMETRY BREATHING CAPACITY|Medicare|MEDICARE A & B|4.74||||3.65||| 94010|EAP|0460|SPIROMETRY|Managed Medicaid|MOLINA MEDICAID|||||4.74||| 94010|EAP|0460|SPIROMETRY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|4.74||||4.74||| 94010|EAP|0460||Managed Medicaid|MEDICAID CSHCN|||||4.74||| 94010|EAP|0510||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| 94010|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 94010|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 94010|EAP|0460|SPIROMETRY|Managed Medicaid|MEDICAID CSHCN|||||4.74||| 94010|EAP|0460|SPIROMETRY|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||4.74||| 94010|EAP|0460|SPIROMETRY|Blue Cross PPO|BLUE CROSS PPO|4.74||||4.74||| 94010|EAP|0460|SPIROMETRY|Blue Cross PPO|BCBS TRANE PPO|||||4.74||| 94010|EAP|0460|SPIROMETRY|Blue Cross PPO|BCBS WALMART|||||4.74||| 94010|EAP|0460|SPIROMETRY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.74||| 94010|EAP|0460||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.74||| 94010|EAP|0260||Medicare|MEDICARE A & B|||||181.41||| 94010|EAP|0460|SPIROMETRY|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.74||| 94010|EAP|0460|SPIROMETRY|Blue Cross PPO|BLUE CROSS POS|||||4.74||| 94010|EAP|0460||Blue Cross PPO|BLUE CROSS PPO|4.74||||4.74||| 94010|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 94010|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 94010|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| 94010|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 94010|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 94010|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 94010|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 94010|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 94010|EAP|0460|SPIROMETRY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.74||| 94010|EAP|0460||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.74||| 94010|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 94010|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 94010|EAP|0942||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.05||| 94010|EAP|0251|SPIRONOLACTONE 12.5MG HFTAB PO|Blue Cross PPO|BLUE CROSS PPO|||||3.15||| 94010|EAP|0260||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||213.82||| 94010|EAP|0460|SPIROMETRY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.74||| 94010|EAP|0460|SPIROMETRY|Aetna|AETNA|||||4.74||| 94060|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 94060|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Aetna|AETNA EXXON MOBIL|||||7.09||| 94060|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Aetna|AETNA|||||7.09||| 94060|EAP|0460|BRNCDILAT RSPSE SPMTRY PRE&POS|Blue Cross PPO|BLUE CROSS PPO|||||7.09||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||3.79||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross PPO|BLUE CROSS POS|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross PPO|BLUE CROSS PPO|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross PPO|BCBS WALMART|||||7.09||| 94060|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 94060|EAP|0301|GENERAL HEALTH PANEL|Blue Cross PPO|BLUE CROSS PPO|||||0.86||| 94060|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.14||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||7.09||| 94060|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.79||| 94060|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Managed Medicaid|MOLINA MEDICAID|||||7.09||| 94060|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||7.09||| 94060|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.28||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross PPO|BCBS TRANE PPO|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Managed Medicaid|OTHER MEDICAID|||||7.09||| 94060|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.09||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||7.09||| 94060|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Cigna|CIGNA OPEN ACCESS PLUS|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Cigna|CIGNA OF TN CHATTANOOGA|||||7.09||| 94060|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross PPO Select|BCBS UTHCT|||||7.09||| 94060|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 94060|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Multiplan|TML GRP INS|||||7.09||| 94060|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|NON CONTRACTED|COMMERCIAL OTHER|||||7.09||| 94060|EAP|0460|BRNCDILAT RSPSE SPMTRY PRE&POS|Medicare|MEDICARE A & B|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Medicare|MEDICARE RAILROAD|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Medicare|MEDICARE PART A|||||7.09||| 94060|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Medicare|MEDICARE A & B|7.09||||7.09||| 94060|EAP|0419||Medicare|MEDICARE A & B|7.09||||7.09||| 94060|EAP|0260||Medicare|MEDICARE A & B|||||181.41||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Medicaid|MEDICAID|||||7.09||| 94060|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| 94060|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||45.15||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|United Healthcare|UMR|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.09||| 94060|EAP|0419|SPIROMETRY, PRE & POST BRONCH|PHCS|TML GRP INS|||||7.09||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|United Healthcare|UMR|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|PHCS|WEB TPA|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|Multiplan|WEB TPA|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|Blue Cross PPO|BLUE CROSS PPO|||||4.30||| 94070|EAP|0460|BRONCHIAL PROV, SPIROMETRY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.30||| 94375|EAP|0460|FLOW VOLUME LOOP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|Blue Cross PPO|BLUE CROSS PPO|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|Medicaid|MEDICAID|2.88||||||| 94375|EAP|0460|FLOW VOLUME LOOP|Medicare|MEDICARE A & B|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.88||| 94375|EAP|0460|FLOW VOLUME LOOP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.88||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|United Healthcare|UMR|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||8.25||| 94618|EAP|0510||Medicare|MEDICARE RAILROAD|||||2.50||| 94618|EAP|0320||Medicare|MEDICARE A & B|||||2.35||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Medicare|MEDICARE PART A|8.25||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Medicare|MEDICARE A & B|8.25||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|NON CONTRACTED|COMMERCIAL OTHER|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Medicaid|MEDICAID|||||8.25||| 94618|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Cigna|CIGNA OPEN ACCESS PLUS|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|NON CONTRACTED|COMMERCIAL OTHER 2|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Cigna|CIGNA OF TN CHATTANOOGA|||||8.25||| 94618|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||200.04||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross PPO Select|BCBS UTHCT|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Medicare|MEDICARE RAILROAD|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Managed Medicaid|MOLINA MEDICAID|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Managed Medicaid|MEDICAID CSHCN|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross PPO|BCBS WALMART|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross PPO|BCBS TRANE PPO|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross PPO|BLUE CROSS PPO|||||8.25||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross PPO|BLUE CROSS POS|||||8.25||| 94618|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 94618|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 94618|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.25||| 94618|EAP|0771||Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| 94618|EAP|0460|PULMONARY STRESS TEST, SIMPLE|Aetna|AETNA EL PASO CLAIMS OFFICE|8.25||||8.25||| 94621|EAP|0460|PULMONARY STRESS TEST|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.68||| 94621|EAP|0460|PULMONARY STRESS TEST|Blue Cross PPO|BLUE CROSS PPO|||||4.68||| 94621|EAP|0460|PULMONARY STRESS TEST|Blue Cross PPO|BCBS WALMART|||||4.68||| 94621|EAP|0460|PULMONARY STRESS TEST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.68||| 94621|EAP|0460|PULMONARY STRESS TEST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.68||| 94621|EAP|0460|PULMONARY STRESS TEST|Medicare|MEDICARE A & B|||||4.68||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|United Healthcare|UMR|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|United Healthcare|UMR|2.20||||||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|2.20||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|2.20||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.20||||2.20||| 94640|EAP|0410||PHCS|WEB TPA|||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|PHCS|TML GRP INS|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|PHCS|TML GRP INS|2.20||||||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.20||||||| 94640|EAP|0410|SPUTUM INDUCTION (PUL SERVICE)|Medicaid|MEDICAID|2.20||||2.20||| 94640|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 94640|EAP|0410|NEBULIZATION TREATMENT(CFC)|Medicaid|MEDICAID|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Medicaid|MEDICAID|2.20||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Medicaid|MEDICAID|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Medicaid|MEDICAID|2.20||||2.20||| 94640|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 94640|EAP|0510|AIRWAY INHALATION TREATMENT|Medicare|MEDICARE A & B|||||2.20||| 94640|EAP|0510||Medicare|MEDICARE A & B|||||3.26||| 94640|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Multiplan|WEB TPA|||||2.20||| 94640|EAP|0410||Multiplan|WEB TPA|||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Multiplan|TML GRP INS|2.20||||||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Medicare|MEDICARE PART A|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Medicare|MEDICARE RAILROAD|2.20||||2.20||| 94640|EAP|0450||Medicare|MEDICARE A & B|||||197.62||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|NON CONTRACTED|COMMERCIAL OTHER|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Medicare|MEDICARE RAILROAD|2.20||||||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Medicare|MEDICARE PART A|2.20||||||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0410|MINI NEB TX OR SPUTUM IND(IMC)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0410||Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Medicare|MEDICARE PART A|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|ChampVA|CHAMPVA OF CO DENVER|2.20||||||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Cigna|NALC HLTH BENEFIT|2.20||||||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|ChampVA|CHAMPVA OF CO DENVER|2.20||||||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Cigna|NALC HLTH BENEFIT|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Cigna|NALC HLTH BENEFIT|2.20||||||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Blue Cross PPO Select|BCBS UTHCT|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Blue Cross PPO Select|BCBS UTHCT|2.20||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Blue Cross PPO Select|BCBS UTHCT|2.20||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Blue Cross PPO Select|BCBS UTHCT|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Blue Cross PPO Select|BCBS UTHCT|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Blue Cross PPO Select|BCBS UTHCT|||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Managed Medicaid|MEDICAID CSHCN|||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Managed Medicaid|OTHER MEDICAID|||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (INFD)|Medicare|MEDICARE A & B|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Managed Medicaid|SUPERIOR STAR MCD|2.20||||2.20||| 94640|EAP|0410|INHALATION TREATMENT (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||1.79||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|NON CONTRACTED|COMMERCIAL OTHER|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Multiplan|TML GRP INS|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.20||||||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Managed Medicaid|MOLINA MEDICAID|||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||2.20||| 94640|EAP|0981||Medicaid|MEDICAID|||||0.00||| 94640|EAP|0410|NEBULIZER TREATMENT (INFD)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||2.20||| 94640|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (INFD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.20||||||| 94640|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Medicare|MEDICARE A & B|||||3.45||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||||| 94640|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.20||| 94640|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 94640|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|PHCS|WEB TPA|||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Blue Cross PPO|BLUE CROSS POS|2.20||||||| 94640|EAP|0410||Blue Cross PPO|BLUE CROSS PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.20||||2.20||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.20||| 94640|EAP|0410|NEBULIZATION TRMT (PUL SERV)|Blue Cross PPO|BCBS WALMART|2.20||||||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Blue Cross PPO|BLUE CROSS PPO|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Blue Cross PPO|BLUE CROSS POS|2.20||||||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Blue Cross PPO|BCBS TRANE PPO|||||2.20||| 94640|EAP|0412|AIRWAY INHAL TREATMENT, REPEAT|Blue Cross PPO|BCBS WALMART|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Blue Cross PPO|BLUE CROSS PPO|2.20||||||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Blue Cross PPO|BCBS WALMART|2.20||||||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.20||||2.20||| 94640|EAP|0410|INHALER METER DOSE TRTM (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.20||||||| 94640|EAP|0410|NEBULIZER TREATMENT (PULMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.20||||2.20||| 94640|EAP|0412|INHALATION, BRONCHODILAT (ER)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.20||||2.20||| 94640|EAP|0419|INH MET DOSE TRTM (PUL SERV)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.20||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|6.37||||||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Blue Cross PPO|BCBS WALMART|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|6.37||||||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Blue Cross PPO|BCBS WALMART|6.37||||||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Blue Cross PPO|BLUE CROSS PPO|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|6.37||||||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.37||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Humana Medicare Advantage|HUMANA MEDICARE PPO|6.37||||6.37||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|NON CONTRACTED|COMMERCIAL OTHER|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Blue Cross PPO|BLUE CROSS PPO|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|NON CONTRACTED|COMMERCIAL OTHER|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Medicare|MEDICARE PART A|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Medicare|MEDICARE A & B|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Medicare|MEDICARE A & B|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Medicare|MEDICARE PART A|6.37||||||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|Medicaid|MEDICAID|||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Medicaid|MEDICAID|||||6.37||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|United Healthcare|UMR|||||6.37||| 94660|EAP|0410|CPAP/BIPAP NONINVAS, INITIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|6.37||||6.37||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|6.37||||||| 94660|EAP|0419|CPAP/BIPAP NONINVASIVE (DAILY)|Veterans Affairs|VETERANS CHOICE - TRI WEST|6.37||||||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|2.20||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Medicare|MEDICARE RAILROAD|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Medicare|MEDICARE A & B|||||2.33||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Medicare|MEDICARE A & B|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.33||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Blue Cross PPO|BLUE CROSS PPO|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.20||| 94664|EAP|0410|EVALUATE PT USE OF INHALER|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.20||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Aetna|AETNA EL PASO CLAIMS OFFICE|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Blue Cross PPO|BLUE CROSS PPO|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Cigna|NALC HLTH BENEFIT|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||2.20||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Medicaid|MEDICAID|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Medicare|MEDICARE A & B|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Medicare|MEDICARE PART A|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Medicare|MEDICARE RAILROAD|2.20||||||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94667|EAP|0410|MANIPULATION CHEST WALL, INTL|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.20||||2.20||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Medicare|MEDICARE PART A|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Medicare|MEDICARE A & B|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|NON CONTRACTED|COMMERCIAL OTHER|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Medicare|MEDICARE RAILROAD|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Medicaid|MEDICAID|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Cigna|NALC HLTH BENEFIT|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Blue Cross PPO|BLUE CROSS PPO|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.20||||||| 94668|EAP|0410|MANIPULATION CHEST WALL; SUBSQ|Aetna|AETNA EL PASO CLAIMS OFFICE|2.20||||||| 947|DRG||SIGNS & SYMPTOMS W MCC|Medicare|MEDICARE A & B|34,705.58|10302.27|10302.27|10302.27|||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.35||| 94726|EAP|0460||Medicare|MEDICARE A & B|2.35||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Multiplan|TML GRP INS|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Medicare|MEDICARE A & B|2.35||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Medicare|MEDICARE PART A|2.35||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Medicare|MEDICARE RAILROAD|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|NON CONTRACTED|COMMERCIAL OTHER|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Medicaid|MEDICAID|||||2.35||| 94726|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.35||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Managed Medicaid|MOLINA MEDICAID|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.35||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross PPO|BCBS WALMART|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross PPO Select|BCBS UTHCT|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross PPO|BLUE CROSS PPO|||||2.35||| 94726|EAP|0460||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Cigna|CIGNA OF TN CHATTANOOGA|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross PPO|BLUE CROSS POS|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Workers Compensation|WC OTHER|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Cigna|CIGNA OPEN ACCESS PLUS|||||2.35||| 94726|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|PHCS|TML GRP INS|||||2.35||| 94726|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|United Healthcare|UMR|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.35||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Blue Cross PPO|BCBS TRANE PPO|||||2.35||| 94726|EAP|0460|LUNG VOLUMNS/AIRWAY RES|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.35||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.82||| 94729|EAP|0460||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.82||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Cigna|CIGNA OF TN CHATTANOOGA|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Workers Compensation|WC OTHER|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Medicare|MEDICARE RAILROAD|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.82||||2.82||| 94729|EAP|0460||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Aetna|AETNA|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.82||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Managed Medicaid|MOLINA MEDICAID|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Blue Cross PPO Select|BCBS UTHCT|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Blue Cross PPO|BLUE CROSS PPO|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Workers Compensation|WC OTHER|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Cigna|CIGNA OPEN ACCESS PLUS|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Cigna|CIGNA OPEN ACCESS PLUS|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross PPO Select|BCBS UTHCT|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Multiplan|TML GRP INS|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|PHCS|TML GRP INS|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross PPO|BCBS WALMART|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross PPO|BLUE CROSS POS|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|NON CONTRACTED|COMMERCIAL OTHER|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross PPO|BCBS TRANE PPO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|United Healthcare|UMR|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Cigna|CIGNA OF TN CHATTANOOGA|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Medicare|MEDICARE A & B|2.82||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|NON CONTRACTED|COMMERCIAL OTHER|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Medicaid|MEDICAID|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Blue Cross PPO|BLUE CROSS POS|||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Medicare|MEDICARE PART A|2.82||||2.82||| 94729|EAP|0460|DIFFUSING CAPACITY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Medicare|MEDICARE RAILROAD|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.82||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Blue Cross PPO|BLUE CROSS PPO|||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.82||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|Medicare|MEDICARE A & B|2.82||||2.82||| 94729|EAP|0460|DIFF CAP - SINGLE BREATH|United Healthcare|UMR|||||2.82||| 94729|EAP|0460||Medicare|MEDICARE A & B|2.82||||2.82||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Cigna|CIGNA OF TN CHATTANOOGA|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Aetna|AETNA EL PASO CLAIMS OFFICE|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.93||||1.93||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Cigna|NALC HLTH BENEFIT|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Medicare|MEDICARE RAILROAD|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Blue Cross PPO|BLUE CROSS PPO|1.93||||1.93||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|PHCS|TML GRP INS|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Blue Cross PPO|BCBS WALMART|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|NON CONTRACTED|COMMERCIAL OTHER|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.93||||1.93||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|NON CONTRACTED|COMMERCIAL OTHER 2|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Medicare|MEDICARE PART A|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|United Healthcare|UMR|1.93||||||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Medicare|MEDICARE A & B|1.93||||1.93||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Medicaid|MEDICAID|||||1.93||| 94760|EAP|0460|PULSE OXIMETRY; SINGLE|Multiplan|TML GRP INS|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|United Healthcare|UMR|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Aetna|AETNA EL PASO CLAIMS OFFICE|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Blue Cross PPO|BLUE CROSS PPO|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Cigna|CIGNA OF TN CHATTANOOGA|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Blue Cross PPO|BLUE CROSS POS|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Blue Cross PPO|BCBS TRANE PPO|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Managed Medicaid|SUPERIOR STAR MCD|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Medicare|MEDICARE RAILROAD|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Blue Cross PPO Select|BCBS UTHCT|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Blue Cross PPO|BCBS WALMART|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Cigna|NALC HLTH BENEFIT|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|PHCS|TML GRP INS|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Cigna|CIGNA OPEN ACCESS PLUS|||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|NON CONTRACTED|COMMERCIAL OTHER|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|ChampVA|CHAMPVA OF CO DENVER|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Medicare|MEDICARE A & B|1.93||||1.93||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|NON CONTRACTED|COMMERCIAL OTHER 2|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Multiplan|TML GRP INS|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Medicare|MEDICARE PART A|1.93||||||| 94761|EAP|0460|PULSE OXIMETRY; MULTIPLE|Medicaid|MEDICAID|1.93||||1.93||| 94762|EAP|0460|NONINVASIVE/PULSE OXIMETER CON|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|10.44||||||| 94762|EAP|0460|NONINVASIVE/PULSE OXIMETER CON|Medicare|MEDICARE PART A|10.44||||||| 94762|EAP|0460|NONINVASIVE/PULSE OXIMETER CON|Medicare|MEDICARE A & B|10.44||||||| 94762|EAP|0460|NONINVASIVE/PULSE OXIMETER CON|Humana Medicare Advantage|HUMANA MEDICARE PPO|10.44||||||| 94762|EAP|0460|NONINVASIVE/PULSE OXIMETER CON|Blue Cross PPO|BLUE CROSS PPO|10.44||||10.44||| 94762|EAP|0460|NONINVASIVE/PULSE OXIMETER CON|Blue Cross PPO Select|BCBS UTHCT|10.44||||||| 94770|EAP|0460|CAPNOGRAPH SPOT CHECK|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.75||| 94770|EAP|0460|CAPNOGRAPH SPOT CHECK|Blue Cross PPO|BLUE CROSS PPO|||||2.75||| 94770|EAP|0460|CAPNOGRAPH SPOT CHECK|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.75||||||| 94770|EAP|0460|CAPNOGRAPH SPOT CHECK|Medicaid|MEDICAID|||||2.75||| 94770|EAP|0460|CAPNOGRAPH SPOT CHECK|Medicare|MEDICARE A & B|||||2.75||| 94799|EAP|0460|MAXIMUM RESPIRATORY PRESSURES|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.93||||1.93||| 94799|EAP|0460|MAXIMUM RESPIRATORY PRESSURES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.93||| 94799|EAP|0460|MAXIMUM RESPIRATORY PRESSURES|Blue Cross PPO|BLUE CROSS PPO|||||1.93||| 94799|EAP|0460|MAXIMUM RESPIRATORY PRESSURES|Medicare|MEDICARE A & B|1.93||||1.93||| 94799|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Medicare|MEDICARE A & B|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Managed Medicaid|MOLINA MEDICAID|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Blue Cross PPO|BLUE CROSS POS|||||0.81||| 95004|EAP|0924|PERCUT ALLERGY SKIN TEST|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.81||| 95012|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Aetna|AETNA|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.63||| 95012|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross PPO|BCBS WALMART|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross PPO|BLUE CROSS POS|||||1.63||| 95012|EAP|0419||Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Medicaid|MEDICAID|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Cigna|CIGNA OPEN ACCESS PLUS|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross PPO Select|BCBS UTHCT|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|NON CONTRACTED|COMMERCIAL OTHER|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Managed Medicaid|MOLINA MEDICAID|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Cigna|CIGNA OF TN CHATTANOOGA|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Medicare|MEDICARE A & B|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|United Healthcare|UMR|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Cigna|CIGNA BEHAVIORAL HEALTH|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.63||| 95012|EAP|0419|NITRIC OXIDE EXPIRED GAS DETER|Blue Cross PPO|BLUE CROSS PPO|||||1.63||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|NON CONTRACTED|COMMERCIAL OTHER|77.67|77.67|6608.51|77.67|||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|Medicare|MEDICARE A & B|8,405.30|6608.51|6608.51|77.67|||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Blue Cross PPO|BLUE CROSS PPO|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Medicare|MEDICARE A & B|||||1.02||| 95115|EAP|0403|MAMMO SCREENING,BILAT,INCL CAD|Blue Cross PPO|BLUE CROSS PPO|||||4.83||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Blue Cross PPO|BLUE CROSS POS|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.02||| 95115|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 95115|EAP|0403|SCREENING DIGIT BRST TOMO;BILA|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Aetna|TRS COORDINATED CARE|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|NON CONTRACTED|COMMERCIAL OTHER|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Medicaid|MEDICAID|||||1.02||| 95115|EAP|0940|IMMUNOTHERAPY ONE INJECTION|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Aetna|TRS COORDINATED CARE|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Blue Cross PPO Select|BCBS UTHCT|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Blue Cross PPO|BLUE CROSS PPO|||||1.02||| 95117|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 95117|EAP|0940|IMMUNOTHERAPY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Blue Cross PPO|BLUE CROSS POS|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Medicare|MEDICARE A & B|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Medicaid|MEDICAID|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 95117|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 95117|EAP|0940|IMMUNOTHERAPY|Cigna|CIGNA OF TN CHATTANOOGA|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|NON CONTRACTED|COMMERCIAL OTHER|||||1.02||| 95117|EAP|0940|IMMUNOTHERAPY|United Healthcare|GOLDEN RULE INSURANCE|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Cigna|CIGNA OF TN CHATTANOOGA|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|United Healthcare|UMR|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|NON CONTRACTED|COMMERCIAL OTHER|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|United Healthcare|GOLDEN RULE INSURANCE|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Blue Cross PPO|BLUE CROSS PPO|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Blue Cross PPO|BLUE CROSS POS|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Medicare|MEDICARE A & B|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 95165|EAP|0940|ANTIGEN THERAPY SERVICES|Blue Cross PPO Select|BCBS UTHCT|||||1.02||| 95170|EAP|0510|ANTIGEN THERAPY WHL INSECT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.02||| 95249|EAP|0942|CONT GLUC MONIT PT PROV EQUIP|Medicare|MEDICARE A & B|||||1.50||| 95250|EAP|0920||Medicare|MEDICARE A & B|||||3.35||| 95250|EAP|0920||Blue Cross PPO|BLUE CROSS PPO|||||3.35||| 95250|EAP|0920||Blue Cross PPO|BLUE CROSS POS|||||3.35||| 95250|EAP|0920||Blue Cross PPO Select|BCBS UTHCT|||||3.35||| 95250|EAP|0920||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.35||| 95782|EAP|0922||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||21.88||| 95782|EAP|0922||United Healthcare|UMR|||||21.88||| 95782|EAP|0922||Blue Cross PPO|BLUE CROSS PPO|||||21.88||| 95805|EAP|0740|MULTIPLE SLEEP LATENCY TEST|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||21.51||| 95810|EAP|0740||Medicare|MEDICARE A & B|||||37.81||| 95810|EAP|0740||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||37.81||| 95810|EAP|0740||NON CONTRACTED|COMMERCIAL OTHER|||||37.81||| 95810|EAP|0740||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||37.81||| 95810|EAP|0740||Managed Medicaid|MOLINA MEDICAID|||||37.81||| 95810|EAP|0740||United Healthcare|UMR|||||37.81||| 95810|EAP|0301|CREATININE, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||0.92||| 95810|EAP|0740||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||37.81||| 95810|EAP|0740||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||37.81||| 95810|EAP|0740||Aetna|AETNA EL PASO CLAIMS OFFICE|||||37.81||| 95810|EAP|0740||Blue Cross PPO|BLUE CROSS PPO|||||37.81||| 95810|EAP|0740||Blue Cross PPO Select|BCBS UTHCT|||||37.81||| 95810|EAP|0740|SLEEP STUDY, DIAGNOSTIC, SLEEP|Blue Cross PPO Select|BCBS UTHCT|||||37.81||| 95810|EAP|0740||Cigna|CIGNA OPEN ACCESS PLUS|||||37.81||| 95810|EAP|0740||Cigna|CIGNA OF TN CHATTANOOGA|||||37.81||| 95810|EAP|0301|VENIPUNCTURE, ROUTINE|Cigna|CIGNA OPEN ACCESS PLUS|||||0.19||| 95810|EAP|0740||Blue Cross PPO|BCBS TRANE PPO|||||37.81||| 95810|EAP|0740||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||37.81||| 95810|EAP|0740||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||37.81||| 95810|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Cigna|CIGNA OPEN ACCESS PLUS|||||0.80||| 95810|EAP|0740||ChampVA|CHAMPVA OF CO DENVER|||||37.81||| 95810|EAP|0610|MRI; PELVIS WITH & WITHOUT CO|Cigna|CIGNA OPEN ACCESS PLUS|||||44.33||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Medicare|MEDICARE RAILROAD|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Blue Cross PPO|BLUE CROSS POS|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|United Healthcare|UMR|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|NON CONTRACTED|COMMERCIAL OTHER|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Cigna|CIGNA OPEN ACCESS PLUS|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|ChampVA|CHAMPVA OF CO DENVER|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Cigna|CIGNA OF TN CHATTANOOGA|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Blue Cross PPO|BLUE CROSS PPO|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Blue Cross PPO Select|BCBS UTHCT|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Medicare|MEDICARE A & B|||||44.88||| 95811|EAP|0740|SLEEP STUDY, THERAPUTIC, CPAP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||44.88||| 95992|EAP|0420|CANALITH REPOSITIONING PROC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.13||| 95992|EAP|0420|CANALITH REPOSITIONING PROC|Medicare|MEDICARE A & B|||||1.13||| 95992|EAP|0420|CANALITH REPOSITIONING PROC|Blue Cross PPO|BLUE CROSS PPO|||||1.13||| 96101|EAP|0914|ASSESS HLTH/BEHA/INI EA 15 MIN|Medicaid|MEDICAID|||||0.82||| 96116|EAP|0918||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 96116|EAP|0918||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 96116|EAP|0900||Aetna|AETNA EL PASO CLAIMS OFFICE|||||299.07||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 96116|EAP|0900||Medicare|MEDICARE A & B|||||266.61||| 96116|EAP|0900||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||299.07||| 96116|EAP|0900||Blue Cross PPO|BLUE CROSS PPO|||||299.07||| 96116|EAP|0900||Blue Cross PPO|BLUE CROSS PPO|||||266.61||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Blue Cross PPO|BLUE CROSS POS|||||3.26||| 96116|EAP|0900||Blue Cross PPO|BLUE CROSS POS|||||299.07||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.26||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Medicare|MEDICARE A & B|||||3.26||| 96116|EAP|0900||Blue Cross PPO|BLUE CROSS POS|||||266.61||| 96116|EAP|0918||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||3.26||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Medicare|MEDICARE RAILROAD|||||3.26||| 96116|EAP|0918|NEUROBEHAVIORAL STATUS EXAM|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||3.26||| 96116|EAP|0900||Medicare|MEDICARE A & B|||||299.07||| 96125|EAP|0440|COGNITIVE PERFORMANCE TESTING|Medicare|MEDICARE A & B|3.50||||3.50||| 96125|EAP|0440|COGNITIVE PERFORMANCE TESTING|Blue Cross PPO|BLUE CROSS POS|||||3.50||| 96125|EAP|0440|COGNITIVE PERFORMANCE TESTING|NON CONTRACTED|COMMERCIAL OTHER|||||3.50||| 96125|EAP|0440|COGNITIVE PERFORMANCE TESTING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.50||| 96130|EAP|0900|PSYCH TESTING AND EVAL 1ST HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||397.45||| 96130|EAP|0900|PSYCH TESTING AND EVAL 1ST HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.30||| 96130|EAP|0900|PSYCH TESTING AND EVAL 1ST HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||364.89||| 96130|EAP|0900|PSYCH TESTING AND EVAL 1ST HR|Medicare|MEDICARE A & B|||||4.30||| 96130|EAP|0900|PSYCH TESTING AND EVAL 1ST HR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||364.89||| 96131|EAP|0900|PSYCH TESTING AND EVAL|Medicare|MEDICARE A & B|||||364.89||| 96131|EAP|0900|PSYCH TESTING AND EVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||364.89||| 96131|EAP|0900|PSYCH TESTING AND EVAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||364.89||| 96132|EAP|0900|PSYCH TESTING EVAL|Medicare|MEDICARE RAILROAD|||||4.30||| 96132|EAP|0900|PSYCH TESTING EVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||266.61||| 96132|EAP|0900|PSYCH TESTING EVAL|Blue Cross PPO|BLUE CROSS POS|||||266.61||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| 96132|EAP|0900|PSYCH TESTING EVAL|Blue Cross PPO|BLUE CROSS PPO|||||266.61||| 96132|EAP|0900|PSYCH TESTING EVAL|Medicare|MEDICARE A & B|||||266.61||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Medicare|MEDICARE A & B|||||4.30||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||3.26||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Blue Cross PPO|BLUE CROSS POS|||||3.26||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| 96132|EAP|0900||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||299.07||| 96132|EAP|0918|NEUROPSYCH TST INIT HOUR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.26||| 96133|EAP|0900|PSYCH TESTING EVAL|Blue Cross PPO|BLUE CROSS POS|||||299.07||| 96133|EAP|0900|PSYCH TESTING EVAL|Medicare|MEDICARE RAILROAD|||||299.07||| 96133|EAP|0900|NEUROPSYCH TST ADD HOUR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||299.07||| 96133|EAP|0900|NEUROPSYCH TST ADD HOUR|Medicare|MEDICARE A & B|||||299.07||| 96133|EAP|0900|NEUROPSYCH TST ADD HOUR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||299.07||| 96133|EAP|0900|NEUROPSYCH TST ADD HOUR|Blue Cross PPO|BLUE CROSS PPO|||||299.07||| 96133|EAP|0900|NEUROPSYCH TST ADD HOUR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||299.07||| 96133|EAP|0900|PSYCH TESTING EVAL|Blue Cross PPO|BLUE CROSS PPO|||||299.07||| 96133|EAP|0900|PSYCH TESTING EVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||299.07||| 96133|EAP|0900|PSYCH TESTING EVAL|Medicare|MEDICARE A & B|||||299.07||| 96133|EAP|0900|NEUROPSYCH TST ADD HOUR|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||299.07||| 96136|EAP|0900|NEUROPSYCH TST ADD HOUR|Medicare|MEDICARE A & B|||||46.08||| 96136|EAP|0918|NEUROPSYCH TESTING INIT 30 MIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.26||| 96137|EAP|0900|PSYCH TEST ADMIN|Medicare|MEDICARE A & B|||||15.36||| 96137|EAP|0900|NEUROP TST ADMIN ADD 30 MIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||15.36||| 96150|EAP|0914|ASSESS HLTH/BEHAV/INIT|Medicaid|MEDICAID|||||0.82||| 96153|EAP|0915|H&B INTERV GROUP EA 15 MIN|Medicare|MEDICARE A & B|0.66||||||| 96156|EAP|0914|HLTH BHV ASSMT/REASSESSMENT|Medicaid|MEDICAID|||||2.36||| 96156|EAP|0914|HLTH BHV ASSMT/REASSESSMENT|Blue Cross PPO Select|BCBS UTHCT|||||2.36||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Medicare|MEDICARE A & B|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Medicaid|MEDICAID|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|ChampVA|CHAMPVA OF CO DENVER|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.70||| 96160|EAP|0510|ANNL DEPRESS SCRN,15 MIN(FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.70||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.14||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Medicare|MEDICARE A & B|1.14||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BCBS TRANE PPO|||||391.92||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||391.92||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BLUE CROSS POS|||||669.83||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BLUE CROSS PPO|||||669.83||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||391.92||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 96360|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.14||||1.14||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||669.83||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BCBS WALMART|||||669.83||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Managed Medicaid|MEDICAID CSHCN|||||669.83||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Blue Cross PPO|BLUE CROSS PPO|1.14||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|669.83||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|United Healthcare|UMR|||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.14||| 96360|EAP|0410||Medicare|MEDICARE A & B|||||2.20||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Medicaid|MEDICAID|1.14||||||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|NON CONTRACTED|COMMERCIAL OTHER|||||391.92||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.14||||669.83||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Medicare|MEDICARE A & B|1.14||||391.92||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||669.83||| 96360|EAP|0450|HYDRATION IV INF,31MIN-1HR|Veterans Affairs|VETERANS CHOICE - TRI WEST|669.83||||1.14||| 96360|EAP|0260|HYDRATION IV INF,31MIN-1HR|Medicare|MEDICARE A & B|1.14||||669.83||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BCBS TRANE PPO|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BLUE CROSS PPO|3.45||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BCBS TRANE PPO|3.45||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|United Healthcare|UMR|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO Select|BCBS UTHCT|||||3.45||| 96361|EAP|0250||ChampVA|CHAMPVA OF CO DENVER|||||15.40||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|SUPERIOR STAR MCD|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|MOLINA MEDICAID|||||3.45||| 96361|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 96361|EAP|0270||Medicare|MEDICARE A & B|||||6.30||| 96361|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.45||| 96361|EAP|0335||Blue Cross PPO|BLUE CROSS PPO|||||10.47||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Medicare|MEDICARE A & B|3.45||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.45||| 96361|EAP|0335||Blue Cross PPO|BLUE CROSS PPO|||||4.52||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|United Healthcare|UMR|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Medicaid|MEDICAID|3.45||||3.45||| 96361|EAP|0251||NON CONTRACTED|COMMERCIAL OTHER|||||11.50||| 96361|EAP|0260||Medicare|MEDICARE A & B|3.45||||1.14||| 96361|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 96361|EAP|0272||Medicare|MEDICARE A & B|||||12.60||| 96361|EAP|0270||NON CONTRACTED|COMMERCIAL OTHER|||||17.85||| 96361|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.45||| 96361|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 96361|EAP|0260||NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.45||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.45||||||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Cigna|CIGNA OF TN CHATTANOOGA|3.45||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.45||| 96361|EAP|0636||ChampVA|CHAMPVA OF CO DENVER|||||11.50||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 96361|EAP|0258||ChampVA|CHAMPVA OF CO DENVER|||||42.85||| 96361|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||3,126.31||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BCBS WALMART|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BLUE CROSS POS|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BLUE CROSS PPO|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BCBS WALMART|3.45||||3.45||| 96361|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||50.40||| 96361|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||37.80||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross PPO|BLUE CROSS POS|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|ChampVA|CHAMPVA OF CO DENVER|||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Cigna|CIGNA OF TN CHATTANOOGA|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.45||| 96361|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||11.55||| 96361|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||17.85||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.45||||3.45||| 96361|EAP|0270||NON CONTRACTED|COMMERCIAL OTHER|||||50.40||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Aetna|AETNA EL PASO CLAIMS OFFICE|3.45||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|PHCS|WEB TPA OF GRAND PRAIRIE|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|MEDICAID CSHCN|||||3.45||| 96361|EAP|0258||ChampVA|CHAMPVA OF CO DENVER|||||41.10||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.45||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|NON CONTRACTED|COMMERCIAL OTHER|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Cigna|NALC HLTH BENEFIT|3.45||||||| 96361|EAP|0272||Medicare|MEDICARE A & B|||||45.15||| 96361|EAP|0335||Medicare|MEDICARE A & B|||||10.47||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|NON CONTRACTED|COMMERCIAL OTHER|3.45||||3.45||| 96361|EAP|0270||NON CONTRACTED|COMMERCIAL OTHER|||||37.80||| 96361|EAP|0335||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 96361|EAP|0335||NON CONTRACTED|COMMERCIAL OTHER|||||10.47||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|NON CONTRACTED|MRAMVA|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Medicare|MEDICARE PART A|3.45||||||| 96361|EAP|0260||Medicare|MEDICARE A & B|3.45||||3.45||| 96361|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||45.15||| 96361|EAP|0270||Medicare|MEDICARE A & B|||||50.40||| 96361|EAP|0270||NON CONTRACTED|COMMERCIAL OTHER|||||11.55||| 96361|EAP|0360||NON CONTRACTED|COMMERCIAL OTHER|||||135.56||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Multiplan|WEB TPA OF GRAND PRAIRIE|||||3.45||| 96361|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Medicare|MEDICARE A & B|3.45||||3.45||| 96361|EAP|0260||Medicare|MEDICARE A & B|3.45||||5.69||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|Medicaid|MEDICAID|||||3.45||| 96361|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.45||||3.45||| 96361|EAP|0260|HYDRATE IV INFUSE, EA ADD'L HR|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.45||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|NON CONTRACTED|COMMERCIAL OTHER|||||5.69||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE A & B|5.69||||619.42||| 96365|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 96365|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|669.83||||5.69||| 96365|EAP|0270||Medicare|MEDICARE A & B|||||50.40||| 96365|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 96365|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE PART A|669.83||||||| 96365|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|5.69||||5.69||| 96365|EAP|0450||Medicare|MEDICARE A & B|5.69||||619.42||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|NON CONTRACTED|COMMERCIAL OTHER|5.69||||5.69||| 96365|EAP|0450||Medicare|MEDICARE RAILROAD|669.83||||669.83||| 96365|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.69||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.69||| 96365|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|||||181.41||| 96365|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||669.83||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|PHCS|TML GRP INS|5.69||||||| 96365|EAP|0251||Medicare|MEDICARE A & B|||||0.65||| 96365|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|669.83||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|United Healthcare|UMR|||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.69||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.69||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.69||| 96365|EAP|0251||Medicare|MEDICARE A & B|||||55.05||| 96365|EAP|0250||Medicare|MEDICARE A & B|||||15.40||| 96365|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER 2|5.69||||5.69||| 96365|EAP|0450||Medicaid|MEDICAID|669.83||||669.83||| 96365|EAP|0272||Medicare|MEDICARE A & B|||||45.15||| 96365|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 96365|EAP|0272||Medicare|MEDICARE A & B|||||12.60||| 96365|EAP|0260||Medicare|MEDICARE A & B|5.69||||181.41||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|United Healthcare|UMR|5.69||||||| 96365|EAP|0260|THER/PROPH/DIAG IV INF INIT|Medicare|MEDICARE A & B|5.69||||5.69||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Multiplan|TML GRP INS|5.69||||||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE A & B|5.69||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE A & B|5.69||||5.69||| 96365|EAP|0260||Medicare|MEDICARE A & B|3.82||||1.03||| 96365|EAP|0260||Medicare|MEDICARE A & B|5.69||||1.14||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Medicaid|MEDICAID|||||5.69||| 96365|EAP|0270||Medicare|MEDICARE A & B|||||6.30||| 96365|EAP|0258||Medicare|MEDICARE A & B|||||41.10||| 96365|EAP|0257||Medicare|MEDICARE A & B|||||0.65||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Multiplan|TML GRP INS|||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|PHCS|TML GRP INS|||||5.69||| 96365|EAP|0410||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.20||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS PPO|||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS POS|||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BCBS WALMART|||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||669.83||| 96365|EAP|0270||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||50.40||| 96365|EAP|0260|THER/PROPH/DIAG IV INF INIT|Blue Cross PPO|BLUE CROSS PPO|||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.69||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS POS|669.83||||||| 96365|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|5.69||||||| 96365|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|5.69||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO Select|BCBS UTHCT|||||5.69||| 96365|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.38||| 96365|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|5.69||||5.69||| 96365|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||669.83||| 96365|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.69||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Cigna|NALC HLTH BENEFIT|5.69||||||| 96365|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|5.69||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.69||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS PPO|5.69||||5.69||| 96365|EAP|0250||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||15.40||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Cigna|CIGNA OF TN CHATTANOOGA|||||5.69||| 96365|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|669.83||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.69||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||5.69||| 96365|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.03||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|ChampVA|CHAMPVA OF CO DENVER|||||5.69||| 96365|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|5.69||||5.69||| 96365|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 96365|EAP|0270||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.55||| 96365|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||45.15||| 96365|EAP|0270||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||17.85||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO Select|BCBS UTHCT|5.69||||||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.69||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||669.83||| 96365|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 96365|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.69||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||669.83||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|669.83||||669.83||| 96365|EAP|0260|IV INFUSION THERAPY,UP TO 1 HR|Blue Cross PPO|BLUE CROSS PPO|||||5.69||| 96365|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|5.69||||669.83||| 96365|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||1.03||| 96365|EAP|0260|THER/PROPH/DIAG IV INF INIT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.69||| 96365|EAP|0250||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||42.85||| 96365|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||17.75||| 96365|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|669.83||||669.83||| 96365|EAP|0450||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||669.83||| 96365|EAP|0450||Managed Medicaid|OTHER MEDICAID|||||5.69||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|PHCS|TML GRP INS|||||1.03||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|United Healthcare|UMR|2.24||||||| 96366|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Medicaid|MEDICAID|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|NON CONTRACTED|COMMERCIAL OTHER|||||1.03||| 96366|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.24||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|Medicaid|MEDICAID|3.45||||||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|NON CONTRACTED|COMMERCIAL OTHER|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.45||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|Medicare|MEDICARE PART A|3.45||||||| 96366|EAP|0450||Medicare|MEDICARE A & B|3.45||||3.45||| 96366|EAP|0450||Medicare|MEDICARE RAILROAD|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Medicare|MEDICARE A & B|1.03||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Medicare|MEDICARE A & B|1.03||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Medicare|MEDICARE A & B|0.74||||3.45||| 96366|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.45||||3.45||| 96366|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.03||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.45||| 96366|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Multiplan|TML GRP INS|||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.03||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|NON CONTRACTED|COMMERCIAL OTHER|1.03||||||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO|BLUE CROSS POS|3.45||||||| 96366|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|3.45||||3.45||| 96366|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO|BLUE CROSS POS|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO|BLUE CROSS PPO|||||2.24||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.03||| 96366|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.45||||1.03||| 96366|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.03||||3.45||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.03||||||| 96366|EAP|0450|IV INFUSION THER,EA ADD'L HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.24||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO Select|BCBS UTHCT|||||1.03||| 96366|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.03||||3.45||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross PPO|BLUE CROSS PPO|||||1.03||| 96366|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|1.03||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.03||| 96366|EAP|0260|IV INFUSION THER,EA ADD'L HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.03||| 96367|EAP|0335||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.47||| 96367|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|197.41||||||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96367|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||37.80||| 96367|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||37.80||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross PPO|BCBS TRANE PPO|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADDL SEQ IV INF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.81||| 96367|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.55||| 96367|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||50.40||| 96367|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||12.60||| 96367|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||14.70||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADDL SEQ IV INF|Blue Cross PPO|BLUE CROSS PPO|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross PPO|BLUE CROSS POS|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross PPO|BLUE CROSS PPO|||||1.81||| 96367|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|213.82||||197.41||| 96367|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 96367|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||50.40||| 96367|EAP|0335||Blue Cross PPO|BLUE CROSS PPO|||||10.47||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross PPO|BCBS WALMART|||||213.83||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 96367|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|Aetna|AETNA EL PASO CLAIMS OFFICE|213.82||||||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.83||| 96367|EAP|0251||ChampVA|CHAMPVA OF CO DENVER|||||11.50||| 96367|EAP|0260||ChampVA|CHAMPVA OF CO DENVER|||||1.14||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Cigna|CIGNA OF TN CHATTANOOGA|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|ChampVA|CHAMPVA OF CO DENVER|||||1.81||| 96367|EAP|0272||ChampVA|CHAMPVA OF CO DENVER|||||45.15||| 96367|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.81||| 96367|EAP|0335||ChampVA|CHAMPVA OF CO DENVER|||||10.47||| 96367|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|213.82||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Managed Medicaid|SUPERIOR STAR MCD|||||1.81||| 96367|EAP|0270||ChampVA|CHAMPVA OF CO DENVER|||||50.40||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.81||| 96367|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||3,126.31||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross PPO|BLUE CROSS POS|213.82||||||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||213.83||| 96367|EAP|0260|TX/PROPH/DG ADDL SEQ IV INF|Medicare|MEDICARE A & B|1.07||||1.81||| 96367|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Medicare|MEDICARE A & B|1.07||||1.81||| 96367|EAP|0270||ChampVA|CHAMPVA OF CO DENVER|||||37.80||| 96367|EAP|0450||Managed Medicaid|OTHER MEDICAID|||||1.81||| 96367|EAP|0260||Medicare|MEDICARE A & B|1.07||||1.81||| 96367|EAP|0258||Medicaid|MEDICAID|||||21.33||| 96367|EAP|0636||Medicaid|MEDICAID|||||8,411.96||| 96367|EAP|0636||Medicaid|MEDICAID|||||137.10||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|Medicaid|MEDICAID|213.82||||||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|Multiplan|TML GRP INS|1.81||||||| 96367|EAP|0258||NON CONTRACTED|COMMERCIAL OTHER|||||32.60||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|Medicare|MEDICARE PART A|213.82||||||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|NON CONTRACTED|COMMERCIAL OTHER|||||213.83||| 96367|EAP|0636||Medicaid|MEDICAID|||||134.42||| 96367|EAP|0450||Medicare|MEDICARE A & B|213.82||||197.41||| 96367|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||336.65||| 96367|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.81||| 96367|EAP|0636||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||18,649.20||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||213.83||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.81||| 96367|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 96367|EAP|0636||Medicaid|MEDICAID|||||0.01||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.83||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.81||| 96367|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|United Healthcare|UMR|||||1.81||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||213.83||| 96367|EAP|0450|TX/PROPH/DG ADD SEQ INF,1ST HR|PHCS|TML GRP INS|1.81||||||| 96367|EAP|0260|TX/PROPH/DG ADD SEQ INF,1ST HR|Medicaid|MEDICAID|||||1.81||| 96367|EAP|0636||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||18,179.05||| 96367|EAP|0636||Medicaid|MEDICAID|||||74.26||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Blue Cross PPO|BLUE CROSS PPO|3.45||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.70||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|PHCS|TML GRP INS|0.70||||||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Medicaid|MEDICAID|||||0.27||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Medicare|MEDICARE RAILROAD|||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|NON CONTRACTED|COMMERCIAL OTHER|||||0.27||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Medicare|MEDICARE A & B|0.70||||3.45||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.27||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.70||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.70||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Multiplan|TML GRP INS|0.70||||||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Blue Cross PPO|BLUE CROSS POS|3.45||||||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Medicare|MEDICARE A & B|0.70||||0.70||| 96368|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Blue Cross PPO|BLUE CROSS PPO|||||0.70||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.70||||||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.27||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Blue Cross PPO|BLUE CROSS POS|||||0.27||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Blue Cross PPO|BCBS TRANE PPO|||||0.27||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.70||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|United Healthcare|UMR|3.45||||||| 96368|EAP|0450|THER/DIAG CONCURRENT INF|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.70||| 96368|EAP|0260|THER/DIAG CONCURRENT INF|Cigna|CIGNA OF TN CHATTANOOGA|||||0.70||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||213.82||| 96372|EAP|0260||Medicare|MEDICARE A & B|181.41||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|MOLINA MEDICAID|||||213.82||| 96372|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|181.41||||213.82||| 96372|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11,820.61||| 96372|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|181.41||||213.82||| 96372|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.25||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|181.41||||181.41||| 96372|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 96372|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 96372|EAP|0636||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 96372|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||7,977.80||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|ChampVA|CHAMPVA OF CO DENVER|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 96372|EAP|0270||Managed Medicaid|SUPERIOR STAR MCD|||||11.55||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 96372|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 96372|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|181.41||||181.41||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 96372|EAP|0450||Managed Medicaid|MEDICAID CSHCN|||||213.82||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Cigna|NALC HLTH BENEFIT|||||213.82||| 96372|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|ChampVA|CHAMPVA OF CO DENVER|||||181.41||| 96372|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 96372|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OPEN ACCESS PLUS|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OF TN CHATTANOOGA|||||181.41||| 96372|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||63.90||| 96372|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||23,641.20||| 96372|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||106.75||| 96372|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.50||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS POS|||||181.41||| 96372|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|181.41||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Aetna|AETNA|||||213.82||| 96372|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS TRANE PPO|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 96372|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 96372|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15,007.45||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS POS|||||213.82||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Blue Cross PPO|BLUE CROSS POS|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS WALMART|||||213.82||| 96372|EAP|0636||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23,641.20||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Aetna|AETNA EL PASO CLAIMS OFFICE|181.41||||213.82||| 96372|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||3,263.80||| 96372|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|181.41||||0.00||| 96372|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|181.41||||213.82||| 96372|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS PPO|181.41||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS TRANE PPO|||||181.41||| 96372|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|181.41||||213.82||| 96372|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 96372|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 96372|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 96372|EAP|0260|THER/PROPH/DIAG INJ SC/IM|Blue Cross PPO|BLUE CROSS PPO|||||181.41||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Blue Cross PPO|BCBS WALMART|||||213.82||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BLUE CROSS POS|||||213.82||| 96372|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS WALMART|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||181.41||| 96372|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 96372|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 96372|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 96372|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| 96372|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 96372|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OTHER|||||181.41||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|ChampVA|CHAMPVA OF CO DENVER|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Cigna|NALC HLTH BENEFIT|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OPEN ACCESS PLUS|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|OTHER MEDICAID|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 96372|EAP|0949||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||197.62||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 96372|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||181.41||| 96372|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||197.62||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||197.62||| 96372|EAP|0920|VENOUS REFLUX BIL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.89||| 96372|EAP|0300|CAPILLARY BLOOD DRAW|Medicare|MEDICARE A & B|||||0.09||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||181.41||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||213.82||| 96372|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.86||| 96372|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 96372|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID|213.82||||213.82||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|FAMILY PLANNING GRANT|||||181.41||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||197.62||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 96372|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 96372|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 96372|EAP|0310|TUMOR IMMUNOHISTOCHEM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||127.72||| 96372|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 96372|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 96372|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||197.62||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 96372|EAP|0940|INJECTION OF ANTIBIOTIC|Managed Medicaid|MOLINA MEDICAID|||||181.41||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|181.41||||213.82||| 96372|EAP|0260|THER/PROPH/DIAG INJ SC/IM|Medicare|MEDICARE A & B|181.41||||181.41||| 96372|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||36.25||| 96372|EAP|0999||Managed Medicaid|SUPERIOR STAR MCD|||||0.09||| 96372|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 96372|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE RAILROAD|||||197.62||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID|||||197.62||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID|||||181.41||| 96372|EAP|0302||Medicare|MEDICARE A & B|||||3.35||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Multiplan|WEB TPA|||||213.82||| 96372|EAP|0510||Medicare|MEDICARE A & B|||||197.62||| 96372|EAP|0450||Multiplan|WEB TPA|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Multiplan|WEB TPA|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicaid|MEDICAID|||||213.82||| 96372|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Multiplan|WEB TPA OF GRAND PRAIRIE|||||213.82||| 96372|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 96372|EAP|0636||Medicare|MEDICARE A & B|||||15,535.65||| 96372|EAP|0636||Medicare|MEDICARE A & B|||||13,416.80||| 96372|EAP|0305|PROTHROMBIN TIME W/INR|Medicare|MEDICARE A & B|||||1.22||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Multiplan|TML GRP INS|||||213.82||| 96372|EAP|0636||Medicare|MEDICARE A & B|||||3,329.05||| 96372|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|181.41||||197.62||| 96372|EAP|0636||Medicare|MEDICARE A & B|||||67.60||| 96372|EAP|0636||Medicare|MEDICARE A & B|||||67.60||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE RAILROAD|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|181.41||||213.82||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|||||213.82||| 96372|EAP|0450||Medicare|MEDICARE A & B|213.82||||213.82||| 96372|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE PART A|181.41||||181.41||| 96372|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER 2|||||213.82||| 96372|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||197.62||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|COMMERCIAL OTHER 2|||||197.62||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Medicare|MEDICARE A & B|||||213.82||| 96372|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 96372|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.30||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE RAILROAD|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|213.82||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||181.41||| 96372|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 96372|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Workers Compensation|WC TX MUTUAL INS|||||181.41||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Workers Compensation|WC OTHER|||||181.41||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|MRAMVA|||||213.82||| 96372|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 96372|EAP|0949||Medicare|MEDICARE A & B|181.41||||213.82||| 96372|EAP|0510||Blue Cross PPO|BCBS WALMART|||||2.64||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|United Healthcare|UMR|||||213.82||| 96372|EAP|0949||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|PHCS|WEB TPA|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|PHCS|WEB TPA OF GRAND PRAIRIE|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|PHCS|TML GRP INS|||||213.82||| 96372|EAP|0450||PHCS|WEB TPA|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|United Healthcare|GOLDEN RULE INSURANCE|||||213.82||| 96372|EAP|0636||Medicare|MEDICARE A & B|||||266.96||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96372|EAP|0949||Medicare|MEDICARE A & B|181.41||||197.62||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|NON CONTRACTED|PPO OTHER|||||181.41||| 96372|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||197.62||| 96372|EAP|0260|THER/PROPH/DIAG INJ SC/IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||181.41||| 96372|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Aetna|TRS COORDINATED CARE|||||213.82||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 96372|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.10||| 96372|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.30||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||181.41||| 96372|EAP|0402||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||14.97||| 96372|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|Cigna|CIGNA OF TN CHATTANOOGA|||||181.41||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|181.41||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Healthcare|UMR|||||213.82||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||213.82||| 96372|EAP|0270||United Healthcare|GOLDEN RULE INSURANCE|||||0.07||| 96372|EAP|0510||Aetna|AETNA|||||2.50||| 96372|EAP|0940|THER/PROPH/DIAG INJ SC/IM|United Healthcare|UMR|||||213.82||| 96372|EAP|0260|THERAP OR DX INJ; SQ OR IM|PHCS|WEB TPA|||||213.82||| 96372|EAP|0450|THERAP OR DX INJ; SQ OR IM|Veterans Affairs|VETERANS CHOICE - TRI WEST|213.82||||181.41||| 96372|EAP|0949|THERAP OR DX INJ; SQ OR IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96372|EAP|0940|THERAP OR DX INJ; SQ OR IM|United Healthcare|UMR|||||213.82||| 96374|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.51||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||669.83||| 96374|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|5.51||||669.83||| 96374|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Medicare|MEDICARE PART A|669.83||||||| 96374|EAP|0450||Multiplan|WEB TPA OF GRAND PRAIRIE|||||669.83||| 96374|EAP|0450||Multiplan|WEB TPA|||||5.51||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Medicare|MEDICARE A & B|5.51||||5.51||| 96374|EAP|0450||Medicare|MEDICARE A & B|669.83||||1.14||| 96374|EAP|0450||Medicare|MEDICARE A & B|5.51||||669.83||| 96374|EAP|0450||Medicaid|MEDICAID|||||5.51||| 96374|EAP|0260||Medicare|MEDICARE A & B|||||5.51||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Medicare|MEDICARE A & B|||||5.51||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|669.83||||669.83||| 96374|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|669.83||||5.51||| 96374|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||610.42||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.51||| 96374|EAP|0450||Managed Medicaid|MEDICAID CSHCN|||||5.51||| 96374|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|610.42||||669.83||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|669.83||||669.83||| 96374|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|669.83||||669.83||| 96374|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||669.83||| 96374|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||669.83||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||669.83||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||610.42||| 96374|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO Select|BCBS UTHCT|610.42||||5.51||| 96374|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|610.42||||610.42||| 96374|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|5.51||||11.19||| 96374|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|5.51||||3.45||| 96374|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|5.51||||0.00||| 96374|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||5.51||| 96374|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||669.83||| 96374|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||610.42||| 96374|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|5.51||||7.27||| 96374|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|5.51||||669.83||| 96374|EAP|0307||Blue Cross PPO|BLUE CROSS PPO|||||1.18||| 96374|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||10.50||| 96374|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO Select|BCBS UTHCT|||||5.51||| 96374|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.14||| 96374|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.22||| 96374|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 96374|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.59||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.51||||669.83||| 96374|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|610.42||||669.83||| 96374|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|610.42||||1.14||| 96374|EAP|0260|IV, THER/PROPH/DIAG IV PUSH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||610.42||| 96374|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||669.83||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||610.42||| 96374|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||669.83||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||133.88||| 96374|EAP|0252|CALCIUM CHLORIDE 10% LIFESHIEL|Blue Cross PPO|BLUE CROSS PPO|||||31.95||| 96374|EAP|0258||Blue Cross PPO|BLUE CROSS PPO|||||28.90||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BLUE CROSS POS|||||5.51||| 96374|EAP|0260|IV, THER/PROPH/DIAG IV PUSH|Blue Cross PPO|BLUE CROSS PPO|669.83||||669.83||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BLUE CROSS PPO|669.83||||669.83||| 96374|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.77||| 96374|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||89.25||| 96374|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||0.84||| 96374|EAP|0271||Blue Cross PPO|BLUE CROSS PPO|||||0.47||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.24||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.17||| 96374|EAP|0450||Cigna|NALC HLTH BENEFIT|669.83||||669.83||| 96374|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|669.83||||669.83||| 96374|EAP|0258||Blue Cross PPO|BLUE CROSS PPO|||||55.50||| 96374|EAP|0260|IV, THER/PROPH/DIAG IV PUSH|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.51||| 96374|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||669.83||| 96374|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.05||| 96374|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||499.95||| 96374|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||47.95||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||669.83||| 96374|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||121.35||| 96374|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.51||| 96374|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||1.82||| 96374|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 96374|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||669.83||| 96374|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 96374|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER 2|||||5.51||| 96374|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||669.83||| 96374|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||62.15||| 96374|EAP|0450||Blue Cross PPO|BCBS WALMART|5.51||||5.51||| 96374|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|5.51||||610.42||| 96374|EAP|0260|IV, THER/PROPH/DIAG IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||610.42||| 96374|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||31.10||| 96374|EAP|0450||Medicare|MEDICARE A & B|5.51||||1.77||| 96374|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|||||669.83||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|United Healthcare|UMR|||||669.83||| 96374|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|Humana Medicare Advantage|HUMANA MEDICARE PPO|669.83||||5.51||| 96374|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|5.51||||610.42||| 96374|EAP|0450||NON CONTRACTED|MRAMVA|||||5.51||| 96374|EAP|0260|THERAP PROPH/DX INJ;IV PUSH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||669.83||| 96374|EAP|0450||United Healthcare|UMR|||||5.51||| 96374|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||669.83||| 96374|EAP|0450||PHCS|WEB TPA|||||5.51||| 96374|EAP|0450|THERAP PROPH/DX INJ;IV PUSH|United Healthcare|UMR|||||5.51||| 96374|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.51||||669.83||| 96374|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||123.15||| 96374|EAP|0450||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||669.83||| 96374|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.51||||1.14||| 96374|EAP|0450||PHCS|WEB TPA OF GRAND PRAIRIE|||||669.83||| 96375|EAP|0260||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.10||| 96375|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.62||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.14||| 96375|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BCBS TRANE PPO|||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BLUE CROSS POS|||||1.14||| 96375|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| 96375|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.14||||2.10||| 96375|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|1.14||||1.14||| 96375|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|1.14||||2.10||| 96375|EAP|0450||Blue Cross PPO|BLUE CROSS POS|2.10||||1.14||| 96375|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||2.10||| 96375|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.14||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|Blue Cross PPO|BLUE CROSS PPO|||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO Select|BCBS UTHCT|||||2.10||| 96375|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||50.40||| 96375|EAP|0260||Blue Cross PPO Select|BCBS UTHCT|||||1.14||| 96375|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|1.14||||2.10||| 96375|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|2.10||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.14||| 96375|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|2.10||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BCBS WALMART|||||2.10||| 96375|EAP|0251||ChampVA|CHAMPVA OF CO DENVER|||||11.50||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|ChampVA|CHAMPVA OF CO DENVER|||||1.14||| 96375|EAP|0272||ChampVA|CHAMPVA OF CO DENVER|||||45.15||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.14||||2.10||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.10||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.10||||2.10||| 96375|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.10||||1.14||| 96375|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.62||||2.10||| 96375|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||1.62||| 96375|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.14||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|SUPERIOR STAR MCD|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.62||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.10||||2.10||| 96375|EAP|0450||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.10||| 96375|EAP|0450||Managed Medicaid|OTHER MEDICAID|||||1.14||| 96375|EAP|0450||Managed Medicaid|MEDICAID CSHCN|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE A & B|1.14||||1.14||| 96375|EAP|0260||Medicare|MEDICARE A & B|1.14||||1.14||| 96375|EAP|0270||Medicare|MEDICARE A & B|||||37.80||| 96375|EAP|0272||Medicare|MEDICARE A & B|||||45.15||| 96375|EAP|0450||Medicaid|MEDICAID|2.10||||2.10||| 96375|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 96375|EAP|0270||Medicare|MEDICARE A & B|||||50.40||| 96375|EAP|0450||Multiplan|WEB TPA|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|NON CONTRACTED|COMMERCIAL OTHER|||||2.10||| 96375|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||1.62||| 96375|EAP|0450||Medicare|MEDICARE RAILROAD|2.10||||2.10||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE A & B|1.14||||1.14||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Medicare|MEDICARE PART A|2.10||||||| 96375|EAP|0335||Medicare|MEDICARE A & B|||||4.52||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|NON CONTRACTED|COMMERCIAL OTHER|||||1.14||| 96375|EAP|0940|TX/PRO/DX INJ NEW DRUG ADDON|Medicare|MEDICARE A & B|||||1.14||| 96375|EAP|0510||Medicare|MEDICARE A & B|||||2.10||| 96375|EAP|0450||PHCS|WEB TPA|||||1.14||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|United Healthcare|UMR|1.62||||1.14||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|United Healthcare|UMR|||||1.14||| 96375|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.10||| 96375|EAP|0335||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.52||| 96375|EAP|0335||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||10.47||| 96375|EAP|0335||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96375|EAP|0335||ChampVA|CHAMPVA OF CO DENVER|||||10.47||| 96375|EAP|0270||ChampVA|CHAMPVA OF CO DENVER|||||50.40||| 96375|EAP|0636||United Healthcare|UMR|||||203.45||| 96375|EAP|0940|TX/PRO/DX INJ NEW DRUG ADDON|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.14||| 96375|EAP|0510||United Healthcare|UMR|||||2.10||| 96375|EAP|0636||United Healthcare|UMR|||||11.50||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.14||||1.62||| 96375|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.14||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.10||| 96375|EAP|0260||Blue Cross PPO|BLUE CROSS PPO|||||1.14||| 96375|EAP|0450||Cigna|NALC HLTH BENEFIT|1.14||||2.10||| 96375|EAP|0450|THER/PROPH/DIAG INJ ADD-ON|Blue Cross PPO|BLUE CROSS PPO|1.14||||2.10||| 96375|EAP|0335||Blue Cross PPO|BLUE CROSS PPO|||||10.47||| 96375|EAP|0301||United Healthcare|UMR|||||3.14||| 96375|EAP|0450||Blue Cross PPO|BCBS WALMART|1.14||||2.10||| 96375|EAP|0450||United Healthcare|UMR|1.62||||1.62||| 96375|EAP|0301||United Healthcare|UMR|||||0.19||| 96375|EAP|0450||NON CONTRACTED|MRAMVA|||||1.14||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.14||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.10||| 96375|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.50||| 96375|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|1.14||||1.14||| 96375|EAP|0335||Medicare|MEDICARE A & B|||||10.47||| 96375|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.14||| 96375|EAP|0305||United Healthcare|UMR|||||1.68||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.10||| 96375|EAP|0636||Medicare|MEDICARE A & B|||||160.50||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.10||| 96375|EAP|0636||Medicare|MEDICARE A & B|||||161.22||| 96375|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||50.40||| 96375|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||37.80||| 96375|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.55||| 96375|EAP|0270||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||17.85||| 96375|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||45.15||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|Medicare|MEDICARE A & B|||||1.14||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.14||| 96375|EAP|0257||United Healthcare|UMR|||||0.65||| 96375|EAP|0510|IV PUSH NEW SUBS/DRUG EA|Medicaid|MEDICAID|||||2.10||| 96375|EAP|0258||United Healthcare|UMR|||||32.60||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|United Healthcare|UMR|||||2.10||| 96375|EAP|0260|THER/PROPH/DIAG INJ ADD-ON|Medicaid|MEDICAID|||||1.62||| 96375|EAP|0272||United Healthcare|UMR|||||14.20||| 96375|EAP|0450||Medicare|MEDICARE A & B|1.62||||2.10||| 96375|EAP|0300||United Healthcare|UMR|||||3.55||| 96375|EAP|0300||United Healthcare|UMR|||||3.56||| 96375|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|2.10||||2.10||| 96376|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.77||||1.77||| 96376|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.77||| 96376|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.77||| 96376|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.77||| 96376|EAP|0450||Medicare|MEDICARE A & B|1.77||||1.77||| 96376|EAP|0450||NON CONTRACTED|MRAMVA|||||1.77||| 96376|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|1.77||||1.77||| 96376|EAP|0450||Medicaid|MEDICAID|||||1.77||| 96376|EAP|0450||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.77||| 96376|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||1.77||| 96376|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.77||||1.77||| 96376|EAP|0450||Blue Cross PPO Select|BCBS UTHCT|||||1.77||| 96376|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||1.77||| 96376|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.77||| 96376|EAP|0260|THER/PROPH/DIAG/INJ ADD-ON|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.77||| 96376|EAP|0260||Blue Cross PPO Select|BCBS UTHCT|||||1.77||| 96376|EAP|0450||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.77||| 96376|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.77||||1.77||| 96376|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||1.77||| 96376|EAP|0450|TX/PRO/DX INJ SAME DRUG ADON|Blue Cross PPO|BCBS WALMART|1.77||||||| 96376|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|1.77||||1.77||| 96376|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.77||| 96376|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.77||| 96376|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|1.77||||1.77||| 96376|EAP|0260||Medicare|MEDICARE A & B|1.77||||1.77||| 96376|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.77||| 96377|EAP|0360||Blue Cross PPO|BLUE CROSS PPO|||||135.56||| 96377|EAP|0360||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||135.56||| 96377|EAP|0360||Blue Cross PPO|BLUE CROSS POS|||||135.56||| 96377|EAP|0360||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||135.56||| 96377|EAP|0360||Managed Medicaid|SUPERIOR STAR MCD|||||135.56||| 96377|EAP|0360||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||135.56||| 96377|EAP|0360||Medicaid|MEDICAID|||||135.56||| 96377|EAP|0360|APP OF ON BODY INJECTOR|Medicare|MEDICARE A & B|||||135.56||| 96377|EAP|0360||Medicare|MEDICARE A & B|||||135.56||| 96377|EAP|0360||NON CONTRACTED|COMMERCIAL OTHER|||||135.56||| 96377|EAP|0360||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||135.56||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Medicare|MEDICARE RAILROAD|||||2.48||| 96401|EAP|0270||Medicare|MEDICARE A & B|||||11.55||| 96401|EAP|0272|SOLUTION IV SOD. CHLORIDE 0.90|Medicare|MEDICARE A & B|||||45.15||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Blue Cross PPO|BLUE CROSS POS|||||2.48||| 96401|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Blue Cross PPO|BLUE CROSS PPO|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.48||| 96401|EAP|0270||Medicare|MEDICARE A & B|||||17.85||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Medicare|MEDICARE A & B|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.48||| 96401|EAP|0331|CHEMO,NH ANTI-NEOPL,SQ/IM(ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.48||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Aetna|AETNA|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Blue Cross PPO|BLUE CROSS POS|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Blue Cross PPO Select|BCBS UTHCT|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Cigna|NALC HLTH BENEFIT|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 96402|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4,878.25||| 96402|EAP|0260||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||200.04||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.67||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Medicare|MEDICARE RAILROAD|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Medicare|MEDICARE PART B|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 96402|EAP|0331|CHEMO HORMON ANTINEOPL SQ/IM|Medicare|MEDICARE A & B|||||213.82||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||10.47||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||10.47||| 96413|EAP|0335||United Healthcare|UMR|||||10.47||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|United Healthcare|UMR|||||10.47||| 96413|EAP|0270||Medicare|MEDICARE A & B|||||6.30||| 96413|EAP|0270||Medicare|MEDICARE A & B|||||4.90||| 96413|EAP|0270||Medicare|MEDICARE A & B|||||50.40||| 96413|EAP|0272||Medicare|MEDICARE A & B|||||45.15||| 96413|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 96413|EAP|0270||Medicare|MEDICARE A & B|||||37.80||| 96413|EAP|0272||Medicare|MEDICARE A & B|||||12.60||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|Medicaid|MEDICAID|||||10.47||| 96413|EAP|0301||Medicare|MEDICARE A & B|||||2.28||| 96413|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 96413|EAP|0301||Medicare|MEDICARE A & B|||||2.36||| 96413|EAP|0335||Medicare|MEDICARE A & B|||||10.47||| 96413|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.47||| 96413|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|Aetna|AETNA EL PASO CLAIMS OFFICE|||||10.47||| 96413|EAP|0272||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.01||| 96413|EAP|0258||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.01||| 96413|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.01||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.47||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|NON CONTRACTED|COMMERCIAL OTHER|||||10.47||| 96413|EAP|0335|CHEMO, INFUSION, UP TO 1 HR|Medicare|MEDICARE A & B|||||10.47||| 96413|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|Medicare|MEDICARE A & B|||||4.52||| 96415|EAP|0335||Medicare|MEDICARE A & B|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|United Healthcare|UMR|||||4.52||| 96415|EAP|0335||United Healthcare|UMR|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.52||| 96415|EAP|0335|CHEMO,INFUSE, EA ADD'L UP TO 8|Medicaid|MEDICAID|||||4.52||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Medicare|MEDICARE A & B|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Cigna|CIGNA OF TN CHATTANOOGA|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Blue Cross PPO|BLUE CROSS POS|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Blue Cross PPO|BCBS TRANE PPO|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Blue Cross PPO|BLUE CROSS PPO|||||1,031.99||| 96416|EAP|0335|CHEMO PROLONG INFUSE W/PUMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,031.99||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Blue Cross PPO|BLUE CROSS PPO|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Blue Cross PPO|BCBS WALMART|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|ChampVA|CHAMPVA OF CO DENVER|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Blue Cross PPO|BLUE CROSS POS|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Medicaid|MEDICAID|||||213.82||| 96417|EAP|0335||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|United Healthcare|UMR|||||213.82||| 96417|EAP|0335|CHEMO IV INFUS EACH ADDL SEQ|Medicare|MEDICARE A & B|||||213.82||| 96522|EAP|0510|REFILL/MAINT PORT/IMPL PUMP|Blue Cross PPO|BLUE CROSS PPO|||||669.83||| 96522|EAP|0510|REFILL/MAINT PORT/IMPL PUMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||669.83||| 96523|EAP|0760|IRRIG DRUG DELIVERY DEVICE|United Healthcare|UMR|||||200.04||| 96523|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||15.40||| 96523|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||13.20||| 96523|EAP|0760|IRRIG DRUG DELIVERY DEVICE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||200.04||| 96523|EAP|0250|VARICELLA ZOSTER SHINGRIX EA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||389.35||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|United Healthcare|UMR|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|NON CONTRACTED|COMMERCIAL OTHER|||||200.04||| 96523|EAP|0636||Medicare|MEDICARE A & B|||||13.20||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Medicare|MEDICARE A & B|200.04||||200.04||| 96523|EAP|0270||Medicare|MEDICARE A & B|||||17.85||| 96523|EAP|0270||Medicare|MEDICARE A & B|||||11.55||| 96523|EAP|0760|IRRIG DRUG DELIVERY DEVICE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||200.04||| 96523|EAP|0251||Medicare|MEDICARE A & B|||||11.50||| 96523|EAP|0636||Managed Medicaid|MEDICAID CSHCN|||||15.40||| 96523|EAP|0760|IRRIG DRUG DELIVERY DEVICE|Managed Medicaid|MEDICAID CSHCN|||||200.04||| 96523|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||200.04||| 96523|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.55||| 96523|EAP|0270||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||17.85||| 96523|EAP|0760|IRRIG DRUG DELIVERY DEVICE|Medicare|MEDICARE A & B|||||200.04||| 96523|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||11.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Blue Cross PPO|BLUE CROSS PPO|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Blue Cross PPO|BLUE CROSS POS|||||200.04||| 96523|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||11.55||| 96523|EAP|0251||Blue Cross PPO Select|BCBS UTHCT|||||11.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Blue Cross PPO Select|BCBS UTHCT|||||200.04||| 96523|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||17.85||| 96523|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||11.55||| 96523|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||17.85||| 96523|EAP|0251||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Blue Cross PPO|BCBS TRANE PPO|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||200.04||| 96523|EAP|0270||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||17.85||| 96523|EAP|0270||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.55||| 96523|EAP|0760|IRRIG DRUG DELIVERY DEVICE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||200.04||| 96523|EAP|0250||Managed Medicaid|MEDICAID CSHCN|||||15.40||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||200.04||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVICE|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||200.04||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Blue Cross PPO Select|BCBS UTHCT|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Blue Cross PPO|BLUE CROSS PPO|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Multiplan|WEB TPA|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Medicare|MEDICARE A & B|||||0.31||| 97010|EAP|0420|CRYOTHERAPY; ICE PACKS, PT|Medicare|MEDICARE A & B|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|Workers Compensation|WC OTHER|||||0.31||| 97010|EAP|0420|CRYOTHERAPY; ICE PACKS, PT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|PHCS|WEB TPA|||||0.31||| 97010|EAP|0420|HEAT TREATMENT; HOT PACKS, PT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.31||| 97014|EAP|0430||Medicare|MEDICARE A & B|||||1.32||| 97014|EAP|0430|ELECTRICAL STIMULATION, OT|Medicare|MEDICARE A & B|||||0.39||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Blue Cross PPO Select|BCBS UTHCT|||||1.22||| 97035|EAP|0430|ULTRASOUND; 15 MINUTES, OT|Blue Cross PPO Select|BCBS UTHCT|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|PHCS|TML GRP INS|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|PHCS|WEB TPA|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Multiplan|TML GRP INS|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Multiplan|WEB TPA|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Multiplan|GILSBAR INC|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Cigna|CIGNA OPEN ACCESS PLUS|||||1.22||| 97035|EAP|0420|ULTRASOUND; 15 MINUTES, PT|Medicare|MEDICARE A & B|||||1.22||| 97110|EAP|0420||Humana Medicare Advantage|HUMANA MEDICARE PPO|1.81||||1.56||| 97110|EAP|0420||Medicare|MEDICARE A & B|1.81||||1.56||| 97110|EAP|0420||Medicare|MEDICARE A & B|1.81||||1.32||| 97110|EAP|0420||Medicare|MEDICARE A & B|1.81||||0.75||| 97110|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 97110|EAP|0430||Medicare|MEDICARE A & B|1.81||||1.32||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|NON CONTRACTED|COMMERCIAL OTHER|||||1.81||| 97110|EAP|0420||NON CONTRACTED|COMMERCIAL OTHER 2|||||1.89||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|NON CONTRACTED|COMMERCIAL OTHER|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Medicare|MEDICARE PART A|1.81||||||| 97110|EAP|0420||Medicare|MEDICARE A & B|1.81||||5.06||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Medicare|MEDICARE A & B|1.81||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Workers Compensation|WC RISK MANAGEMENT|||||1.81||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Workers Compensation|WC TX MUTUAL INS|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|United Healthcare|UMR|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Medicaid|MEDICAID|1.81||||||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.81||| 97110|EAP|0420||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.32||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|PHCS|WEB TPA|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|PHCS|TML GRP INS|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Multiplan|WEB TPA|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.81||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.81||||||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.81||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Workers Compensation|WC OTHER|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Multiplan|TML GRP INS|||||1.81||| 97110|EAP|0420||Medicare|MEDICARE A & B|1.81||||1.89||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.81||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Medicare|MEDICARE A & B|1.81||||1.81||| 97110|EAP|0430||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.46||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Managed Medicaid|MOLINA MEDICAID|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.81||||1.81||| 97110|EAP|0420||NON CONTRACTED|COMMERCIAL OTHER 2|||||1.32||| 97110|EAP|0420||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.81||||1.89||| 97110|EAP|0420||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.81||||1.32||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|ChampVA|CHAMPVA OF CO DENVER|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Cigna|CIGNA OTHER|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Cigna|CIGNA OPEN ACCESS PLUS|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Cigna|CIGNA OF TN CHATTANOOGA|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Blue Cross PPO Select|BCBS UTHCT|||||1.81||| 97110|EAP|0420||Medicare|MEDICARE A & B|1.81||||1.66||| 97110|EAP|0420||Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 97110|EAP|0424||Blue Cross PPO Select|BCBS UTHCT|||||2.71||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Blue Cross PPO Select|BCBS UTHCT|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Blue Cross PPO|BLUE CROSS PPO|1.81||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Blue Cross PPO|BLUE CROSS POS|1.81||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Blue Cross PPO|BCBS TRANE PPO|||||1.81||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Blue Cross PPO|BLUE CROSS PPO|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.81||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Aetna|AETNA EXXON MOBIL|||||1.81||| 97110|EAP|0420|THERAPEUTIC EXERCISE, 15 MINU|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.81||| 97110|EAP|0430|THERAPEUTIC EXERCISE, OT, 15|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.81||||1.81||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Blue Cross PPO|BLUE CROSS PPO|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Blue Cross PPO|BLUE CROSS POS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Blue Cross PPO|BCBS TRANE PPO|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Cigna|CIGNA OTHER|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Cigna|CIGNA OF TN CHATTANOOGA|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|ChampVA|CHAMPVA OF CO DENVER|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Managed Medicaid|MOLINA MEDICAID|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Blue Cross PPO Select|BCBS UTHCT|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Cigna|CIGNA OPEN ACCESS PLUS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Workers Compensation|WC GALLAGHER BASSETT|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Multiplan|TML GRP INS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Multiplan|WEB TPA|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|NON CONTRACTED|COMMERCIAL OTHER|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Multiplan|GILSBAR INC|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Medicare|MEDICARE A & B|1.89||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Workers Compensation|WC RISK MANAGEMENT|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Workers Compensation|WC OTHER|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|PHCS|WEB TPA|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|PHCS|TML GRP INS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.89||| 97112|EAP|0430|NEUROMUSC RE-EDU; 15 MINUTES,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.89||| 97112|EAP|0420|NEUROMUSCULAR RE-EDUCATION; 15|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.89||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Medicare|MEDICARE A & B|1.66||||1.66||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Medicare|MEDICARE PART A|1.66||||||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|NON CONTRACTED|COMMERCIAL OTHER|1.66||||||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.66||||||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.66||||1.66||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.66||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Blue Cross PPO|BLUE CROSS PPO|1.66||||||| 97116|EAP|0420|GAIT TRAINING; 15 MINUTES|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.66||| 97124|EAP|0420|CRYOTHERAPY; ICE MASSAGE, PT|Blue Cross PPO Select|BCBS UTHCT|||||0.75||| 97124|EAP|0420|CRYOTHERAPY; ICE MASSAGE, PT|Medicare|MEDICARE A & B|||||0.75||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Workers Compensation|WC RISK MANAGEMENT|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Workers Compensation|WC OTHER|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Workers Compensation|WC GALLAGHER BASSETT|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|United Healthcare|UMR|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|PHCS|WEB TPA|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Medicare|MEDICARE A & B|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Medicare|MEDICARE A & B|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Multiplan|WEB TPA|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Multiplan|TML GRP INS|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Multiplan|GILSBAR INC|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|NON CONTRACTED|COMMERCIAL OTHER|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|NON CONTRACTED|COMMERCIAL OTHER|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Blue Cross PPO|BLUE CROSS PPO|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Blue Cross PPO|BLUE CROSS POS|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|PHCS|TML GRP INS|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Blue Cross PPO|BCBS TRANE PPO|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Workers Compensation|WC TX MUTUAL INS|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Blue Cross PPO|BLUE CROSS PPO|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Cigna|CIGNA OPEN ACCESS PLUS|||||1.32||| 97140|EAP|0430|MANUAL THERAPY, 15 MINUTES, OT|Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Cigna|CIGNA OF TN CHATTANOOGA|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Blue Cross PPO Select|BCBS UTHCT|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Cigna|CIGNA OTHER|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|ChampVA|CHAMPVA OF CO DENVER|||||1.32||| 97140|EAP|0420|MANUAL THERAPY, 15 MINUTES, PT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.32||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|ChampVA|CHAMPVA OF CO DENVER|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Blue Cross PPO Select|BCBS UTHCT|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Managed Medicaid|MOLINA MEDICAID|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.71||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Blue Cross PPO|BLUE CROSS PPO|2.71||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Aetna|AETNA EXXON MOBIL|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Cigna|CIGNA OPEN ACCESS PLUS|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Multiplan|GILSBAR INC|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|NON CONTRACTED|COMMERCIAL OTHER|2.71||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Medicaid|MEDICAID|2.71||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|United Healthcare|UMR|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Medicare|MEDICARE A & B|2.71||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Workers Compensation|WC OTHER|||||2.71||| 97161|EAP|0424|PHYSICAL THERAPY EVAL, LOW COM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.71||||2.71||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Workers Compensation|WC RISK MANAGEMENT|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Workers Compensation|WC OTHER|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|United Healthcare|UMR|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Veterans Affairs|VETERANS CHOICE - TRI WEST|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|PHCS|TML GRP INS|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|4.37||||||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|PHCS|WEB TPA|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Medicare|MEDICARE PART A|4.37||||||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Medicare|MEDICARE A & B|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Multiplan|TML GRP INS|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Multiplan|WEB TPA|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|NON CONTRACTED|COMMERCIAL OTHER|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Medicaid|MEDICAID|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Aetna|AETNA EL PASO CLAIMS OFFICE|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross PPO|BLUE CROSS PPO|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross PPO|BLUE CROSS POS|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross PPO|BCBS WALMART|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross PPO|BCBS TRANE PPO|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|4.37||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Managed Medicaid|MOLINA MEDICAID|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Managed Medicaid|SUPERIOR STAR MCD|4.37||||||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Cigna|CIGNA OTHER|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Cigna|CIGNA OPEN ACCESS PLUS|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|ChampVA|CHAMPVA OF CO DENVER|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Cigna|CIGNA OF TN CHATTANOOGA|||||4.37||| 97162|EAP|0420|PHY THERAPY EVAL, MOD COMP|Blue Cross PPO Select|BCBS UTHCT|||||4.37||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Blue Cross PPO|BLUE CROSS POS|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|ChampVA|CHAMPVA OF CO DENVER|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Cigna|CIGNA OF TN CHATTANOOGA|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Blue Cross PPO Select|BCBS UTHCT|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|5.06||||||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Managed Medicaid|MEDICAID CSHCN|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Blue Cross PPO|BLUE CROSS PPO|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Managed Medicaid|MOLINA MEDICAID|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Blue Cross PPO|BCBS WALMART|5.06||||||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Medicaid|MEDICAID|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Medicare|MEDICARE RAILROAD|5.06||||||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Medicare|MEDICARE PART A|5.06||||||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Medicare|MEDICARE A & B|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Multiplan|TML GRP INS|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|NON CONTRACTED|COMMERCIAL OTHER|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|NON CONTRACTED|PPO OTHER|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|United Healthcare|UMR|||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|PHCS|TML GRP INS|5.06||||5.06||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Veterans Affairs|VETERANS CHOICE - TRI WEST|5.06||||||| 97163|EAP|0420|PHY THERAPY EVAL,HIGH COMP|Workers Compensation|WC OTHER|||||5.06||| 97164|EAP|0420|PHY THERAPY RE-EVALUATION|Medicare|MEDICARE A & B|||||2.37||| 97164|EAP|0420|PHY THERAPY RE-EVALUATION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.37||||||| 97164|EAP|0420|PHY THERAPY RE-EVALUATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.37||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Blue Cross PPO Select|BCBS UTHCT|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.48||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Blue Cross PPO|BLUE CROSS PPO|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Blue Cross PPO|BLUE CROSS POS|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Workers Compensation|WC TX MUTUAL INS|||||3.48||| 97165|EAP|0430|OCC THERAPY EVAL,LOW COMP|Medicare|MEDICARE A & B|||||3.48||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Medicaid|MEDICAID|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Medicare|MEDICARE A & B|4.19||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|NON CONTRACTED|COMMERCIAL OTHER|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Blue Cross PPO|BLUE CROSS PPO|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Cigna|CIGNA OF TN CHATTANOOGA|||||4.19||| 97166|EAP|0430|OCC THERAPY EVAL,MOD COMP|Blue Cross PPO Select|BCBS UTHCT|||||4.19||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Medicaid|MEDICAID|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.89||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Cigna|CIGNA OPEN ACCESS PLUS|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Blue Cross PPO Select|BCBS UTHCT|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.89||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Blue Cross PPO|BLUE CROSS PPO|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Blue Cross PPO|BLUE CROSS POS|||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|4.89||||4.89||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.89||| 97167|EAP|0420||Medicare|MEDICARE A & B|||||5.06||| 97167|EAP|0430|OCC THERAPY EVAL, HIGH COMP|Medicare|MEDICARE A & B|4.89||||4.89||| 97168|EAP|0430|OCCUPATIONAL THERAPY RE-EVALUA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.37||| 97168|EAP|0430|OCCUPATIONAL THERAPY RE-EVALUA|Blue Cross PPO Select|BCBS UTHCT|||||2.37||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|1.56||||||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|ChampVA|CHAMPVA OF CO DENVER|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Multiplan|WEB TPA|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Medicare|MEDICARE RAILROAD|1.56||||||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Medicaid|MEDICAID|1.56||||||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Medicare|MEDICARE PART A|1.56||||||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Medicare|MEDICARE A & B|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Multiplan|TML GRP INS|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Workers Compensation|WC OTHER|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|PHCS|TML GRP INS|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|PHCS|WEB TPA|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|1.56||||||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.56||||||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Managed Medicaid|MOLINA MEDICAID|||||1.56||| 97530|EAP|0430|FUNCTION OT ACTIVITIES; 15 MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Cigna|CIGNA OF TN CHATTANOOGA|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Blue Cross PPO Select|BCBS UTHCT|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Blue Cross PPO|BLUE CROSS PPO|1.56||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.56||| 97530|EAP|0420|FUNCTIONAL ACTIVITIES; 15 MIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.56||||1.56||| 97535|EAP|0430|ADL TRAINING; PER 15 MINUTES,|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.46||||||| 97535|EAP|0430|ADL TRAINING; PER 15 MINUTES,|Blue Cross PPO Select|BCBS UTHCT|||||1.46||| 97535|EAP|0430|ADL TRAINING; PER 15 MINUTES,|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.46||| 97535|EAP|0430|ADL TRAINING; PER 15 MINUTES,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.46||| 97535|EAP|0430|ADL TRAINING; PER 15 MINUTES,|Medicare|MEDICARE A & B|||||1.46||| 97537|EAP|0420|WORK-SITE EVALUATION/REC; 15 M|Medicare|MEDICARE A & B|||||0.66||| 97597|EAP|0272|DRESSING KERLIX 4 1/2 X 4.1 YD|Medicare|MEDICARE A & B|||||4.90||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Blue Cross PPO Select|BCBS UTHCT|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Blue Cross PPO|BLUE CROSS POS|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Blue Cross PPO|BCBS WALMART|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.51||| 97597|EAP|0510|SLCTV WND DEBRIDEM 20 CM OR <|Medicare|MEDICARE A & B|2.51||||2.51||| 977|DRG||HIV W OR W/O OTHER RELATED CONDITION|Medicare|MEDICARE A & B|29,503.82|10975.97|10975.97|10975.97|||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|PHCS|TML GRP INS|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Blue Cross PPO|BLUE CROSS PPO|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Workers Compensation|WC OTHER|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|PHCS|WEB TPA|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Medicare|MEDICARE A & B|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Multiplan|WEB TPA|||||1.93||| 97750|EAP|0420|PHYS PERFORMANCE TEST, 15 MIN,|Multiplan|TML GRP INS|||||1.93||| 97760|EAP|0420|ORTHOTIC FIT/TRAINING, 15 MINU|Medicare|MEDICARE A & B|||||1.41||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross PPO|BLUE CROSS PPO|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross PPO Select|BCBS UTHCT|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross PPO|BCBS WALMART|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross PPO|BLUE CROSS POS|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|United Healthcare|UMR|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Cigna|CIGNA OF TN CHATTANOOGA|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Managed Medicaid|MOLINA MEDICAID|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Managed Medicaid|FAMILY PLANNING GRANT|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Medicaid|MEDICAID|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Multiplan|GILSBAR INC|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|NON CONTRACTED|COMMERCIAL OTHER|||||0.56||| 97802|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Medicare|MEDICARE A & B|||||0.56||| 97802|EAP|0942||Medicare|MEDICARE A & B|||||0.56||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.48||| 97803|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Medicare|MEDICARE A & B|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Multiplan|GILSBAR INC|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Managed Medicaid|MOLINA MEDICAID|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Managed Medicaid|FAMILY PLANNING GRANT|||||0.48||| 97803|EAP|0301||Medicare|MEDICARE A & B|||||2.34||| 97803|EAP|0301||Medicare|MEDICARE A & B|||||2.10||| 97803|EAP|0301||Medicare|MEDICARE A & B|||||0.29||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Blue Cross PPO|BLUE CROSS PPO|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Blue Cross PPO|BCBS WALMART|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.48||| 97803|EAP|0942|MED NUTR THER, EA 15 MIN, RECK|Blue Cross PPO Select|BCBS UTHCT|||||0.48||| 99|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC|Medicare|MEDICARE A & B|21,359.18|9496.27|9496.27|9496.27|||| 99001|EAP|0309|HANDLING/PROCESS FEE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Blue Cross PPO|BLUE CROSS PPO|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Cigna|CIGNA OF TN CHATTANOOGA|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Blue Cross PPO Select|BCBS UTHCT|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Managed Medicaid|MEDICAID CSHCN|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Aetna|AETNA|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|NON CONTRACTED|COMMERCIAL OTHER|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Medicare|MEDICARE A & B|||||0.98||| 99001|EAP|0309|HANDLING/PROCESS FEE|Medicare|MEDICARE PART A|0.98||||0.98||| 99195|EAP|0940|PHLEBOTOMY, THERAPEUTIC|Medicare|MEDICARE A & B|||||381.05||| 99195|EAP|0940|PHLEBOTOMY, THERAPEUTIC|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||381.05||| 99195|EAP|0940|PHLEBOTOMY, THERAPEUTIC|Blue Cross PPO|BLUE CROSS POS|||||381.05||| 99195|EAP|0940|PHLEBOTOMY, THERAPEUTIC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||381.05||| 99195|EAP|0940|PHLEBOTOMY, THERAPEUTIC|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||381.05||| 99195|EAP|0940|PHLEBOTOMY, THERAPEUTIC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||381.05||| 99203|EAP|0513||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.99||| 99203|EAP|0513||Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| 99203|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.99||| 99203|EAP|0513||United Healthcare|UMR|||||2.99||| 99203|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.99||| 99203|EAP|0513||Medicaid|MEDICAID|||||2.99||| 99203|EAP|0513||Medicare|MEDICARE A & B|||||2.99||| 99204|EAP|0513||Medicare|MEDICARE A & B|||||3.79||| 99204|EAP|0513||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.79||| 99204|EAP|0513||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.79||| 99204|EAP|0513||United Healthcare|UMR|||||3.79||| 99204|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.79||| 99204|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| 99204|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||3.79||| 99205|EAP|0513||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.38||| 99205|EAP|0513||Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| 99205|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||4.38||| 99205|EAP|0513||Blue Cross PPO|BCBS WALMART|||||4.38||| 99205|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| 99205|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.38||| 99205|EAP|0513||Medicare|MEDICARE A & B|||||4.38||| 99211|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.09||| 99211|EAP|0513||Medicare|MEDICARE A & B|||||2.09||| 99212|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.25||| 99212|EAP|0513||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.25||| 99212|EAP|0513||Medicare|MEDICARE A & B|||||2.25||| 99213|EAP|0513||United Healthcare|UMR|||||2.50||| 99213|EAP|0513||Tricare|TRICARE WEST UNITED HEALTH|||||2.50||| 99213|EAP|0513||Medicare|MEDICARE A & B|||||2.50||| 99213|EAP|0513||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| 99213|EAP|0513||Managed Medicaid|MOLINA MEDICAID|||||2.50||| 99213|EAP|0513||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 99213|EAP|0513||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| 99213|EAP|0513||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| 99213|EAP|0513||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.50||| 99213|EAP|0513||Medicaid|MEDICAID|||||2.50||| 99213|EAP|0513||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| 99213|EAP|0513||Aetna|AETNA EXXON MOBIL|||||2.50||| 99213|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| 99213|EAP|0513||Aetna|AETNA|||||2.50||| 99213|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 99213|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| 99213|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| 99213|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| 99213|EAP|0513||Blue Cross PPO|BLUE CROSS POS|||||2.50||| 99213|EAP|0513||Blue Cross PPO|BCBS WALMART|||||2.50||| 99213|EAP|0513||Blue Cross PPO|BCBS TRANE PPO|||||2.50||| 99213|EAP|0513||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| 99213|EAP|0513||Optum Behavioral Health|OPTUM|||||2.50||| 99214|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| 99214|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| 99214|EAP|0513||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| 99214|EAP|0513||Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.64||| 99214|EAP|0513||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| 99214|EAP|0513||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| 99214|EAP|0513||Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| 99214|EAP|0513||Medicaid|MEDICAID|||||2.64||| 99214|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| 99214|EAP|0513||United Healthcare|GOLDEN RULE INSURANCE|||||2.64||| 99214|EAP|0513||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| 99214|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| 99214|EAP|0513||United Healthcare|UMR|||||2.64||| 99214|EAP|0513||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| 99214|EAP|0513||Medicare|MEDICARE A & B|||||2.64||| 99214|EAP|0513||Medicare|MEDICARE PART A|||||2.64||| 99214|EAP|0513||Optum Behavioral Health|OPTUM|||||2.64||| 99214|EAP|0513||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| 99214|EAP|0513||Managed Medicaid|MOLINA MEDICAID|||||2.64||| 99214|EAP|0513||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| 99214|EAP|0513||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| 99214|EAP|0513||ChampVA|CHAMPVA OF CO DENVER|||||2.64||| 99214|EAP|0513||Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| 99214|EAP|0513||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| 99214|EAP|0513||Blue Cross PPO|BCBS WALMART|||||2.64||| 99214|EAP|0513||Blue Cross PPO|BLUE CROSS POS|||||2.64||| 99215|EAP|0513||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.26||| 99215|EAP|0513||Blue Cross PPO|BCBS WALMART|||||3.26||| 99215|EAP|0513||Blue Cross PPO|BLUE CROSS PPO|||||3.26||| 99215|EAP|0513||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| 99215|EAP|0513||Managed Medicaid|MOLINA MEDICAID|||||3.26||| 99215|EAP|0513||Medicare|MEDICARE A & B|||||3.26||| 99215|EAP|0513||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.26||| 99243|EAP|0510|CLINIC VISIT; MID, CONSULT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.94||| 99243|EAP|0510||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.99||| 99243|EAP|0510|CLINIC VISIT; MID, CONSULT|Managed Medicaid|FAMILY PLANNING GRANT|||||4.94||| 99243|EAP|0510|CLINIC VISIT; MID, CONSULT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.94||| 99244|EAP|0510||Medicare|MEDICARE A & B|||||6.83||| 99244|EAP|0301|DEPAKENE (VALPROIC ACID)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.11||| 99244|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.83||| 99244|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||6.83||| 99244|EAP|0510|CLINIC VISIT; HIGH MODERATE, C|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.83||| 99244|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||6.83||| 99244|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.14||| 99244|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.36||| 99244|EAP|0510||United Healthcare|GOLDEN RULE INSURANCE|||||6.83||| 99244|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 99281|EAP|0450|CLSD TX HUMERAL SHFT FX,W/MANI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||32.78||| 99281|EAP|0450|ER SUTURE REMOVAL|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99281|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|||||4.15||| 99281|EAP|0307||Blue Cross PPO|BLUE CROSS PPO|||||1.18||| 99281|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.86||| 99281|EAP|0305||Blue Cross PPO|BLUE CROSS PPO|||||1.68||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| 99281|EAP|0450|ER SUTURE REMOVAL|ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Cigna|CIGNA OF TN CHATTANOOGA|||||1.65||| 99281|EAP|0981|ER VISIT; LEVEL II|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Blue Cross PPO Select|BCBS UTHCT|||||1.65||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.34||| 99281|EAP|0450|ER SUTURE REMOVAL|Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 99281|EAP|0450||Managed Medicaid|MOLINA MEDICAID|||||4.15||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Managed Medicaid|MOLINA MEDICAID|||||2.34||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||2.44||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||1.02||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||1.44||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||1.76||| 99281|EAP|0251||Medicare|MEDICARE A & B|||||3.15||| 99281|EAP|0981|ER VISIT; LEVEL II|Medicare|MEDICARE A & B|||||0.00||| 99281|EAP|0450||Medicare|MEDICARE A & B|2.34||||0.00||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Medicare|MEDICARE A & B|2.34||||2.34||| 99281|EAP|0450||Medicare|MEDICARE A & B|2.34||||2.34||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Medicare|MEDICARE A & B|1.65||||1.65||| 99281|EAP|0981|ER VISIT; LEVEL II|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 99281|EAP|0450|ER SUTURE REMOVAL|Workers Compensation|WC TX MUTUAL INS|||||0.01||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.34||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.65||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.34||| 99281|EAP|0981|ER VISIT; LEVEL II|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.34||| 99281|EAP|0450|ER SUTURE REMOVAL|Workers Compensation|WC OTHER|||||0.00||| 99281|EAP|0981|ER VISIT; LEVEL II|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 99281|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|NON CONTRACTED|COMMERCIAL OTHER|1.65||||1.65||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|NON CONTRACTED|COMMERCIAL OTHER|||||2.34||| 99281|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Medicare|MEDICARE PART A|||||1.65||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.65||| 99281|EAP|0450|ER SUTURE REMOVAL|Medicare|MEDICARE A & B|2.34||||0.00||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.65||| 99281|EAP|0459||Medicare|MEDICARE A & B|1.65||||5.42||| 99281|EAP|0450||Medicare|MEDICARE A & B|2.34||||4.15||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Medicare|MEDICARE PART A|||||2.34||| 99281|EAP|0320||Medicare|MEDICARE A & B|||||2.35||| 99281|EAP|0252||Medicare|MEDICARE A & B|||||9.75||| 99281|EAP|0307||Medicare|MEDICARE A & B|||||0.69||| 99281|EAP|0251||Medicare|MEDICARE A & B|||||9.75||| 99281|EAP|0250||Medicare|MEDICARE A & B|||||27.35||| 99281|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 99281|EAP|0981|ER VISIT; LEVEL II|Medicaid|MEDICAID|||||0.00||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||2.28||| 99281|EAP|0301||Medicare|MEDICARE A & B|||||2.27||| 99281|EAP|0306||Medicare|MEDICARE A & B|||||1.36||| 99281|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Medicaid|MEDICAID|||||2.34||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Medicaid|MEDICAID|||||1.65||| 99281|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Managed Medicaid|SUPERIOR STAR MCD|||||1.65||| 99281|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.15||| 99281|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 99281|EAP|0981|ER VISIT; LEVEL II|Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.34||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Managed Medicaid|SUPERIOR STAR MCD|||||2.34||| 99281|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.36||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.65||| 99281|EAP|0450|ER SUTURE REMOVAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 99281|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 99281|EAP|0450|ER SUTURE REMOVAL|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 99281|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.07||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Cigna|CIGNA OF TN CHATTANOOGA|||||2.34||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Cigna|CIGNA OPEN ACCESS PLUS|||||2.34||| 99281|EAP|0981|ER VISIT; LEVEL II|Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.44||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.27||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.02||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.28||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.14||| 99281|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99281|EAP|0981|ER VISIT; LEVEL II|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 99281|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.76||| 99281|EAP|0981|ER VISIT; LEVEL II|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Blue Cross PPO|BLUE CROSS POS|||||2.34||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Blue Cross PPO|BLUE CROSS PPO|||||2.34||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Blue Cross PPO|BLUE CROSS PPO|||||1.65||| 99281|EAP|0450|ER SUTURE REMOVAL|Blue Cross PPO|BLUE CROSS POS|||||0.00||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Aetna|AETNA|||||2.34||| 99281|EAP|0981|ER VISIT; LEVEL II|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.65||| 99281|EAP|0450|ER SUTURE REMOVAL|Blue Cross PPO Select|BCBS UTHCT|||||0.01||| 99281|EAP|0459|EMERGENCY VISIT; MINIMUM,p|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.65||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 99281|EAP|0450|EMERGENCY VISIT; MINIMUM|Blue Cross PPO Select|BCBS UTHCT|||||2.34||| 99282|EAP|0270||Medicaid|MEDICAID|||||11.55||| 99282|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| 99282|EAP|0301|HEPATIC FUNCTION PANEL|Medicare|MEDICARE A & B|||||2.46||| 99282|EAP|0301||Medicare|MEDICARE A & B|||||1.58||| 99282|EAP|0301||Medicare|MEDICARE A & B|||||1.73||| 99282|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 99282|EAP|0981||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.00||| 99282|EAP|0981||Medicaid|MEDICAID|||||0.00||| 99282|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| 99282|EAP|0305|RETIC COUNT, AUTOMATED|Medicare|MEDICARE A & B|||||0.76||| 99282|EAP|0306||Medicare|MEDICARE A & B|||||1.39||| 99282|EAP|0306||Medicare|MEDICARE A & B|||||1.30||| 99282|EAP|0306||Medicare|MEDICARE A & B|||||0.40||| 99282|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.14||| 99282|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 99282|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 99282|EAP|0305||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.68||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.15||||4.15||| 99282|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|4.15||||181.41||| 99282|EAP|0258|DEXTROSE 5% - 0.45% NACL 1000|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||55.50||| 99282|EAP|0270||Managed Medicaid|SUPERIOR STAR MCD|||||0.64||| 99282|EAP|0271||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| 99282|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.25||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|SUPERIOR STAR MCD|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|MEDICAID CSHCN|||||4.15||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||10.56||| 99282|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||4.15||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.36||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||213.82||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||669.83||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.00||| 99282|EAP|0450||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 99282|EAP|0450||Cigna|CIGNA OPEN ACCESS PLUS|||||0.01||| 99282|EAP|0450||Cigna|CIGNA OF TN CHATTANOOGA|||||213.82||| 99282|EAP|0981||Cigna|CIGNA OPEN ACCESS PLUS|||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross PPO Select|BCBS UTHCT|4.15||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross PPO|BCBS WALMART|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross PPO|BCBS TRANE PPO|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.15||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||2.34||| 99282|EAP|0450||Blue Cross PPO|BCBS WALMART|||||181.41||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Blue Cross PPO|BCBS TRANE PPO|||||3.00||| 99282|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99282|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.15||| 99282|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 99282|EAP|0270||Blue Cross PPO|BLUE CROSS PPO|||||47.25||| 99282|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||22.05||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Aetna|AETNA|||||4.15||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.00||| 99282|EAP|0450||Aetna|AETNA EL PASO CLAIMS OFFICE|||||181.41||| 99282|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 99282|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| 99282|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| 99282|EAP|0270||Blue Cross PPO Select|BCBS UTHCT|||||0.07||| 99282|EAP|0981||Blue Cross PPO|BCBS TRANE PPO|||||0.00||| 99282|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|||||0.65||| 99282|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.34||| 99282|EAP|0981||Blue Cross PPO|BCBS WALMART|||||0.00||| 99282|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| 99282|EAP|0981||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.00||| 99282|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Blue Cross PPO|BCBS WALMART|||||3.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Blue Cross PPO|BLUE CROSS PPO|3.00||||3.00||| 99282|EAP|0450||Blue Cross PPO|BCBS TRANE PPO|||||181.41||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||181.41||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||0.01||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||4.18||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||4.36||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||7.27||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross PPO|BLUE CROSS POS|||||4.15||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||5.18||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||213.82||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Blue Cross PPO Select|BCBS UTHCT|3.00||||3.00||| 99282|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|4.15||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Blue Cross PPO|BLUE CROSS PPO|4.15||||4.15||| 99282|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 99282|EAP|0270||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||47.25||| 99282|EAP|0981||ChampVA|CHAMPVA OF CO DENVER|||||0.00||| 99282|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||106.75||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Cigna|CIGNA OF TN CHATTANOOGA|||||4.15||| 99282|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||11.50||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Cigna|CIGNA OPEN ACCESS PLUS|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|ChampVA|CHAMPVA OF CO DENVER|||||4.15||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Managed Medicaid|SUPERIOR STAR MCD|||||3.00||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.45||| 99282|EAP|0450||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||4.36||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.34||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.15||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||213.82||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||2.34||| 99282|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||9.45||| 99282|EAP|0981||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.00||| 99282|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.07||| 99282|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|MOLINA MEDICAID|||||4.15||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Managed Medicaid|MOLINA MEDICAID|||||3.00||| 99282|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.18||| 99282|EAP|0450||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.27||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.15||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.12||| 99282|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.21||| 99282|EAP|0272||Medicaid|MEDICAID|||||4.90||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||4.15||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.20||| 99282|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||0.19||| 99282|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||181.41||| 99282|EAP|0301||Medicare|MEDICARE A & B|||||1.88||| 99282|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.17||| 99282|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.07||| 99282|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||47.25||| 99282|EAP|0270||Managed Medicaid|SUPERIOR STAR MCD|||||47.25||| 99282|EAP|0306||Medicare|MEDICARE A & B|||||0.91||| 99282|EAP|0270||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.55||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.00||||3.00||| 99282|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|4.15||||2.32||| 99282|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|4.15||||4.36||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.15||| 99282|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Managed Medicaid|OTHER MEDICAID|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|PHCS|WEB TPA|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|PHCS|TML GRP INS|||||4.15||| 99282|EAP|0450||PHCS|WEB TPA|||||213.82||| 99282|EAP|0450||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||181.41||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|United Healthcare|GOLDEN RULE INSURANCE|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.15||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.00||| 99282|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||6.25||| 99282|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.15||||5.18||| 99282|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.15||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.15||||4.15||| 99282|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.15||||2.16||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.00||||3.00||| 99282|EAP|0981||United Healthcare|UMR|||||0.00||| 99282|EAP|0981||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||0.00||| 99282|EAP|0981||PHCS|WEB TPA|||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Tricare|TRICARE WEST UNITED HEALTH|||||4.15||| 99282|EAP|0981||Tricare|TRICARE WEST UNITED HEALTH|||||0.00||| 99282|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 99282|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||197.62||| 99282|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.18||| 99282|EAP|0450||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||181.41||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.15||| 99282|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||5.18||| 99282|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||4.20||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Workers Compensation|DO NOT USE----ENABLE COMP|||||4.15||| 99282|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 99282|EAP|0981||Workers Compensation|WC TX MUTUAL INS|||||0.00||| 99282|EAP|0981||Workers Compensation|WC TRAVELERS|||||0.00||| 99282|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 99282|EAP|0981||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.00||||3.00||| 99282|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Workers Compensation|WC OTHER|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Workers Compensation|WC TX MUTUAL INS|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Workers Compensation|WC GALLAGHER BASSETT|||||4.15||| 99282|EAP|0450||Workers Compensation|WC TX MUTUAL INS|||||4.12||| 99282|EAP|0981||Medicare|MEDICARE PART A|||||0.00||| 99282|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 99282|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|Medicare|MEDICARE A & B|||||3.26||| 99282|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Medicare|MEDICARE A & B|||||3.79||| 99282|EAP|0510||Medicare|MEDICARE A & B|||||2.64||| 99282|EAP|0450||Multiplan|WEB TPA|||||213.82||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Multiplan|GILSBAR INC|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Multiplan|TML GRP INS|||||4.15||| 99282|EAP|0352||Medicare|MEDICARE A & B|||||28.51||| 99282|EAP|0981||Multiplan|WEB TPA|||||0.00||| 99282|EAP|0352||Medicare|MEDICARE A & B|||||27.12||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Multiplan|WEB TPA|||||4.15||| 99282|EAP|0981||Multiplan|TML GRP INS|||||0.00||| 99282|EAP|0981||Multiplan|GILSBAR INC|||||0.00||| 99282|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 99282|EAP|0352||Medicare|MEDICARE A & B|||||23.77||| 99282|EAP|0320|BONE DENSITY STUDY (DEXA)|Medicare|MEDICARE A & B|||||5.06||| 99282|EAP|0320||Medicare|MEDICARE A & B|||||2.16||| 99282|EAP|0272||NON CONTRACTED|COMMERCIAL OTHER|||||4.90||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||213.82||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Medicare|MEDICARE RAILROAD|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Workers Compensation|WC TRAVELERS|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Medicare|MEDICARE PART A|4.15||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Medicare|MEDICARE A & B|4.15||||4.15||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||669.83||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||181.41||| 99282|EAP|0450||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.00||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||6.25||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||4.20||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||4.19||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||2.34||| 99282|EAP|0450||Workers Compensation|WC TRAVELERS|||||181.41||| 99282|EAP|0450||Medicare|MEDICARE A & B|4.15||||0.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Medicare|MEDICARE RAILROAD|3.00||||||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Medicare|MEDICARE PART A|3.00||||||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Medicare|MEDICARE A & B|3.00||||3.00||| 99282|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| 99282|EAP|0460||Medicare|MEDICARE A & B|||||2.82||| 99282|EAP|0460||Medicare|MEDICARE A & B|||||2.35||| 99282|EAP|0730||Medicare|MEDICARE A & B|||||3.09||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.15||| 99282|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|NON CONTRACTED|MRAMVA|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|NON CONTRACTED|COMMERCIAL OTHER|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|NON CONTRACTED|BOONE CHAPMAN|||||4.15||| 99282|EAP|0981||PHCS|TML GRP INS|||||0.00||| 99282|EAP|0450||NON CONTRACTED|COMMERCIAL OTHER|||||213.82||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|NON CONTRACTED|COMMERCIAL OTHER|3.00||||3.00||| 99282|EAP|0981||NON CONTRACTED|MRAMVA|||||0.00||| 99282|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 99282|EAP|0419|SPIROMETRY, PRE & POST BRONCH|Medicare|MEDICARE A & B|||||7.09||| 99282|EAP|0255||Medicare|MEDICARE A & B|||||5.25||| 99282|EAP|0270||Medicare|MEDICARE A & B|||||47.25||| 99282|EAP|0270||Medicare|MEDICARE A & B|||||11.55||| 99282|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|4.15||||213.82||| 99282|EAP|0271|WALKER BOOT,TALL MEN,SZ3(MED)|Medicare|MEDICARE A & B|||||1.26||| 99282|EAP|0272||Medicare|MEDICARE A & B|||||14.70||| 99282|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| 99282|EAP|0272||Medicare|MEDICARE A & B|||||6.30||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|United Healthcare|UMR|||||3.00||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|United Healthcare|UMR|||||4.15||| 99282|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 99282|EAP|0981||Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||0.00||| 99282|EAP|0981||Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.00||| 99282|EAP|0981||Managed Medicaid|OTHER MEDICAID|||||0.00||| 99282|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 99282|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 99282|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 99282|EAP|0450||Medicaid|MEDICAID|||||5.18||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||4.15||| 99282|EAP|0450|EMERGENCY VISIT; LOW LEVEL|Medicaid|MEDICAID|||||4.15||| 99282|EAP|0450||Medicaid|MEDICAID|||||213.82||| 99282|EAP|0450||Medicaid|MEDICAID|||||0.00||| 99282|EAP|0459|EMERGENCY VISIT; LOW LEVEL,p|Medicaid|MEDICAID|||||3.00||| 99282|EAP|0306||Medicare|MEDICARE A & B|||||1.36||| 99282|EAP|0306||Medicare|MEDICARE A & B|||||0.68||| 99282|EAP|0251||Medicare|MEDICARE A & B|||||3.15||| 99283|EAP|0307||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.69||| 99283|EAP|0320||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.69||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.27||||7.27||| 99283|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.27||||11.19||| 99283|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.27||||5.51||| 99283|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.27||||0.00||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.42||||5.42||| 99283|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 99283|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| 99283|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| 99283|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.82||| 99283|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.05||| 99283|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.90||| 99283|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.07||| 99283|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 99283|EAP|0271||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| 99283|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.59||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.21||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.14||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.28||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.29||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.02||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.51||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Aetna|TRS COORDINATED CARE|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross PPO|BCBS TRANE PPO|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross PPO|BLUE CROSS PPO|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross PPO|BLUE CROSS POS|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|7.27||||7.27||| 99283|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|7.27||||669.83||| 99283|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|7.27||||4.36||| 99283|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|7.27||||4.12||| 99283|EAP|0450||Blue Cross PPO|BLUE CROSS POS|||||4.36||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Blue Cross PPO|BLUE CROSS PPO|5.42||||5.42||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Blue Cross PPO|BCBS WALMART|5.42||||5.42||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|5.42||||||| 99283|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99283|EAP|0981||Blue Cross PPO|BLUE CROSS POS|||||0.00||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|ChampVA|CHAMPVA OF CO DENVER|||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Cigna|NALC HLTH BENEFIT|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Cigna|CIGNA OTHER|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Cigna|CIGNA OF TN CHATTANOOGA|||||7.27||| 99283|EAP|0981||Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| 99283|EAP|0981||Blue Cross PPO Select|BCBS UTHCT|||||0.00||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross PPO Select|BCBS UTHCT|7.27||||7.27||| 99283|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.19||| 99283|EAP|0305||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.68||| 99283|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.19||| 99283|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.14||| 99283|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| 99283|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||7.27||| 99283|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|7.27||||669.83||| 99283|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|7.27||||2.10||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Humana Medicare Advantage|HUMANA MEDICARE PPO|5.42||||5.42||| 99283|EAP|0270||Managed Medicaid|SUPERIOR STAR MCD|||||0.64||| 99283|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||4.90||| 99283|EAP|0272||Managed Medicaid|SUPERIOR STAR MCD|||||14.70||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|MOLINA MEDICAID|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||7.27||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.42||| 99283|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||5.28||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|5.42||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|OTHER MEDICAID|||||7.27||| 99283|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.20||| 99283|EAP|0450||Humana Medicare Advantage|HUMANA MEDICARE PPO|7.27||||4.12||| 99283|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.36||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|SUPERIOR STAR MCD|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||7.27||| 99283|EAP|0450||Managed Medicaid|SUPERIOR STAR MCD|||||4.18||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|7.27||||7.27||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Managed Medicaid|SUPERIOR STAR MCD|||||5.42||| 99283|EAP|0272||Medicare|MEDICARE A & B|||||0.07||| 99283|EAP|0272||Medicare|MEDICARE A & B|||||5.25||| 99283|EAP|0981||Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| 99283|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.02||| 99283|EAP|0981||Managed Medicaid|MOLINA MEDICAID|||||0.00||| 99283|EAP|0981||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 99283|EAP|0981||Managed Medicaid|CHIP MOLINA HEALTHCARE|||||0.00||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicaid|MEDICAID|7.27||||7.27||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Medicaid|MEDICAID|||||5.42||| 99283|EAP|0301|PROGESTERONE (REF)|Medicare|MEDICARE A & B|||||2.50||| 99283|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Cigna|CIGNA OPEN ACCESS PLUS|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|ChampVA|CHAMPVA OF CO DENVER|||||7.27||| 99283|EAP|0301|TESTOSTERONE, TOTAL|Medicare|MEDICARE A & B|||||2.34||| 99283|EAP|0301|ESTRADIOL (REF)|Medicare|MEDICARE A & B|||||2.54||| 99283|EAP|0301|DHEA, SERUM (REF)|Medicare|MEDICARE A & B|||||0.55||| 99283|EAP|0301|TESTOSTERONE, FREE (REF)|Medicare|MEDICARE A & B|||||0.64||| 99283|EAP|0981||Medicaid|MEDICAID|||||0.00||| 99283|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| 99283|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Multiplan|WEB TPA|||||7.27||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Blue Cross PPO|BCBS TRANE PPO|||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Multiplan|TML GRP INS|7.27||||||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Multiplan|WEB TPA OF GRAND PRAIRIE|||||7.27||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Multiplan|WEB TPA|||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicare|MEDICARE RAILROAD|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Blue Cross PPO|BCBS WALMART|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicare|MEDICARE PART A|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicare|MEDICARE A & B|7.27||||7.27||| 99283|EAP|0450||Medicare|MEDICARE A & B|7.27||||5.51||| 99283|EAP|0450||Medicare|MEDICARE A & B|7.27||||1.77||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Aetna|AETNA EL PASO CLAIMS OFFICE|||||5.42||| 99283|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| 99283|EAP|0450||Medicare|MEDICARE A & B|7.27||||1.14||| 99283|EAP|0450||Medicare|MEDICARE A & B|7.27||||0.00||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Medicare|MEDICARE A & B|5.42||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|NON CONTRACTED|MRAMVA|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|NON CONTRACTED|COMMERCIAL OTHER 2|||||7.27||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|NON CONTRACTED|COMMERCIAL OTHER|5.42||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|NON CONTRACTED|COMMERCIAL OTHER|7.27||||7.27||| 99283|EAP|0981||NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| 99283|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| 99283|EAP|0981||Workers Compensation|WC OTHER|||||0.00||| 99283|EAP|0450||Workers Compensation|WC OTHER|||||4.36||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Veterans Affairs|VETERANS CHOICE - TRI WEST|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Workers Compensation|WC OTHER|||||7.27||| 99283|EAP|0272||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.25||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|Veterans Affairs|VETERANS CHOICE - TRI WEST|5.42||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Workers Compensation|DO NOT USE----ENABLE COMP|||||7.27||| 99283|EAP|0270||Workers Compensation|WC OTHER|||||47.25||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|7.27||||7.27||| 99283|EAP|0271||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.90||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Workers Compensation|WC TX MUTUAL INS|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|Workers Compensation|WC TRAVELERS|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|PHCS|WEB TPA OF GRAND PRAIRIE|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|United Healthcare|UMR|7.27||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|United Healthcare|GOLDEN RULE INSURANCE|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|PHCS|WEB TPA|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|PHCS|TML GRP INS|7.27||||||| 99283|EAP|0305||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.68||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|United Healthcare|UMR|5.42||||||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|PHCS|WEB TPA|||||5.42||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||7.27||| 99283|EAP|0450|EMERGENCY VISIT; MID LEVEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|7.27||||7.27||| 99283|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|7.27||||181.41||| 99283|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 99283|EAP|0459|EMERGENCY VISIT; MID LEVEL,p|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.42||||5.42||| 99283|EAP|0981||United Healthcare|UMR|||||0.00||| 99283|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.86||| 99283|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.00||| 99283|EAP|0981||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|United Healthcare|GOLDEN RULE INSURANCE|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|United Healthcare|UMR|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|United Healthcare|UMR|8.95||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|PHCS|TML GRP INS|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|8.95||||8.95||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|11.19||||11.19||| 99284|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Multiplan|TML GRP INS|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Multiplan|WEB TPA|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Medicare|MEDICARE RAILROAD|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Medicare|MEDICARE PART A|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Medicare|MEDICARE A & B|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Medicare|MEDICARE A & B|8.95||||8.95||| 99284|EAP|0459||Medicare|MEDICARE A & B|8.95||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|NON CONTRACTED|COMMERCIAL OTHER|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|NON CONTRACTED|MRAMVA|||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|NON CONTRACTED|COMMERCIAL OTHER|8.95||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Medicaid|MEDICAID|11.19||||11.19||| 99284|EAP|0450||Medicaid|MEDICAID|11.19||||1.14||| 99284|EAP|0981||Medicaid|MEDICAID|||||0.00||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|11.19||||||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|8.95||||||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Humana Medicare Advantage|HUMANA MEDICARE PPO|8.95||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|SUPERIOR STAR MCD|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|MEDICAID CSHCN|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|FAMILY PLANNING GRANT|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Medicaid|MEDICAID|||||8.95||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||8.95||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Managed Medicaid|SUPERIOR STAR MCD|||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|OTHER MEDICAID|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|MOLINA MEDICAID|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|NON CONTRACTED|COMMERCIAL OTHER 2|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|8.95||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|ChampVA|CHAMPVA OF CO DENVER|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Cigna|NALC HLTH BENEFIT|11.19||||||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Cigna|CIGNA OPEN ACCESS PLUS|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Cigna|CIGNA OF TN CHATTANOOGA|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|NON CONTRACTED|PPO OTHER|||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Cigna|CIGNA OPEN ACCESS PLUS|||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross PPO Select|BCBS UTHCT|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Blue Cross PPO Select|BCBS UTHCT|8.95||||8.95||| 99284|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|11.19||||5.51||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross PPO|BLUE CROSS POS|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross PPO|BLUE CROSS PPO|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Workers Compensation|WC OTHER|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Workers Compensation|WC GALLAGHER BASSETT|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross PPO|BCBS WALMART|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross PPO|BCBS TRANE PPO|11.19||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.19||| 99284|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|11.19||||3.45||| 99284|EAP|0450||Blue Cross PPO|BLUE CROSS PPO|11.19||||1.14||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Blue Cross PPO|BLUE CROSS PPO|8.95||||8.95||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Blue Cross PPO|BLUE CROSS POS|8.95||||||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Blue Cross PPO|BCBS WALMART|8.95||||8.95||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|PHCS|WEB TPA|||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Blue Cross PPO|BCBS TRANE PPO|8.95||||||| 99284|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99284|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.19||||669.83||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.19||||11.19||| 99284|EAP|0450||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.19||||2.10||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|8.95||||8.95||| 99284|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 99284|EAP|0981||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Aetna|AETNA US HEALTHCARE PA|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Aetna|AETNA|||||11.19||| 99284|EAP|0450|EMERGENCY ROOM; HIGH LEVEL IV|Aetna|AETNA EL PASO CLAIMS OFFICE|11.19||||11.19||| 99284|EAP|0459|EMERGENCY RM; HIGH LEVEL IV,p|Aetna|AETNA EL PASO CLAIMS OFFICE|8.95||||8.95||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|18.68||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.15||||||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Aetna|AETNA EL PASO CLAIMS OFFICE|13.15||||13.15||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|18.68||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross PPO|BLUE CROSS POS|18.68||||||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross PPO|BCBS WALMART|18.68||||18.68||| 99285|EAP|0450||Blue Cross PPO|BLUE CROSS POS|18.68||||||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross PPO|BLUE CROSS PPO|13.15||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross PPO|BLUE CROSS POS|13.15||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross PPO|BCBS WALMART|13.15||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross PPO|BCBS TRANE PPO|13.15||||13.15||| 99285|EAP|0459||Blue Cross PPO|BLUE CROSS PPO|13.15||||13.15||| 99285|EAP|0981||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Cigna|CIGNA OF TN CHATTANOOGA|||||13.15||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.68||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Humana Medicare Advantage|HUMANA MEDICARE PPO|18.68||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Humana Medicare Advantage|HUMANA MEDICARE PPO|13.15||||||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Managed Medicaid|SUPERIOR STAR MCD|||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross PPO Select|BCBS UTHCT|||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Managed Medicaid|SUPERIOR STAR MCD|||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Managed Medicaid|MOLINA MEDICAID|||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|13.15||||||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|13.15||||13.15||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Medicaid|MEDICAID|||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Medicaid|MEDICAID|||||13.15||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Medicare|MEDICARE RAILROAD|18.68||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Medicare|MEDICARE PART A|18.68||||||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Medicare|MEDICARE A & B|18.68||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Medicare|MEDICARE RAILROAD|||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Medicare|MEDICARE PART A|13.15||||||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Blue Cross PPO|BLUE CROSS PPO|18.68||||18.68||| 99285|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Medicare|MEDICARE A & B|13.15||||13.15||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|NON CONTRACTED|COMMERCIAL OTHER|18.68||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|NON CONTRACTED|COMMERCIAL OTHER 2|||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|NON CONTRACTED|COMMERCIAL OTHER|13.15||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Veterans Affairs|VETERANS CHOICE - TRI WEST|13.15||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||13.15||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|United Healthcare|UMR|||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|United Healthcare|UMR|||||13.15||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|United Healthcare|GOLDEN RULE INSURANCE|||||13.15||| 99285|EAP|0450||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.68||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.68||||18.68||| 99285|EAP|0450|EMERGENCY VISIT; HIGH LEVEL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||18.68||| 99285|EAP|0459|EMERGENCY VISIT; HIGH LEVEL,p|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|13.15||||13.15||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Medicare|MEDICARE A & B|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Managed Medicaid|MOLINA MEDICAID|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 99291|EAP|0981|CRITICAL CARE, FIRST HOUR|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| 99292|EAP|0981||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| 99292|EAP|0981||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| 99292|EAP|0981||Medicare|MEDICARE A & B|||||0.00||| 99292|EAP|0981||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.00||| 99406|EAP|0942||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Managed Medicaid|FAMILY PLANNING GRANT|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.05||| 99406|EAP|0942||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.05||| 99406|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| 99406|EAP|0510||Medicare|MEDICARE A & B|||||2.09||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Medicare|MEDICARE A & B|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNS3-10 (WWC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.05||| 99406|EAP|0942||Medicare|MEDICARE A & B|||||1.05||| 99406|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Blue Cross PPO Select|BCBS UTHCT|||||1.05||| 99406|EAP|0942|SMOKE/TOBACCO COUNSEL 3-10 (UP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNS3-10 (WWC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.05||| 99406|EAP|0942||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Blue Cross PPO|BCBS WALMART|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNS3-10 (WWC)|Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 99406|EAP|0942||Blue Cross PPO|BLUE CROSS PPO|||||1.05||| 99406|EAP|0942||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.05||| 99406|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| 99406|EAP|0942|SMOKE/TOB SYMPT CNSELING 3-10|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.05||| 99406|EAP|0942|SMOKE/TOB SYMPT CNS3-10 (WWC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.05||| 99406|EAP|0942||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.05||| 99407|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| 99407|EAP|0942|SMOKE/TOB SYMPT CNSELING > 10|Blue Cross PPO Select|BCBS UTHCT|||||1.05||| 99407|EAP|0942|SMOKE/TOB SYMPT CNSELING > 10|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.05||| 99407|EAP|0942|SMOKE/TOB SYMPT CNSELING > 10|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.05||| 99408|EAP|0510|ALCHOL/SUBSTANCE ABUSE 15TO30M|Medicare|MEDICARE A & B|||||0.34||| 99408|EAP|0510|ALCHOL/SUBSTANCE ABUSE 15TO30M|Managed Medicaid|FAMILY PLANNING GRANT|||||0.34||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Blue Cross PPO|BLUE CROSS PPO|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Managed Medicaid|FAMILY PLANNING GRANT|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|PHCS|WEB TPA|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||327.55||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Medicare|MEDICARE A & B|||||327.55||| 99495|EAP|0510||Medicare|MEDICARE A & B|||||3.13||| 99495|EAP|0510|TRANS CARE MGMT 14 DAY DISCH|Multiplan|WEB TPA|||||327.55||| 99496|EAP|0510|TRANS CARE MGT W/PT;HIGH(IMC)|Medicare|MEDICARE A & B|||||3.13||| 99496|EAP|0510|TRANS CARE MGT W/PT;HIGH(IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.13||| 99496|EAP|0510|TRANS CARE MGT W/PT;HIGH(IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.13||| 99496|EAP|0510|TRANS CARE MGT W/PT;HIGH(IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.13||| 99497|EAP|0510|ADVANCE CARE PLANNING FIRST 30|Medicaid|MEDICAID|||||2.36||| 99497|EAP|0510|ADVANCE CARE PLANNING FIRST 30|Medicare|MEDICARE A & B|||||2.36||| A4216|EAP|0258|STERILE WATER FOR INJ 1000 ML|Medicare|MEDICARE A & B|46.15||||||| A4217|EAP|0258|SODIUM CHLORIDE 0.9% 1000ML IR|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|46.15||||||| A4270|EAP|0272|CYSTO ENDOSHEATH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.98||| A4270|EAP|0272|CYSTO ENDOSHEATH|Medicare|MEDICARE A & B|||||0.98||| A4270|EAP|0272|CYSTO ENDOSHEATH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.98||| A4270|EAP|0272|CYSTO ENDOSHEATH|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.98||| A4565|EAP|0270|SLING SMALL (ER)|Blue Cross PPO Select|BCBS UTHCT|||||16.80||| A4565|EAP|0270|SLING SMALL (ER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||16.80||| A4565|EAP|0274|SLING LARGE (ER)|Blue Cross PPO|BLUE CROSS PPO|||||0.14||| A4565|EAP|0270|SLING SMALL (ER)|Blue Cross PPO|BLUE CROSS PPO|||||16.80||| A4565|EAP|0274|SLING LARGE (ER)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.14||| A4565|EAP|0274|SLING XLG (ER)|Blue Cross PPO|BLUE CROSS PPO|||||13.65||| A4565|EAP|0274|SLING XLG (ER)|Blue Cross PPO|BLUE CROSS POS|||||13.65||| A4565|EAP|0274|SLING LARGE (ER)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.14||| A4565|EAP|0274|SLING MEDIUM (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.09||| A4565|EAP|0274|SLING LARGE (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.14||| A4565|EAP|0274|SLING LARGE (ER)|ChampVA|CHAMPVA OF CO DENVER|||||0.14||| A4565|EAP|0270|SLING SMALL (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||16.80||| A4565|EAP|0274|SLING MEDIUM (ER)|Blue Cross PPO|BLUE CROSS PPO|||||0.09||| A4565|EAP|0274|SLING LARGE (ER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.14||| A4565|EAP|0270|SLING SMALL (ER)|Managed Medicaid|MOLINA MEDICAID|||||16.80||| A4565|EAP|0274|SLING MEDIUM (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||0.09||| A4565|EAP|0274|SLING, CHILD (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||5.25||| A4565|EAP|0274|SLING XLG (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||13.65||| A4565|EAP|0274|SLING XLG (ER)|NON CONTRACTED|MRAMVA|||||13.65||| A4565|EAP|0274|SLING LARGE (ER)|NON CONTRACTED|COMMERCIAL OTHER|||||0.14||| A4565|EAP|0270|SLING SMALL (ER)|Medicare|MEDICARE A & B|||||16.80||| A4565|EAP|0274|SLING MEDIUM (ER)|Medicare|MEDICARE A & B|0.09||||0.09||| A4565|EAP|0274|SLING LARGE (ER)|Medicare|MEDICARE A & B|0.09||||0.14||| A4565|EAP|0270|SLING SMALL (ER)|Medicaid|MEDICAID|||||16.80||| A4565|EAP|0274|SLING MEDIUM (ER)|Medicaid|MEDICAID|||||0.09||| A4565|EAP|0274|SLING LARGE (ER)|Workers Compensation|WC OTHER|||||0.14||| A4565|EAP|0274|SLING MEDIUM (ER)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.09||| A4565|EAP|0274|SLING MEDIUM (ER)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.09||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Medicaid|MEDICAID|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Medicare|MEDICARE A & B|||||3.72||| A4641|EAP|0343|NM ISOTOPE 99M TC MAG3|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.72||| A4641|EAP|0343|NM ISOTOPE 99M TC MAG3|Medicare|MEDICARE A & B|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Medicare|MEDICARE PART B|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Blue Cross PPO Select|BCBS UTHCT|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|ChampVA|CHAMPVA OF CO DENVER|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.72||| A4641|EAP|0343|NM ISOTOPE 99M TC MAG3|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Blue Cross PPO|BLUE CROSS POS|||||3.72||| A4641|EAP|0343|NM ISOTOPE TC-99M HDP|Blue Cross PPO|BLUE CROSS PPO|||||3.72||| A4641|EAP|0343|NM ISOTOPE 99M TC MAG3|Blue Cross PPO|BLUE CROSS PPO|||||3.72||| A4641|EAP|0343|NM ISOTOPE 99M TC MAG3|Blue Cross PPO|BLUE CROSS POS|||||3.72||| A6261|EAP|0623|IODOSORB GEL 40GM|Blue Cross PPO|BCBS WALMART|||||404.35||| A6261|EAP|0623|IODOSORB GEL 40GM|Medicare|MEDICARE A & B|404.35||||||| A6261|EAP|0623|IODOSORB GEL 40GM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||404.35||| A6261|EAP|0623|IODOSORB GEL 40GM|Medicaid|MEDICAID|404.35||||||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||9.08||| A9500|EAP|0343|NM CARDIOLITE, SINGLE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|United Healthcare|UMR|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Medicaid|MEDICAID|||||9.08||| A9500|EAP|0343|NM CARDIOLITE, SINGLE|Medicare|MEDICARE A & B|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|NON CONTRACTED|COMMERCIAL OTHER|9.08||||9.08||| A9500|EAP|0343|NM CARDIOLITE, SINGLE|NON CONTRACTED|COMMERCIAL OTHER|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Medicare|MEDICARE A & B|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Veterans Affairs|VETERANS CHOICE - TRI WEST|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Cigna|CIGNA OF TN CHATTANOOGA|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|ChampVA|CHAMPVA OF CO DENVER|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Blue Cross PPO Select|BCBS UTHCT|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||9.08||| A9500|EAP|0343|NM CARDIOLITE, SINGLE|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Blue Cross PPO|BLUE CROSS PPO|9.08||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Blue Cross PPO|BLUE CROSS POS|||||9.08||| A9500|EAP|0343|NM SESTAMIBI, PER DOSE|Blue Cross PPO|BCBS WALMART|9.08||||||| A9513|EAP|0344|LU-177 DOTATATE 200MCI|Blue Cross PPO|BLUE CROSS PPO|||||1,036.68||| A9513|EAP|0344|LU-177 DOTATATE 200MCI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,036.68||| A9513|EAP|0344|LU-177 DOTATATE 200MCI|Medicare|MEDICARE A & B|||||1,036.68||| A9516|EAP|0343|NM 100 UCI I 123|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.75||| A9516|EAP|0343|NM 100 UCI I 123|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.75||| A9516|EAP|0343|NM 100 UCI I 123|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.75||| A9516|EAP|0343|NM 100 UCI I 123|Blue Cross PPO|BLUE CROSS POS|||||3.75||| A9516|EAP|0343|NM 100 UCI I 123|Blue Cross PPO|BLUE CROSS PPO|||||3.75||| A9516|EAP|0343|NM 100 UCI I 123|Blue Cross PPO|BCBS WALMART|||||3.75||| A9517|EAP|0636|I131 IODINE CAP, RX 1MCI|Medicare|MEDICARE A & B|||||3.00||| A9517|EAP|0636|I131 IODIDE CAP, RX, 30 mci|Medicare|MEDICARE A & B|||||10.60||| A9517|EAP|0636|I131 IODIDE CAP, RX, 15 mci|Medicare|MEDICARE A & B|||||5.34||| A9517|EAP|0344|I131 IODIDE CAP, RX, 20 mci|Medicare|MEDICARE A & B|||||10.64||| A9517|EAP|0344|I131 IODIDE CAP, RX, 100 mci|Medicare|MEDICARE A & B|||||90.23||| A9517|EAP|0344|I131 IODIDE CAP, RX, 100 mci|Blue Cross PPO|BLUE CROSS PPO|||||90.23||| A9517|EAP|0344|I131 IODIDE CAP, RX, 100 mci|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||90.23||| A9517|EAP|0636|I131 IODIDE CAP, RX, 150 mci|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||61.05||| A9517|EAP|0344|I131 IODIDE CAP, RX, 100 mci|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||90.23||| A9517|EAP|0636|I131 IODIDE CAP, RX, 150 mci|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||61.05||| A9537|EAP|0343|NM 99M TC - IDA (3-10 MCI)|Blue Cross PPO Select|BCBS UTHCT|||||3.72||| A9537|EAP|0343|NM 99M TC - IDA (3-10 MCI)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.72||| A9537|EAP|0343|NM 99M TC - IDA (3-10 MCI)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.72||| A9537|EAP|0343|NM 99M TC - IDA (3-10 MCI)|Blue Cross PPO|BLUE CROSS PPO|||||3.72||| A9537|EAP|0343|NM 99M TC - IDA (3-10 MCI)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.72||| A9537|EAP|0343|NM 99M TC - IDA (3-10 MCI)|Medicare|MEDICARE A & B|||||3.72||| A9538|EAP|0343|TC99 PRYOPHOSPHATE|Medicare|MEDICARE A & B|||||1.86||| A9538|EAP|0343|TC99 PRYOPHOSPHATE|Blue Cross PPO Select|BCBS UTHCT|||||1.86||| A9540|EAP|0343|NM 4.0 MCI MAA|Blue Cross PPO|BLUE CROSS PPO|||||12.30||| A9540|EAP|0343|NM 4.0 MCI MAA|Humana Medicare Advantage|HUMANA MEDICARE PPO|12.30||||12.30||| A9540|EAP|0343|NM 4.0 MCI MAA|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||12.30||| A9540|EAP|0343|NM 4.0 MCI MAA|Blue Cross PPO Select|BCBS UTHCT|||||12.30||| A9540|EAP|0343|NM 4.0 MCI MAA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||12.30||| A9540|EAP|0343|NM 4.0 MCI MAA|United Healthcare|UMR|||||12.30||| A9540|EAP|0343|NM 4.0 MCI MAA|Medicare|MEDICARE A & B|12.30||||12.30||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|Medicare|MEDICARE A & B|||||4.28||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|Blue Cross PPO Select|BCBS UTHCT|||||4.28||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|ChampVA|CHAMPVA OF CO DENVER|||||4.28||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|4.28||||4.28||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.28||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.28||| A9541|EAP|0343|NM TC-99M SULFUR COLLOID|Blue Cross PPO|BLUE CROSS PPO|||||4.28||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Blue Cross PPO|BLUE CROSS PPO|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Blue Cross PPO|BLUE CROSS POS|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Aetna|AETNA EL PASO CLAIMS OFFICE|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Aetna|TRS COORDINATED CARE|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|ChampVA|CHAMPVA OF CO DENVER|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|United Healthcare|UMR|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Medicaid|MEDICAID|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|NON CONTRACTED|COMMERCIAL OTHER|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Medicare|MEDICARE A & B|||||16.41||| A9552|EAP|0343|FDG 18 - DX, UP TO 45 mCi|Medicare|MEDICARE RAILROAD|||||16.41||| A9558|EAP|0343|XE133 XENON 10 mCi|Medicare|MEDICARE A & B|5.49||||5.49||| A9558|EAP|0343|XE133 XENON 10 mCi|Medicaid|MEDICAID|5.49||||||| A9558|EAP|0343|XE133 XENON 10 mCi|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||5.49||| A9558|EAP|0343|XE133 XENON 10 mCi|Blue Cross PPO Select|BCBS UTHCT|||||5.49||| A9558|EAP|0343|XE133 XENON 10 mCi|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.49||| A9558|EAP|0343|XE133 XENON 10 mCi|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||5.49||| A9558|EAP|0343|XE133 XENON 10 mCi|Blue Cross PPO|BLUE CROSS PPO|||||5.49||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Blue Cross PPO|BLUE CROSS POS|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Aetna|AETNA EL PASO CLAIMS OFFICE|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Aetna|AETNA EL PASO CLAIMS OFFICE|2.40||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.40||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.80||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Blue Cross PPO|BCBS TRANE PPO|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Blue Cross PPO|BLUE CROSS PPO|1.80||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross PPO|BCBS TRANE PPO|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Blue Cross PPO|BLUE CROSS PPO|0.80||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross PPO|BCBS WALMART|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross PPO|BLUE CROSS PPO|1.80||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Blue Cross PPO Select|BCBS UTHCT|||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Blue Cross PPO Select|BCBS UTHCT|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.40||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Managed Medicaid|SUPERIOR STAR MCD|1.80||||||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross PPO Select|BCBS UTHCT|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.40||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Cigna|CIGNA OF TN CHATTANOOGA|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Cigna|CIGNA OF TN CHATTANOOGA|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Cigna|CIGNA OPEN ACCESS PLUS|||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.40||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross PPO|BLUE CROSS POS|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.80||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|ChampVA|CHAMPVA OF CO DENVER|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Aetna|TRS COORDINATED CARE|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.40||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.40||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|United Healthcare|UMR|||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Medicare|MEDICARE A & B|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 10ML|Medicare|MEDICARE A & B|0.80||||0.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Medicare|MEDICARE A & B|1.80||||1.80||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|Medicare|MEDICARE PART A|1.80||||||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|Medicaid|MEDICAID|0.80||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 20ML|NON CONTRACTED|COMMERCIAL OTHER|2.40||||2.40||| A9579|EAP|0255|INJ GAD-BASE MR CONTRAST, 15ML|NON CONTRACTED|COMMERCIAL OTHER|2.40||||1.80||| A9581|EAP|0343|INJ,GADOXETATE DISODIUM,10ML|Medicare|MEDICARE A & B|||||2.90||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||14,415.84||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||266.96||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Blue Cross PPO|BLUE CROSS PPO|||||266.96||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Blue Cross PPO|BLUE CROSS POS|||||14,415.84||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||266.96||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||266.96||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||266.96||| A9587|EAP|0636|GALLIUM 68-SINGLE DOSE|Medicare|MEDICARE A & B|||||266.96||| A9606|EAP|0636|XOFIGO, PER MICROCURIE|Medicare|MEDICARE A & B|||||2.94||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Blue Cross PPO|BLUE CROSS PPO|||||434.70||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Blue Cross PPO|BLUE CROSS POS|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Aetna|AETNA EL PASO CLAIMS OFFICE|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Humana Medicare Advantage|HUMANA MEDICARE PPO|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|434.70||||||| C1751|EAP|0278|MIDLINE 5FR BARD PERQCATH|Medicare|MEDICARE A & B|434.70||||434.70||| C1769|EAP|0272|GUIDEWIRE, MET11 21-480|Medicare|MEDICARE A & B|||||379.05||| C1769|EAP|0272|GUIDEWIRE, MET11 21-480|Medicare|MEDICARE RAILROAD|||||379.05||| C1876|EAP|0278|STENT;BARE METAL CORONARY,VSN|Medicare|MEDICARE A & B|2,756.25||||||| C1888|EAP|0278|CATHETER ENDOVASCULAR ABLATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||14.56||| C1888|EAP|0278|CATHETER ENDOVASCULAR ABLATION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||14.56||| C1888|EAP|0278|CATHETER ENDOVASCULAR ABLATION|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||14.56||| C1888|EAP|0278|CATHETER ENDOVASCULAR ABLATION|Medicare|MEDICARE A & B|||||14.56||| C8929|EAP|0483|TTE W OR WO FOL WCON DOPPLER|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.83||| C8929|EAP|0483|TTE W OR WO FOL WCON DOPPLER|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||15.83||| C9740|EAP|0510|CYSTOURETHROSCOPY SINGLE|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||684.14||| G0008|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0008|EAP|0771||ChampVA|CHAMPVA OF CO DENVER|||||160.36||| G0008|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||45.15||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| G0008|EAP|0771||Cigna|NALC HLTH BENEFIT|||||160.36||| G0008|EAP|0771||Cigna|CIGNA OPEN ACCESS PLUS|||||160.36||| G0008|EAP|0771||Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CARDC)|Blue Cross PPO Select|BCBS UTHCT|||||160.36||| G0008|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC(SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| G0008|EAP|0771|**ADMINISTRATION OF SINGLE VAC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.12||| G0008|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| G0008|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| G0008|EAP|0771||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0771||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||160.36||| G0008|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| G0008|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||45.15||| G0008|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| G0008|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.50||| G0008|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0008|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||45.15||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (GIC)|Blue Cross PPO|BLUE CROSS POS|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CF)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0008|EAP|0771||Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0008|EAP|0771||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||160.36||| G0008|EAP|0513||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0008|EAP|0636|FLU VACC QS (6MOS UP)/PF 0.5ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| G0008|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| G0008|EAP|0771||Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| G0008|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0008|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| G0008|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| G0008|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CF)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CARDC)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0008|EAP|0771|**ADMINISTRATION OF SINGLE VAC|Medicare|MEDICARE A & B|160.36||||0.12||| G0008|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||45.15||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||160.36||| G0008|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.25||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Medicare|MEDICARE RAILROAD|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Medicare|MEDICARE PART B|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Blue Cross PPO|BCBS WALMART|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (GIC)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0771||Medicare|MEDICARE RAILROAD|||||160.36||| G0008|EAP|0771||Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0008|EAP|0771||NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|NON CONTRACTED|COMMERCIAL OTHER|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (RADON)|Medicare|MEDICARE A & B|160.36||||0.49||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Medicare|MEDICARE RAILROAD|||||160.36||| G0008|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|||||2.64||| G0008|EAP|0771|ADM OF INFLUENZA VACC (INFCD)|Medicare|MEDICARE A & B|160.36||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|Medicare|MEDICARE RAILROAD|||||160.36||| G0008|EAP|0942||Medicare|MEDICARE A & B|||||1.05||| G0008|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||69.31||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Medicaid|MEDICAID|||||160.36||| G0008|EAP|0771||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||160.36||| G0008|EAP|0771||Medicaid|MEDICAID|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Managed Medicaid|MOLINA MEDICAID|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (RADON)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.49||| G0008|EAP|0771||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||160.36||| G0008|EAP|0771||Managed Medicaid|MEDICAID CSHCN|||||160.36||| G0008|EAP|0771||Managed Medicaid|FAMILY PLANNING GRANT|||||160.36||| G0008|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||160.36||| G0008|EAP|0510||United Healthcare|UMR|||||2.50||| G0008|EAP|0510||United Healthcare|GOLDEN RULE INSURANCE|||||2.64||| G0008|EAP|0510||United Healthcare|UMR|||||2.64||| G0008|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||213.82||| G0008|EAP|0636||United Healthcare|UMR|||||69.31||| G0008|EAP|0636||United Healthcare|GOLDEN RULE INSURANCE|||||45.15||| G0008|EAP|0771|ADM OF INFLUENZA VACC (GIC)|United Healthcare|UMR|||||160.36||| G0008|EAP|0771||United Healthcare|UMR|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| G0008|EAP|0771||United Healthcare|GOLDEN RULE INSURANCE|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|United Healthcare|UMR|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0008|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|ChampVA|CHAMPVA OF CO DENVER|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|Tricare|TRICARE WEST UNITED HEALTH|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| G0008|EAP|0771|ADMIN NFLUENZA VACCINE (PUL)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| G0008|EAP|0771|ADM OF INFLUENZA VACC (GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0008|EAP|0771||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0008|EAP|0771||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (FPC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (FPC)|Medicare|MEDICARE A & B|160.36||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Medicare|MEDICARE A & B|160.36||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (ONC)|Medicare|MEDICARE A & B|160.36||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Medicare|MEDICARE RAILROAD|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (RADON)|Medicare|MEDICARE A & B|160.36||||0.49||| G0009|EAP|0771|ADMIN OF PNEUMOCOCCAL VACCINE|Medicare|MEDICARE A & B|160.36||||160.36||| G0009|EAP|0771|**ADMINISTRATION OF PNEUMOCOCC|Medicare|MEDICARE A & B|160.36||||0.12||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (ONC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (FPC)|Blue Cross PPO|BLUE CROSS PPO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (PUL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||160.36||| G0009|EAP|0771|ADM, PNEUMOCOCCAL VACC (ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||160.36||| G0010|EAP|0771||Medicare|MEDICARE A & B|||||101.67||| G0010|EAP|0636||Medicare|MEDICARE A & B|||||211.20||| G0101|EAP|0770|CA SCRNING, PELV & BRST EXAM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.94||| G0101|EAP|0770|CA SCRNING, PELV & BRST EXAM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.94||| G0101|EAP|0770|CA SCRNING, PELV & BRST EXAM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.94||| G0101|EAP|0770|CA SCRNING, PELV & BRST EXAM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.94||| G0101|EAP|0770|CA SCRNING, PELV & BRST EXAM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.94||| G0101|EAP|0921|EXT DVT US|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.16||| G0101|EAP|0306||Medicare|MEDICARE A & B|||||1.16||| G0101|EAP|0311||Medicare|MEDICARE A & B|||||0.57||| G0101|EAP|0770|CA SCRNING, PELV & BRST EXAM|Medicare|MEDICARE A & B|0.94||||0.94||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Multiplan|WEB TPA|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|NON CONTRACTED|COMMERCIAL OTHER|||||1.20||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Medicare|MEDICARE PART A|1.88||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Medicare|MEDICARE A & B|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Medicare|MEDICARE PART B|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|United Healthcare|GOLDEN RULE INSURANCE|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|United Healthcare|UMR|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|PHCS|WEB TPA|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|PHCS|TML GRP INS|||||1.20||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.52||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Medicaid|MEDICAID|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross PPO|BLUE CROSS POS|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Medicare|MEDICARE RAILROAD|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross PPO|BCBS TRANE PPO|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross PPO|BCBS WALMART|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross PPO|BLUE CROSS PPO|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Multiplan|TML GRP INS|||||1.20||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Blue Cross PPO Select|BCBS UTHCT|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Cigna|CIGNA OF TN CHATTANOOGA|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.20||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Cigna|CIGNA OF TN CHATTANOOGA|||||0.52||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.88||| G0103|EAP|0301|PSA, TOTAL (SCREENING)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.88||| G0104|EAP|0750|CA SCREENING FLEX SIGMOIDOSCOP|Blue Cross PPO|BLUE CROSS PPO|||||13.20||| G0104|EAP|0750|CA SCREENING FLEX SIGMOIDOSCOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||13.20||| G0104|EAP|0750|CA SCREENING FLEX SIGMOIDOSCOP|Medicare|MEDICARE A & B|||||13.20||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|United Healthcare|UMR|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Medicare|MEDICARE A & B|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Blue Cross PPO|BLUE CROSS POS|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Blue Cross PPO|BCBS TRANE PPO|||||20.18||| G0105|EAP|0750|COLORECTAL SCREENING: HRI|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.18||| G0108|EAP|0942|DIAB SELF MGMT,PER 30 MIN,INDI|Blue Cross PPO|BLUE CROSS POS|||||1.07||| G0108|EAP|0942|DIAB SELF MGMT,PER 30 MIN,INDI|Medicare|MEDICARE A & B|||||1.07||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|United Healthcare|UMR|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Medicare|MEDICARE A & B|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|NON CONTRACTED|COMMERCIAL OTHER|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|NON CONTRACTED|BOONE CHAPMAN|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Cigna|CIGNA OTHER|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Cigna|CIGNA OPEN ACCESS PLUS|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Cigna|CIGNA OF TN CHATTANOOGA|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Blue Cross PPO Select|BCBS UTHCT|||||20.18||| G0121|EAP|0636||Medicare|MEDICARE A & B|||||21.30||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Aetna|AETNA EXXON MOBIL|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Aetna|AETNA EL PASO CLAIMS OFFICE|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Blue Cross PPO|BLUE CROSS PPO|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Blue Cross PPO|BLUE CROSS POS|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Blue Cross PPO|BCBS WALMART|||||20.18||| G0121|EAP|0750|COLORECTAL CA SCREEN; NOT HI R|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.18||| G0123|EAP|0311|ROUTINE SCR PAP SMEAR PRES FLD|Blue Cross PPO|BLUE CROSS POS|||||0.57||| G0123|EAP|0311|ROUTINE SCR PAP SMEAR PRES FLD|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.57||| G0123|EAP|0311|ROUTINE SCR PAP SMEAR PRES FLD|Medicare|MEDICARE A & B|||||0.57||| G0123|EAP|0311||Medicare|MEDICARE A & B|||||0.57||| G0123|EAP|0311|ROUTINE SCR PAP SMEAR PRES FLD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.57||| G0123|EAP|0311|ROUTINE SCR PAP SMEAR PRES FLD|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.57||| G0123|EAP|0311||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.57||| G0246|EAP|0510|FOLLOW UP EVAL FOOT PT W/LOPS|Medicare|MEDICARE A & B|||||1.34||| G0247|EAP|0510|ROUTINE FOOT CARE PT W/LOPS|Medicare|MEDICARE A & B|||||1.12||| G0248|EAP|0510|HOME PTINR DEMONSTR MONITORING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.13||| G0248|EAP|0510|HOME PTINR DEMONSTR MONITORING|Medicare|MEDICARE A & B|||||5.13||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Managed Medicaid|FAMILY PLANNING GRANT|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Cigna|CIGNA OF TN CHATTANOOGA|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Cigna|CIGNA OPEN ACCESS PLUS|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Cigna|CIGNA BEHAVIORAL HEALTH|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Aetna|AETNA EXXON MOBIL|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Blue Cross PPO Select|BCBS UTHCT|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|ChampVA|CHAMPVA OF CO DENVER|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Aetna|AETNA|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Blue Cross PPO|BLUE CROSS POS|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Blue Cross PPO|BLUE CROSS PPO|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Blue Cross PPO|BCBS WALMART|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Medicaid|MEDICAID|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Managed Medicare|RESERVE NAT INS|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Medicare|MEDICARE RAILROAD|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Medicare|MEDICARE A & B|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|NON CONTRACTED|COMMERCIAL OTHER|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.82||| G0279|EAP|0401|DIGITAL BREAST TOMOSYNTH BILAT|United Healthcare|UMR|||||0.82||| G0283|EAP|0420|ELECTRICAL STIMULATION, PT|Workers Compensation|WC OTHER|||||0.39||| G0283|EAP|0420|ELEC STIM,1+ AREA,OTH THA WOUN|Workers Compensation|WC RISK MANAGEMENT|||||0.92||| G0283|EAP|0420|ELEC STIM,1+ AREA,OTH THA WOUN|Workers Compensation|WC GALLAGHER BASSETT|||||0.92||| G0283|EAP|0420|ELECTRICAL STIMULATION, PT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.39||| G0283|EAP|0420|ELECTRICAL STIMULATION, PT|Medicare|MEDICARE A & B|||||0.39||| G0283|EAP|0430||Medicare|MEDICARE A & B|||||0.39||| G0283|EAP|0420|ELECTRICAL STIMULATION, PT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.39||| G0283|EAP|0420|ELECTRICAL STIMULATION, PT|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.39||| G0297|EAP|0352|CT LUNG SCREENING|Cigna|CIGNA OF TN CHATTANOOGA|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Blue Cross PPO Select|BCBS UTHCT|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Blue Cross PPO|BCBS WALMART|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Blue Cross PPO|BLUE CROSS PPO|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Medicare|MEDICARE RAILROAD|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Medicare|MEDICARE A & B|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|NON CONTRACTED|COMMERCIAL OTHER|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||1.06||| G0297|EAP|0352|CT LUNG SCREENING|United Healthcare|UMR|||||1.06||| G0297|EAP|0510||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Medicare|MEDICARE PART A|0.65||||||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Medicare|MEDICARE A & B|0.65||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|NON CONTRACTED|COMMERCIAL OTHER|0.65||||||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.65||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Blue Cross PPO|BLUE CROSS POS|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Blue Cross PPO|BLUE CROSS PPO|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.65||| G0328|EAP|0301|OCCULT BLOOD (*SCREENING); LAB|Blue Cross PPO|BLUE CROSS PPO|||||0.25||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Cigna|CIGNA OF TN CHATTANOOGA|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Cigna|CIGNA OPEN ACCESS PLUS|||||0.65||| G0328|EAP|0305|FIT, COLORECTAL SCREENING|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.65||| G0378|EAP|0762|OBSERVATION; HRLY|Cigna|CIGNA OPEN ACCESS PLUS|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Cigna|CIGNA OPEN ACCESS PLUS|||||3.00||| G0378|EAP|0762|OBSERVATION; HRLY|Blue Cross PPO Select|BCBS UTHCT|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Blue Cross PPO Select|BCBS UTHCT|||||3.00||| G0378|EAP|0762|OBSERVATION; HRLY|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.75||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.00||| G0378|EAP|0762|INITIAL OBSERVATION|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.75||||3.00||| G0378|EAP|0762|OBSERVATION; HRLY|Blue Cross PPO|BLUE CROSS PPO|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|Blue Cross PPO|BCBS WALMART|0.75||||||| G0378|EAP|0762|INITIAL OBSERVATION|Blue Cross PPO|BLUE CROSS PPO|||||3.00||| G0378|EAP|0762||Blue Cross PPO|BLUE CROSS PPO|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.00||| G0378|EAP|0762||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.00||| G0378|EAP|0762||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Blue Cross PPO|BCBS WALMART|3.00||||||| G0378|EAP|0762||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.00||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|Medicare|MEDICARE A & B|0.75||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Medicare|MEDICARE A & B|0.75||||3.00||| G0378|EAP|0762||Medicare|MEDICARE A & B|3.00||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|NON CONTRACTED|COMMERCIAL OTHER|||||3.00||| G0378|EAP|0762|OBSERVATION; HRLY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|NON CONTRACTED|COMMERCIAL OTHER|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.00||| G0378|EAP|0762||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|Medicaid|MEDICAID|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|Medicaid|MEDICAID|||||3.00||| G0378|EAP|0762|INITIAL OBSERVATION|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.00||| G0378|EAP|0762|OBSERVATION; HRLY|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|United Healthcare|UMR|||||3.00||| G0378|EAP|0762||United Healthcare|UMR|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.75||| G0378|EAP|0762||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.75||| G0378|EAP|0762|OBSERVATION; HRLY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.75||| G0378|EAP|0762|INITIAL OBSERVATION|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.00||| G0378|EAP|0762|INITIAL OBSERVATION|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.00||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|United Healthcare|UMR|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Medicaid|MEDICAID|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Medicare|MEDICARE A & B|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Aetna|AETNA EL PASO CLAIMS OFFICE|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Blue Cross PPO|BLUE CROSS PPO|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.50||| G0399|EAP|0740|SLEEP STUDY UNATTD SIMULTANEOU|Blue Cross PPO Select|BCBS UTHCT|||||8.50||| G0402|EAP|0770|INIT MCR ENROLL PREVENTIVE EXM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.00||| G0402|EAP|0770|INIT MCR ENROLL PREVENTIVE EXM|Medicare|MEDICARE A & B|||||1.78||| G0402|EAP|0770|INIT MCR ENROLL PREVENTIVE EXM|Medicare|MEDICARE A & B|||||1.00||| G0402|EAP|0770|INIT MCR ENROLL PREVENTIVE EXM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.78||| G0416|EAP|0312|LEVEL IV, GROSS/ MICRO (REF)|Medicare|MEDICARE A & B|||||3.96||| G0416|EAP|0312|LEVEL IV, GROSS/ MICRO (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.96||| G0416|EAP|0312|LEVEL IV, GROSS/ MICRO (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| G0444|EAP|0510|ANNL DEPRESSN SCRN,15 MIN(IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.70||| G0444|EAP|0510|ANNL DEPRESSN SCRN,15 MIN(IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.70||| G0444|EAP|0510|ANNL DEPRESSN SCRN,15 MIN(IMC)|Medicare|MEDICARE A & B|||||0.70||| G0444|EAP|0510|ANNL DEPRESSN SCRN,15 MIN(IMC)|NON CONTRACTED|COMMERCIAL OTHER|||||0.70||| G0444|EAP|0949||Medicare|MEDICARE A & B|||||213.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross PPO|BCBS TRANE PPO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BCBS TRANE PPO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Blue Cross PPO|BLUE CROSS POS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Blue Cross PPO|BCBS WALMART|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|Blue Cross PPO|BCBS WALMART|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross PPO|BCBS WALMART|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross PPO|BCBS TRANE PPO|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Blue Cross PPO|BLUE CROSS POS|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|Blue Cross PPO|BLUE CROSS POS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Blue Cross PPO|BLUE CROSS POS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (IMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross PPO|BCBS TRANE PPO|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CARDC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Blue Cross PPO|BCBS WALMART|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Blue Cross PPO|BLUE CROSS POS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Blue Cross PPO|BLUE CROSS POS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross PPO|BLUE CROSS POS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross PPO|BCBS WALMART|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross PPO|BLUE CROSS POS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross PPO|BCBS WALMART|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Blue Cross PPO|BLUE CROSS POS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(POD)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross PPO|BCBS TRANE PPO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Blue Cross PPO|BLUE CROSS POS|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (GIC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (CARD)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, NEW|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.62||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Blue Cross PPO|BLUE CROSS POS|||||2.09||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|Blue Cross PPO|BLUE CROSS POS|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|2.64||||2.50||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510||Blue Cross PPO|BCBS TRANE PPO|||||4.38||| G0463|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.79||| G0463|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.99||| G0463|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.79||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Blue Cross PPO|BCBS WALMART|||||2.25||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Blue Cross PPO|BLUE CROSS POS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0513|CLIN VISIT;MIN,EST (BHC)|Blue Cross PPO|BLUE CROSS PPO|||||2.09||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross PPO|BLUE CROSS PPO|||||2.64||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|Blue Cross PPO|BLUE CROSS PPO|||||2.99||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross PPO|BCBS TRANE PPO|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Blue Cross PPO|BCBS WALMART|||||4.38||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Blue Cross PPO|BLUE CROSS PPO|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Blue Cross PPO|BCBS WALMART|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Blue Cross PPO|BLUE CROSS POS|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Blue Cross PPO|BCBS WALMART|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross PPO|BCBS TRANE PPO|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Blue Cross PPO|BLUE CROSS PPO|||||2.25||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.25||| G0463|EAP|0636||Blue Cross PPO|BCBS TRANE PPO|||||45.15||| G0463|EAP|0730||Blue Cross PPO|BLUE CROSS PPO|||||3.09||| G0463|EAP|0403||Blue Cross PPO|BLUE CROSS POS|||||0.82||| G0463|EAP|0403||Blue Cross PPO|BLUE CROSS POS|||||4.83||| G0463|EAP|0301|SALIVARY; CORTISOL AM (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.28||| G0463|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.28||| G0463|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.63||| G0463|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||3.03||| G0463|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.19||| G0463|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.08||| G0463|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.30||| G0463|EAP|0301|ESTRIOL (REF)|Blue Cross PPO Select|BCBS UTHCT|||||1.11||| G0463|EAP|0301|SALIVARY; CORTISOL PM (REF)|Blue Cross PPO|BLUE CROSS POS|||||1.28||| G0463|EAP|0301|SALIVARY; DHEA-S (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.49||| G0463|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||1.02||| G0463|EAP|0301|SALIVARY; ESTRADIOL (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.54||| G0463|EAP|0301|SALIVARY; PROGESTERONE (REF)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0301|SALIVARY; TESTOSTERONE (REF)|Blue Cross PPO|BLUE CROSS POS|||||0.55||| G0463|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.44||| G0463|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.14||| G0463|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.49||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Aetna|AETNA US HEALTHCARE PA|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Aetna|AETNA|||||3.79||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 30 MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Aetna|AETNA EXXON MOBIL|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Aetna|AETNA|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Aetna|AETNA US HEALTHCARE PA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Aetna|AETNA EXXON MOBIL|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Aetna|TRS COORDINATED CARE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Aetna|AETNA|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Aetna|AETNA|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Aetna|AETNA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Aetna|AETNA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Aetna|AETNA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Aetna|AETNA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.09||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Aetna|AETNA|||||2.64||| G0463|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| G0463|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.25||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||4.38||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Aetna|AETNA EXXON MOBIL|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Aetna|AETNA|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Aetna|AETNA EXXON MOBIL|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|||||45.15||| G0463|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.83||| G0463|EAP|0403||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.82||| G0463|EAP|0940||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.02||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.11||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.38||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.40||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.47||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.54||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.00||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.82||| G0463|EAP|0510|CLINIC VISIT; MINIMUM, CONSULT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.37||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (RADON)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(RADON)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (POD)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.11||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.54||| G0463|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| G0463|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| G0463|EAP|0730||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.86||| G0463|EAP|0771||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||160.36||| G0463|EAP|0320||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.35||| G0463|EAP|0250||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.15||| G0463|EAP|0419||Aetna|AETNA EL PASO CLAIMS OFFICE|||||7.09||| G0463|EAP|0419||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.63||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.66||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.13||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.19||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.46||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.73||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||182.99||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.40||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (ONC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Blue Cross PPO Select|BCBS UTHCT|||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Blue Cross PPO Select|BCBS UTHCT|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross PPO Select|BCBS UTHCT|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MIN,NEW (PODC)|Blue Cross PPO Select|BCBS UTHCT|||||2.62||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(INFD)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|ChampVA|CHAMPVA OF CO DENVER|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||3.26||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (CARDC)|Blue Cross PPO Select|BCBS UTHCT|||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|ChampVA|CHAMPVA OF CO DENVER|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|ChampVA|CHAMPVA OF CO DENVER|||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|ChampVA|CHAMPVA OF CO DENVER|||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|ChampVA|CHAMPVA OF CO DENVER|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|ChampVA|CHAMPVA OF CO DENVER|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|ChampVA|CHAMPVA OF CO DENVER|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Blue Cross PPO Select|BCBS UTHCT|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Blue Cross PPO Select|BCBS UTHCT|||||2.09||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross PPO Select|BCBS UTHCT|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Blue Cross PPO Select|BCBS UTHCT|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (PULMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (CARD)|Blue Cross PPO Select|BCBS UTHCT|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.25||| G0463|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Cigna|CIGNA OTHER|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Cigna|CIGNA OTHER|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Cigna|NALC HLTH BENEFIT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Cigna|NALC HLTH BENEFIT|||||2.50||| G0463|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Cigna|CIGNA OTHER|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.09||| G0463|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||6.11||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Cigna|CIGNA OPEN ACCESS PLUS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Cigna|NALC HLTH BENEFIT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Cigna|NALC HLTH BENEFIT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Cigna|CIGNA OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Cigna|CIGNA OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Cigna|NALC HLTH BENEFIT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Cigna|NALC HLTH BENEFIT|||||2.99||| G0463|EAP|0999|COTTON TIP APP STERILE (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||0.00||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Cigna|CIGNA BEHAVIORAL HEALTH|||||2.64||| G0463|EAP|0999|SWAB BENZOIN (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||0.00||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Cigna|CIGNA OPEN ACCESS PLUS|||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Blue Cross PPO Select|BCBS UTHCT|||||4.38||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Blue Cross PPO Select|BCBS UTHCT|||||2.09||| G0463|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||3.79||| G0463|EAP|0510||Cigna|CIGNA OPEN ACCESS PLUS|||||2.99||| G0463|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| G0463|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (POD)|Blue Cross PPO Select|BCBS UTHCT|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0510||Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Cigna|CIGNA OTHER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Cigna|CIGNA OPEN ACCESS PLUS|||||4.38||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Blue Cross PPO Select|BCBS UTHCT|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Blue Cross PPO Select|BCBS UTHCT|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Cigna|CIGNA OTHER|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Blue Cross PPO Select|BCBS UTHCT|||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Cigna|NALC HLTH BENEFIT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Cigna|CIGNA BEHAVIORAL HEALTH|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Blue Cross PPO Select|BCBS UTHCT|||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Cigna|CIGNA OTHER|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|ChampVA|CHAMPVA OF CO DENVER|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Cigna|CIGNA OF TN CHATTANOOGA|||||4.38||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Cigna|CIGNA OF TN CHATTANOOGA|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Cigna|CIGNA BEHAVIORAL HEALTH|||||2.50||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.99||| G0463|EAP|0636||Cigna|CIGNA OPEN ACCESS PLUS|||||45.15||| G0463|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||4.83||| G0463|EAP|0403||Blue Cross PPO Select|BCBS UTHCT|||||0.82||| G0463|EAP|0260||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||181.41||| G0463|EAP|0272||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|ChampVA|CHAMPVA OF CO DENVER|||||2.09||| G0463|EAP|0272|STERI-STRIP 1/2 X 4 (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.25||| G0463|EAP|0272|STAPLE REMOVER (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9.45||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0272|7.5 TRIFLEX STERILE GLOVES|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.05||| G0463|EAP|0272|IV SOL NACL .9 250 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.04||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0272|CHLORAPREP APPLICATOR 3ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| G0463|EAP|0272|SUTURE REMOVAL KIT (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| G0463|EAP|0272|ACU-DYNE SWAB STICKS (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.90||| G0463|EAP|0301||Cigna|CIGNA OF TN CHATTANOOGA|||||0.19||| G0463|EAP|0510||ChampVA|CHAMPVA OF CO DENVER|||||3.26||| G0463|EAP|0272|CHLORAPREP APPLICATOR 3ML|ChampVA|CHAMPVA OF CO DENVER|||||4.90||| G0463|EAP|0272|SUTURE REMOVAL KIT (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||4.90||| G0463|EAP|0272|STERI-STRIP 1/2 X 4 (SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||5.25||| G0463|EAP|0272|PURACOL DRESSING|ChampVA|CHAMPVA OF CO DENVER|||||0.30||| G0463|EAP|0272|NU-GUAZE PLAIN 1/2|ChampVA|CHAMPVA OF CO DENVER|||||8.40||| G0463|EAP|0301||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.02||| G0463|EAP|0305||Cigna|CIGNA OF TN CHATTANOOGA|||||1.68||| G0463|EAP|0320||Blue Cross PPO Select|BCBS UTHCT|||||2.04||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|ChampVA|CHAMPVA OF CO DENVER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|ChampVA|CHAMPVA OF CO DENVER|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Managed Medicaid|SUPERIOR STAR MCD|||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Managed Medicaid|MOLINA MEDICAID|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (INFD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Managed Medicaid|MOLINA MEDICAID|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Managed Medicaid|MOLINA MEDICAID|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0730||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.86||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Blue Cross PPO Select|BCBS UTHCT|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO Select|BCBS UTHCT|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 20 MIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.82||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0301||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.17||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.82||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.79||| G0463|EAP|0949|THERAP OR DX INJ; SQ OR IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||213.82||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||45.15||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (INFD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0309||Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.25||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (INFD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3.26||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (INFD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0999|TOWEL SURGICAL (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0999|SYRINGE 60 CC W/O NEEDLE LL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CF)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0999|SWAB BENZOIN (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| G0463|EAP|0999|ALCOHOL SWAB (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.99||| G0463|EAP|0306||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.83||| G0463|EAP|0510||Managed Medicaid|OTHER MEDICAID|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(RADON)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0730||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.86||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Aetna|AETNA|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Aetna|AETNA EXXON MOBIL|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Aetna|AETNA EXXON MOBIL|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510||Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Aetna|AETNA US HEALTHCARE PA|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(POD)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (INFD)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3.26||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Aetna|AETNA EXXON MOBIL|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Aetna|TRS COORDINATED CARE|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Aetna|AETNA|||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (POD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT; LOW, EST (GIC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (CARD)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.50||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.09||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||2.64||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.26||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.99||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.26||||2.50||| G0463|EAP|0302||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.79||| G0463|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||2.15||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.79||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.99||||3.26||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.50||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||1.63||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|2.50||||2.64||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||3.79||| G0463|EAP|0510||Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.26||| G0463|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| G0463|EAP|0949||Blue Cross PPO|BLUE CROSS PPO|||||213.82||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Blue Cross PPO|BLUE CROSS POS|||||2.25||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.25||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||2.50||| G0463|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.36||| G0463|EAP|0312||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.40||| G0463|EAP|0312|SURG PATH - LEVEL IV G&M EXAM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.96||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.82||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Blue Cross PPO|BLUE CROSS PPO|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.99||| G0463|EAP|0510|COLPO/W BX OR ECC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.23||| G0463|EAP|0251||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Blue Cross PPO|BLUE CROSS PPO|||||4.38||| G0463|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.06||| G0463|EAP|0402||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.48||| G0463|EAP|0320||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.06||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Blue Cross PPO|BLUE CROSS PPO|||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0352||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23.22||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Managed Medicaid|OTHER MEDICAID|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0401|MAMMO DIAGNOSTIC,INCL CAD,UNIL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.38||| G0463|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| G0463|EAP|0320||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.04||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Blue Cross PPO|BLUE CROSS POS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510||Managed Medicaid|MOLINA MEDICAID|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (INFD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.50||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0272|IV SOL NACL .9 250 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.04||| G0463|EAP|0272|STERI-STRIP 1/2 X 4 (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.25||| G0463|EAP|0272|CHLORAPREP APPLICATOR 3ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| G0463|EAP|0272|STAPLE REMOVER (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9.45||| G0463|EAP|0272|SUTURE REMOVAL KIT (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| G0463|EAP|0272||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.90||| G0463|EAP|0272|7.5 TRIFLEX STERILE GLOVES|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.05||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0483||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||14.21||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510||Blue Cross PPO|BCBS WALMART|||||3.79||| G0463|EAP|0510||Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Managed Medicaid|MOLINA MEDICAID|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.38||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (URO)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Blue Cross PPO|BLUE CROSS POS|||||2.25||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Blue Cross PPO|BLUE CROSS POS|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.99||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Blue Cross PPO|BCBS TRANE PPO|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Managed Medicaid|MOLINA MEDICAID|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Blue Cross PPO|BCBS WALMART|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Managed Medicaid|MOLINA MEDICAID|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLINIC VISIT; LOW, CONSULT|Managed Medicaid|FAMILY PLANNING GRANT|||||3.89||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Managed Medicaid|MOLINA MEDICAID|||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Blue Cross PPO|BLUE CROSS POS|||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Blue Cross PPO|BCBS TRANE PPO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Managed Medicaid|SUPERIOR STAR MCD|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Managed Medicaid|MOLINA MEDICAID|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross PPO|BLUE CROSS POS|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Managed Medicaid|MOLINA MEDICAID|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(INFD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Managed Medicaid|MEDICAID CSHCN|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Blue Cross PPO|BCBS WALMART|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Managed Medicaid|MOLINA MEDICAID|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Managed Medicaid|MEDICAID CSHCN|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (POD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Managed Medicaid|MOLINA MEDICAID|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Blue Cross PPO|BCBS TRANE PPO|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.38||| G0463|EAP|0510||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.99||| G0463|EAP|0510||Managed Medicaid|OTHER MEDICAID|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510||Managed Medicaid|MOLINA MEDICAID|||||3.26||| G0463|EAP|0510||Managed Medicaid|FAMILY PLANNING GRANT|||||2.64||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||6.11||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.64||||2.25||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|4.38||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|NON CONTRACTED|BOONE CHAPMAN|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Medicaid|MEDICAID|2.64||||4.38||| G0463|EAP|0999|COTTON TIP APP STERILE (SURGC)|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Medicare|MEDICARE RAILROAD|||||3.79||| G0463|EAP|0510|CLIN VISIT; LOW, EST (OCCMED)|Workers Compensation|WC GALLAGHER BASSETT|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| G0463|EAP|0403||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|United Healthcare|UMR|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (SURGC)|United Healthcare|UMR|||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Blue Cross PPO|BCBS WALMART|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Workers Compensation|WC OTHER|||||2.64||| G0463|EAP|0272|7.5 TRIFLEX STERILE GLOVES|Medicare|MEDICARE A & B|||||0.05||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||1.38||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.19||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Tricare|TRICARE WEST UNITED HEALTH|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CARDC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|United Healthcare|UNITED HEALTHCARE STUDENT RES|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|United Healthcare|GOLDEN RULE INSURANCE|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (INFD)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0312|HPV IN-SITU HYBRIDIZATION-REF|Medicare|MEDICARE A & B|||||4.70||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.30||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Workers Compensation|WC TX MUTUAL INS|||||2.50||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||0.08||| G0463|EAP|0940||Medicare|MEDICARE A & B|||||1.02||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|NON CONTRACTED|COMMERCIAL OTHER|||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| G0463|EAP|0272|IV SOL NACL .9 250 ML|Medicaid|MEDICAID|||||0.04||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.09||| G0463|EAP|0272|J LOOP|Medicare|MEDICARE A & B|||||0.07||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Medicare|MEDICARE RAILROAD|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|NON CONTRACTED|COMMERCIAL OTHER|||||2.09||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||1.58||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|United Healthcare|GOLDEN RULE INSURANCE|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Multiplan|PHCS OF TX ARLINGTON|||||2.64||| G0463|EAP|0272||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.90||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Multiplan|TML GRP INS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Healthcare|GOLDEN RULE INSURANCE|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT;MIN,NEW (CF)|Workers Compensation|DO NOT USE----ENABLE COMP|||||2.62||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(OCCME)|Workers Compensation|WC RISK MANAGEMENT|||||3.79||| G0463|EAP|0301||NON CONTRACTED|PPO OTHER|||||2.78||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.38||| G0463|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||69.31||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(OCCME)|Workers Compensation|WC OTHER|||||3.79||| G0463|EAP|0305||Medicare|MEDICARE A & B|||||1.55||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Managed Medicaid|MOLINA MEDICAID|||||2.99||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0419||Medicare|MEDICARE A & B|||||7.09||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CF)|Medicaid|MEDICAID|2.64||||2.09||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (INFD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO|BCBS TRANE PPO|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||2.15||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Managed Medicaid|MOLINA MEDICAID|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Managed Medicaid|MOLINA MEDICAID|||||2.50||| G0463|EAP|0272|SUTURE REMOVAL KIT (SURGC)|Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|PHCS|TML GRP INS|||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0999|ALCOHOL SWAB (SURGC)|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||1.39||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|United Healthcare|UMR|||||2.99||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||3.47||| G0463|EAP|0450|ACUITY POINT 7|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0402||Medicare|MEDICARE A & B|||||14.97||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.09||| G0463|EAP|0301||NON CONTRACTED|PPO OTHER|||||0.71||| G0463|EAP|0771||Medicare|MEDICARE A & B|||||0.12||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|United Healthcare|UMR|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Multiplan|TML GRP INS|||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|PHCS|TML GRP INS|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Multiplan|WEB TPA|||||4.38||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|United Healthcare|UMR|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Multiplan|TML GRP INS|||||2.64||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Multiplan|WEB TPA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.26||| G0463|EAP|0510|CLIN VISIT; LOW, EST (PULMC)|Medicare|MEDICARE A & B|4.38||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (GIC)|Medicare|MEDICARE A & B|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Medicare|MEDICARE A & B|4.38||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|United Healthcare|UMR|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(POD)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|United Healthcare|UMR|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Medicare|MEDICARE PART B|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|United Healthcare|UMR|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Medicare|MEDICARE RAILROAD|||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (RAD ONC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510||Workers Compensation|WC RISK MANAGEMENT|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(OCCME)|Workers Compensation|WC RISK MANAGEMENT|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Multiplan|WEB TPA|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|PHCS|PHCS OF TX ARLINGTON|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|PHCS|WEB TPA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(RADON)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.38||| G0463|EAP|0949||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||181.41||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| G0463|EAP|0771||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||160.36||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(INFD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.79||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 30 MIN|Blue Cross PPO|BLUE CROSS POS|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.64||| G0463|EAP|0272|ACU-DYNE SWAB STICKS (SURGC)|Medicaid|MEDICAID|||||4.90||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| G0463|EAP|0949||Medicare|MEDICARE A & B|||||181.41||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.64||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Optum Behavioral Health|OPTUM|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0730||NON CONTRACTED|COMMERCIAL OTHER|||||3.86||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Optum Behavioral Health|OPTUM|2.99||||||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|NON CONTRACTED|BOONE CHAPMAN|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Medicaid|MEDICAID|2.64||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|Blue Cross PPO|BLUE CROSS POS|||||2.82||| G0463|EAP|0510||Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.88||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.68||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||0.64||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|Medicaid|MEDICAID|2.64||||2.82||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|NON CONTRACTED|MRAMVA|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Managed Medicaid|MOLINA MEDICAID|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.79||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0636||PHCS|WEB TPA|||||45.15||| G0463|EAP|0999|TOWEL SURGICAL (SURGC)|Medicaid|MEDICAID|||||0.00||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|United Healthcare|GOLDEN RULE INSURANCE|||||2.64||| G0463|EAP|0403||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||4.83||| G0463|EAP|0272|XEROFORM 5 X 9 STRIP|Medicare|MEDICARE A & B|||||0.05||| G0463|EAP|0731||Medicare|MEDICARE A & B|||||9.15||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| G0463|EAP|0310||Medicare|MEDICARE A & B|||||1.84||| G0463|EAP|0999|TOWEL SURGICAL (SURGC)|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 30 MIN|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.25||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||1.65||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||3.17||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (RHEUMC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.09||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.25||| G0463|EAP|0730||Medicare|MEDICARE A & B|||||3.86||| G0463|EAP|0510|CLIN VISIT; LOW, EST (POD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0320||Medicare|MEDICARE A & B|||||3.44||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (OCCMED)|Workers Compensation|WC RISK MANAGEMENT|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|United Healthcare|UMR|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0320||Medicare|MEDICARE A & B|||||2.35||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|United Healthcare|UMR|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Medicare|MEDICARE A & B|||||3.79||| G0463|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.29||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (PODC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.82||| G0463|EAP|0352||Medicare|MEDICARE A & B|||||1.06||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0320||Medicare|MEDICARE A & B|||||2.04||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|PHCS|WEB TPA|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|PHCS|PHCS OF AZ PHEONIX|||||2.50||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Medicare|MEDICARE A & B|3.26||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Multiplan|PHCS OF AZ PHEONIX|||||2.50||| G0463|EAP|0510||United Healthcare|UMR|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Multiplan|GILSBAR INC|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|United Healthcare|UMR|||||4.38||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Multiplan|TML GRP INS|||||2.64||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Blue Cross PPO|BLUE CROSS PPO|2.50||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Multiplan|WEB TPA|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|Multiplan|TML GRP INS|||||2.82||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510||United Healthcare|UMR|||||2.64||| G0463|EAP|0914||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||5.63||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|United Healthcare|UMR|||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Multiplan|TML GRP INS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.79||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|United Healthcare|UMR|||||2.25||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|United Healthcare|UMR|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Tricare|TRICARE WEST UNITED HEALTH|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Medicare|MEDICARE A & B|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (RADON)|Medicare|MEDICARE A & B|4.38||||2.25||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|United Healthcare|UMR|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|United Healthcare|GOLDEN RULE INSURANCE|||||2.50||| G0463|EAP|0510||Multiplan|WEB TPA|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(INFD)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|United Healthcare|UMR|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Medicare|MEDICARE RAILROAD|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Medicare|MEDICARE RAILROAD|||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|United Healthcare|GOLDEN RULE INSURANCE|||||2.64||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.09||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(IMC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|United Healthcare|UMR|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (IMC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;MIN,EST (IMC)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|United Healthcare|UMR|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Medicare|MEDICARE RAILROAD|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|United Healthcare|UMR|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Medicare|MEDICARE PART B|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicare|MEDICARE PART B|||||2.50||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||0.40||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510||Workers Compensation|DO NOT USE----ENABLE COMP|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Workers Compensation|WC RISK MANAGEMENT|||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE PART A|2.50||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Medicare|MEDICARE PART B|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(OCCME)|Workers Compensation|WC OTHER|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0450|IV INFUSION THERAPY,UP TO 1 HR|Medicare|MEDICARE A & B|||||669.83||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Medicaid|MEDICAID|2.64||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|PHCS|WEB TPA|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|PHCS|TML GRP INS|||||2.64||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||1.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.50||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Medicare|MEDICARE A & B|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Medicare|MEDICARE RAILROAD|||||2.99||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, NEW|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.62||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Blue Cross PPO|BCBS WALMART|||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||1.66||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|PHCS|TML GRP INS|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Workers Compensation|WC GALLAGHER BASSETT|||||3.79||| G0463|EAP|0460||Medicare|MEDICARE A & B|||||8.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| G0463|EAP|0510||Workers Compensation|WC OTHER|||||2.50||| G0463|EAP|0510||PHCS|WEB TPA|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(OCCME)|Workers Compensation|DO NOT USE----ENABLE COMP|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|PHCS|TML GRP INS|||||2.64||| G0463|EAP|0510||Managed Medicaid|MEDICAID CSHCN|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0272|IV SOL NACL .9 250 ML|Medicare|MEDICARE A & B|||||0.04||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0999|SWAB BENZOIN (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Managed Medicaid|MOLINA MEDICAID|||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.79||| G0463|EAP|0302||Medicare|MEDICARE A & B|||||1.20||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.25||| G0463|EAP|0272|CHLORAPREP APPLICATOR 3ML|Medicaid|MEDICAID|||||4.90||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0302||Medicare|MEDICARE A & B|||||4.14||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Medicaid|MEDICAID|2.64||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CF)|Medicaid|MEDICAID|2.64||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.25||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 20 MIN|Medicaid|MEDICAID|2.64||||2.82||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.09||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Optum Behavioral Health|OPTUM|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|NON CONTRACTED|BOONE CHAPMAN|||||2.64||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.63||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.50||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Medicaid|MEDICAID|2.64||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CF)|Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510||Medicaid|MEDICAID|2.64||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Medicaid|MEDICAID|2.64||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (BRST/WC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.09||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Medicaid|MEDICAID|2.64||||2.25||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.09||| G0463|EAP|0510||Medicaid|MEDICAID|2.64||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Managed Medicaid|MOLINA MEDICAID|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0949||Medicare|MEDICARE A & B|||||213.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||4.38||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.02||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|NON CONTRACTED|BOONE CHAPMAN|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (URO)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0999|TOWEL SURGICAL (SURGC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| G0463|EAP|0272||Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (OCCMED)|Workers Compensation|DO NOT USE----ENABLE COMP|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| G0463|EAP|0302||Medicare|MEDICARE A & B|||||1.89||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (RADON)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.25||| G0463|EAP|0305||Medicare|MEDICARE A & B|||||0.78||| G0463|EAP|0272|STAPLE REMOVER (SURGC)|Medicare|MEDICARE A & B|||||9.45||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| G0463|EAP|0272|IMED TUBING (ER)|Medicare|MEDICARE A & B|||||0.17||| G0463|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| G0463|EAP|0251||Medicare|MEDICARE A & B|||||32.20||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Managed Medicaid|FAMILY PLANNING GRANT|||||3.79||| G0463|EAP|0272|ACU-DYNE SWAB STICKS (SURGC)|Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0257|ASPIRIN 81mg TAB PO|Medicare|MEDICARE A & B|||||0.65||| G0463|EAP|0510||PHCS|TML GRP INS|||||2.50||| G0463|EAP|0460||NON CONTRACTED|PPO OTHER|||||4.74||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.09||| G0463|EAP|0310||Medicare|MEDICARE A & B|||||1.74||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|PHCS|TML GRP INS|||||2.64||| G0463|EAP|0312||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.96||| G0463|EAP|0301||NON CONTRACTED|PPO OTHER|||||2.15||| G0463|EAP|0351||NON CONTRACTED|COMMERCIAL OTHER|||||18.15||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||207.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (URO)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||2.07||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (ONC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|PHCS|TML GRP INS|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||0.96||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Workers Compensation|WC OTHER|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Blue Cross PPO|BLUE CROSS POS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MIN,NEW (INFD)|Medicare|MEDICARE A & B|4.38||||2.62||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|PHCS|WEB TPA|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|United Healthcare|UMR|||||4.38||| G0463|EAP|0403||Medicare|MEDICARE A & B|||||0.82||| G0463|EAP|0450|ACUITY POINT 15|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0307||Medicare|MEDICARE A & B|||||1.18||| G0463|EAP|0310||Medicare|MEDICARE A & B|||||8.48||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|United Healthcare|UMR|||||3.79||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Blue Cross PPO|BLUE CROSS POS|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.25||| G0463|EAP|0999|SYRINGE 60 CC W/O NEEDLE LL|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|Medicare|MEDICARE A & B|||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Medicare|MEDICARE RAILROAD|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0636||Medicare|MEDICARE A & B|||||17.75||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.79||| G0463|EAP|0301||NON CONTRACTED|PPO OTHER|||||0.19||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|Medicare|MEDICARE RAILROAD|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|PHCS|TML GRP INS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||1.32||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Multiplan|WEB TPA|||||4.38||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Medicare|MEDICARE PART A|2.64||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0510||Medicare|MEDICARE A & B|1.03||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Medicare|MEDICARE A & B|||||2.64||| G0463|EAP|0636||Multiplan|WEB TPA|||||45.15||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CF)|Blue Cross PPO|BLUE CROSS PPO|2.50||||4.38||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Medicare|MEDICARE A & B|||||2.25||| G0463|EAP|0320||Medicare|MEDICARE A & B|||||5.06||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||2.51||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||2.99||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||4.38||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Multiplan|TML GRP INS|||||3.26||| G0463|EAP|0301||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.33||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|PHCS|WEB TPA|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Blue Cross PPO|BCBS WALMART|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Multiplan|WEB TPA|||||2.64||| G0463|EAP|0949||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||181.41||| G0463|EAP|0510||Medicare|MEDICARE RAILROAD|||||3.26||| G0463|EAP|0510||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Multiplan|WEB TPA|||||2.50||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||3.79||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (WWC)|PHCS|TML GRP INS|||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Medicare|MEDICARE PART B|||||2.64||| G0463|EAP|0730||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.86||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Multiplan|TML GRP INS|||||2.09||| G0463|EAP|0510||Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|United Healthcare|UMR|||||3.79||| G0463|EAP|0510||Medicare|MEDICARE A & B|3.26||||6.11||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Multiplan|TML GRP INS|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Blue Cross PPO|BLUE CROSS POS|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Medicare|MEDICARE RAILROAD|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|United Healthcare|UMR|||||3.26||| G0463|EAP|0510|CLIN VISIT;MIN,EST (POD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|PHCS|WEB TPA|||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (INFD)|Medicare|MEDICARE A & B|2.82||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|United Healthcare|UMR|||||3.26||| G0463|EAP|0510||United Healthcare|UMR|||||3.79||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Medicare|MEDICARE A & B|2.50||||2.09||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|Medicare|MEDICARE A & B|3.26||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; MID, NEW|Medicare|MEDICARE A & B|2.09||||2.99||| G0463|EAP|0510|**CLINIC VISIT; LOW, ESTABLISH|Medicare|MEDICARE A & B|2.09||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|Medicare|MEDICARE A & B|4.38||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (CARD)|Medicare|MEDICARE A & B|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|PHCS|WEB TPA|||||2.50||| G0463|EAP|0510||Multiplan|TML GRP INS|||||2.50||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (CARDC)|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Medicare|MEDICARE PART A|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Medicare|MEDICARE PART A|2.50||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|Medicare|MEDICARE A & B|2.50||||2.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (POD)|Medicare|MEDICARE A & B|2.99||||2.25||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (ONC)|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT; LOW, EST (ONC)|Medicare|MEDICARE A & B|2.99||||2.25||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Tricare|TRICARE WEST UNITED HEALTH|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|United Healthcare|GOLDEN RULE INSURANCE|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|United Healthcare|UMR|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(RHEUM)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(PULMC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Medicare|MEDICARE RAILROAD|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|United Healthcare|UMR|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Medicare|MEDICARE A & B|4.38||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Medicare|MEDICARE RAILROAD|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Medicare|MEDICARE PART A|2.50||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RHEUM)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Medicare|MEDICARE A & B|4.38||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (URO)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|Medicare|MEDICARE RAILROAD|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Medicare|MEDICARE RAILROAD|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|United Healthcare|UMR|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Blue Cross PPO|BLUE CROSS POS|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|Medicare|MEDICARE A & B|4.38||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|United Healthcare|UMR|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|United Healthcare|UMR|||||2.64||| G0463|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||21.30||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (GIC)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RHEUMC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|United Healthcare|UMR|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.79||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (URO)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;MIN,EST (BRST/WC)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(URO)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (SURGC)|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CF)|Medicare|MEDICARE PART A|2.50||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|Medicare|MEDICARE A & B|4.38||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicare|MEDICARE PART A|2.50||||2.50||| G0463|EAP|0450|ACUITY POINT 10|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0305||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1.68||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE PART B|||||2.50||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (IMC)|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.26||| G0463|EAP|0510|CLIN VISIT; LOW, EST (OCCMED)|Workers Compensation|DO NOT USE----ENABLE COMP|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (IMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|Workers Compensation|WC OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0301||NON CONTRACTED|PPO OTHER|||||0.31||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0309||Medicare|MEDICARE A & B|||||0.73||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (GIC)|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.79||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||0.83||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (PODC)|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RHEUM)|Medicare|MEDICARE A & B|4.38||||2.50||| G0463|EAP|0510|CLINIC VISIT;MIN,NEW (GIC)|Medicare|MEDICARE A & B|4.38||||2.62||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Blue Cross PPO|BCBS TRANE PPO|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|United Healthcare|UMR|||||2.50||| G0463|EAP|0450|HYDRATE IV INFUSE, EA ADD'L HR|Medicare|MEDICARE A & B|||||3.45||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0999|SWAB BENZOIN (SURGC)|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 20 MIN|Medicare|MEDICARE A & B|4.38||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||1.36||| G0463|EAP|0460||Medicare|MEDICARE A & B|||||2.82||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.82||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||0.50||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Medicare|MEDICARE RAILROAD|||||2.25||| G0463|EAP|0460||Medicare|MEDICARE A & B|||||2.35||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Multiplan|TML GRP INS|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (SURGC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|Medicare|MEDICARE A & B|4.38||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Medicare|MEDICARE A & B|4.38||||2.99||| G0463|EAP|0312||Medicare|MEDICARE A & B|||||3.36||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0480||Medicare|MEDICARE A & B|||||3.22||| G0463|EAP|0450|ACUITY POINT 5|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Medicare|MEDICARE RAILROAD|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| G0463|EAP|0312||Medicare|MEDICARE A & B|||||2.40||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|PHCS|WEB TPA|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.09||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|PHCS|WEB TPA|||||2.64||| G0463|EAP|0271|WRAP COBAN 2 (ER)|Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (GIC)|Blue Cross PPO|BCBS WALMART|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.99||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0510|**CLINIC VISIT; HIGH, ESTABLIS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CARDC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.26||| G0463|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||14.20||| G0463|EAP|0251|NITROGLYCERIN SL TAB 0.4 MG|Medicare|MEDICARE A & B|||||121.35||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Medicaid|MEDICAID|2.64||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (ONC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0305||Medicare|MEDICARE A & B|||||0.49||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||4.38||| G0463|EAP|0403||Medicare|MEDICARE A & B|||||4.83||| G0463|EAP|0999|SYRINGE 60 CC W/O NEEDLE LL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.00||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||0.68||| G0463|EAP|0942|MED NUTR THER, EA 15 MIN, INIT|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.56||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||2.33||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0510|CLIN VISIT;MIN,EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0272|IV CATH 22GA X 1 (ER)|Medicare|MEDICARE A & B|||||5.25||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CARDC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0300||Medicare|MEDICARE A & B|||||1.40||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.64||| G0463|EAP|0513|CLIN VISIT; LOW, EST (BHC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 60 MIN|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(BRSWC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Blue Cross PPO|BCBS WALMART|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(RADON)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.64||| G0463|EAP|0300||Medicare|MEDICARE A & B|||||0.09||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|Medicaid|MEDICAID|2.64||||3.26||| G0463|EAP|0272|DRESSING ABD 5X9 STERILE|Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0272|CHLORAPREP APPLICATOR 3ML|Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||3.51||| G0463|EAP|0510|CLINIC VISIT; MID, EST (INFD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3.79||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Medicaid|MEDICAID|2.64||||2.82||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (PODC)|Medicaid|MEDICAID|2.64||||2.82||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(SURGC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (PODC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (SURGC)|Medicaid|MEDICAID|2.64||||4.38||| G0463|EAP|0510|CLIN VISIT;MIN,EST (PUL)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.09||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Medicaid|MEDICAID|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.09||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Blue Cross PPO|BLUE CROSS POS|||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (IMC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.25||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(URO)|NON CONTRACTED|COMMERCIAL OTHER|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(FPC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CARDC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (RADON)|Medicaid|MEDICAID|2.64||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(ONC)|Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(PULMC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Blue Cross PPO|BLUE CROSS POS|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(FPC)|Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(IMC)|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|NON CONTRACTED|BOONE CHAPMAN|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Medicaid|MEDICAID|2.64||||2.64||| G0463|EAP|0510|CLIN VISIT;MIN,EST (CARD)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.09||| G0463|EAP|0513|CLIN VISIT;HIGH,EST (BHC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(CARDC)|Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||3.79||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|Blue Cross PPO|BLUE CROSS POS|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|Medicaid|MEDICAID|2.64||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (RADON)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLIN VISIT; LOW, EST (WWC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.25||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.50||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (ONC)|Medicaid|MEDICAID|2.64||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.99||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.64||| G0463|EAP|0510|CLINIC VISIT; LOW, CONSULT|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.89||| G0463|EAP|0513|CLINIC VISIT; MID, EST (BHC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| G0463|EAP|0914||Medicare|MEDICARE A & B|||||5.63||| G0463|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.26||| G0463|EAP|0510|CLIN VISIT; LOW, EST (SURGC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(GIC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|Medicaid|MEDICAID|||||2.64||| G0463|EAP|0510||NON CONTRACTED|COMMERCIAL OTHER|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||2.07||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (CARDC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.99||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||2.31||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||2.36||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.99||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||0.91||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Medicaid|MEDICAID|2.64||||2.99||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.29||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (FPC)|Medicaid|MEDICAID|2.64||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Medicaid|MEDICAID|2.64||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.26||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (BRST/WC)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|NON CONTRACTED|BOONE CHAPMAN|||||2.50||| G0463|EAP|0306||NON CONTRACTED|PPO OTHER|||||1.54||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (CF)|Medicaid|MEDICAID|2.64||||2.50||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||1.19||| G0463|EAP|0305||Medicare|MEDICARE A & B|||||0.94||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|NON CONTRACTED|COMMERCIAL OTHER|||||4.38||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|Managed Medicaid|MOLINA MEDICAID|||||2.99||| G0463|EAP|0510|CLINIC VISIT; MID, EST (IMC)|Blue Cross PPO|BCBS TRANE PPO|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0513|CLIN VISIT;HIGH,NEW (BHC)|PHCS|WEB TPA|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (ONC)|NON CONTRACTED|COMMERCIAL OTHER|||||3.26||| G0463|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| G0463|EAP|0272|7.5 TRIFLEX STERILE GLOVES|Medicaid|MEDICAID|||||0.05||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLINIC VISIT; MID, EST (POD)|NON CONTRACTED|BOONE CHAPMAN|||||2.50||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Managed Medicaid|MOLINA MEDICAID|||||2.64||| G0463|EAP|0310||Medicare|MEDICARE A & B|||||1.68||| G0463|EAP|0510|CLINIC VISIT; MID, EST (SURGC)|Managed Medicaid|SUPERIOR STAR MCD|||||2.50||| G0463|EAP|0513|CLINIC VISIT;MID,NEW (BHC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.99||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (PULMC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (RADON)|NON CONTRACTED|COMMERCIAL OTHER|||||4.38||| G0463|EAP|0302||Medicare|MEDICARE A & B|||||1.11||| G0463|EAP|0510|CLINIC VISIT;LOW,NEW (FPC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.82||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0612||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.50||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (PULMC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.64||| G0463|EAP|0305||Medicare|MEDICARE A & B|||||1.22||| G0463|EAP|0510|CLINIC VISIT; MID, EST (WWC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||2.50||| G0463|EAP|0272|IV START KIT (ER)|Medicare|MEDICARE A & B|||||5.25||| G0463|EAP|0510|CLIN VISIT; LOW, EST (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.25||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (IMC)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.99||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (GIC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.99||| G0463|EAP|0510|OFFICE OUTPATIENT NEW 45 MIN|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.79||| G0463|EAP|0999|SYRINGE 60 CC W/O NEEDLE LL|Medicaid|MEDICAID|||||0.00||| G0463|EAP|0272|STERI-STRIP 1/2 X 4 (SURGC)|Medicare|MEDICARE A & B|||||5.25||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||2.50||| G0463|EAP|0250||Medicare|MEDICARE A & B|||||47.65||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (SURGC)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,NEW(BHC)|PHCS|TML GRP INS|||||3.79||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|Managed Medicaid|FAMILY PLANNING GRANT|||||4.38||| G0463|EAP|0510|CLIN VISIT;HIGH,EST (CF)|NON CONTRACTED|PPO OTHER|||||3.26||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(ONC)|NON CONTRACTED|COMMERCIAL OTHER|||||2.64||| G0463|EAP|0306||Medicare|MEDICARE A & B|||||5.21||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0270||Medicare|MEDICARE A & B|||||4.90||| G0463|EAP|0510|**CLINIC VISIT; MINIMUM, ESTAB|United Healthcare|UMR|||||2.09||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (CARDC)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.99||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (ONC)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.50||| G0463|EAP|0510|CLINIC VISIT; MID, EST (FPC)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2.50||| G0463|EAP|0981|ER VISIT; LEVEL III|Medicare|MEDICARE A & B|||||0.00||| G0463|EAP|0510|CLIN VISIT;HIGH,NEW (FPC)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.99||||4.38||| G0463|EAP|0510|CLINIC VISIT; MID, EST (URO)|Blue Cross PPO|BLUE CROSS PPO|2.50||||2.50||| G0463|EAP|0450|EMERGENCY VISIT; MID LEVEL|Medicare|MEDICARE A & B|||||7.27||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,EST(CF)|United Healthcare|UMR|||||2.64||| G0463|EAP|0510|CLIN VISIT;HIGH MOD,NEW(SURGC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.26||||3.79||| G0463|EAP|0510||Medicare|MEDICARE A & B|2.64||||3.26||| G0463|EAP|0513|CLIN VISIT;HIGH MOD,EST(BHC)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.64||| G0463|EAP|0510|**CLINIC VISIT; HIGH MODERATE,|Multiplan|WEB TPA|||||2.64||| G0463|EAP|0510|CLINIC VISIT; MID, EST (PULMC)|Multiplan|WEB TPA|||||2.50||| G0463|EAP|0510|OFFICE OUTPATIENT VISIT 15 MIN|Multiplan|WEB TPA|||||2.50||| G0463|EAP|0510|CLINIC VISIT;MID,NEW (POD)|United Healthcare|UMR|||||2.99||| G0480|EAP|0301|ALCOHOL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Managed Medicaid|MOLINA MEDICAID|||||2.27||| G0480|EAP|0301|ALCOHOL|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||2.27||| G0480|EAP|0301|OPIATES (REF)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.27||||1.34||| G0480|EAP|0301||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.27||||2.27||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.27||||0.83||| G0480|EAP|0301|ALCOHOL|Managed Medicaid|SUPERIOR STAR MCD|||||2.27||| G0480|EAP|0301|ALCOHOL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.27||| G0480|EAP|0300|CONF/QUANT COCAINE METAB (ARUP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.83||| G0480|EAP|0301|ALCOHOL|Aetna|AETNA EL PASO CLAIMS OFFICE|2.27||||2.27||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.72||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.83||| G0480|EAP|0301|ALCOHOL|Cigna|CIGNA OF TN CHATTANOOGA|||||2.27||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.27||||0.83||| G0480|EAP|0301|ALCOHOL|ChampVA|CHAMPVA OF CO DENVER|||||2.27||| G0480|EAP|0301|OPIATES (REF)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.27||||1.34||| G0480|EAP|0300|AMPHETAMINES CONF/QUANT (ARUP)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.73||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.83||| G0480|EAP|0300|METHADONE MET CONF/QUANT (ARUP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.83||| G0480|EAP|0300|AMPHETAMINES CONF/QUANT (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.90||| G0480|EAP|0301|ALCOHOL|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||2.27||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Blue Cross PPO|BLUE CROSS POS|||||0.72||| G0480|EAP|0300|AMPHETAMINES CONF/QUANT (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.90||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|Managed Medicaid|SUPERIOR STAR MCD|||||0.83||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Blue Cross PPO|BCBS WALMART|||||0.72||| G0480|EAP|0300|AMPHETAMINES CONF/QUANT (ARUP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.73||| G0480|EAP|0301|ALCOHOL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Blue Cross PPO Select|BCBS UTHCT|2.27||||2.27||| G0480|EAP|0300|PERAMPANEL SERUM/PLASMA (NMS)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.00||| G0480|EAP|0301|ALCOHOL|Blue Cross PPO|BCBS TRANE PPO|2.27||||2.27||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|Blue Cross PPO Select|BCBS UTHCT|2.27||||0.83||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.72||| G0480|EAP|0300|PERAMPANEL SERUM/PLASMA (NMS)|Blue Cross PPO Select|BCBS UTHCT|||||4.00||| G0480|EAP|0301|ALCOHOL|Blue Cross PPO|BLUE CROSS PPO|2.27||||2.27||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Cigna|CIGNA BEHAVIORAL HEALTH|||||0.72||| G0480|EAP|0301|METHADONE (REF)|Blue Cross PPO|BCBS TRANE PPO|2.27||||0.80||| G0480|EAP|0301|ALCOHOL|Blue Cross PPO|BCBS WALMART|2.27||||2.27||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|Blue Cross PPO|BCBS TRANE PPO|||||0.83||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Blue Cross PPO|BLUE CROSS PPO|||||0.72||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.27||||0.83||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|Blue Cross PPO|BLUE CROSS PPO|||||0.83||| G0480|EAP|0301|ALCOHOL|United Healthcare|GOLDEN RULE INSURANCE|||||2.27||| G0480|EAP|0301|ALCOHOL|United Healthcare|UMR|2.27||||2.27||| G0480|EAP|0300|METHADONE MET CONF/QUANT (ARUP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.83||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.83||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|PHCS|TML GRP INS|||||0.83||| G0480|EAP|0301|ALCOHOL|PHCS|WEB TPA|||||2.27||| G0480|EAP|0301|ALCOHOL|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.27||||2.27||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|United Healthcare|UMR|||||0.83||| G0480|EAP|0301|OPIATES (REF)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.27||||1.34||| G0480|EAP|0301|ALCOHOL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.27||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|NON CONTRACTED|COMMERCIAL OTHER|||||0.72||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|Multiplan|TML GRP INS|||||0.83||| G0480|EAP|0301|ISPROPANOL (INCL ACETONE) ARUP|NON CONTRACTED|COMMERCIAL OTHER|2.27||||0.85||| G0480|EAP|0301|METHANOL, SERUM (REF)|NON CONTRACTED|COMMERCIAL OTHER|2.27||||0.87||| G0480|EAP|0301|ALCOHOL|NON CONTRACTED|COMMERCIAL OTHER|2.27||||2.27||| G0480|EAP|0301|CONF/QUANT CANNABINOIDS (ARUP)|Medicare|MEDICARE A & B|2.27||||0.83||| G0480|EAP|0301|NORTRIPTYLINE , SERUM (REF)|Medicare|MEDICARE A & B|2.27||||1.26||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Medicare|MEDICARE A & B|||||0.72||| G0480|EAP|0301|ALCOHOL|Medicare|MEDICARE PART A|2.27||||||| G0480|EAP|0301|ALCOHOL|Medicare|MEDICARE RAILROAD|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Medicare|MEDICARE A & B|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Medicaid|MEDICAID|||||2.27||| G0480|EAP|0301|ALCOHOL|Multiplan|WEB TPA|||||2.27||| G0480|EAP|0300|METHADONE MET CONF/QUANT (ARUP|Medicare|MEDICARE A & B|||||0.83||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|Medicare|MEDICARE A & B|||||0.83||| G0480|EAP|0301|ALCOHOL|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.27||| G0480|EAP|0301|OPIATES (REF)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.34||| G0480|EAP|0301|ALCOHOL|Cigna|CIGNA OPEN ACCESS PLUS|||||2.27||| G0480|EAP|0301|ALCOHOL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.27||| G0480|EAP|0301|ALCOHOL|NON CONTRACTED|MRAMVA|||||2.27||| G0480|EAP|0301|ALCOHOL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.27||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|United Healthcare|UMR|||||0.72||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.72||| G0480|EAP|0300|AMPHETAMINES CONF/QUANT (ARUP)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.90||| G0480|EAP|0300|Ethyl Glucoron&Sulf,URINE,QUAN|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|||||0.72||| G0480|EAP|0301|ALCOHOL|Blue Cross PPO|BLUE CROSS POS|2.27||||2.27||| G0480|EAP|0301|ALCOHOL|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|2.27||||||| G0480|EAP|0300|OPIATES CONF/QUANT UR (ARUP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.83||| G0498|EAP|0280|PROLONG CHEMO INFUSE W/PUMP|Medicare|MEDICARE A & B|||||5.02||| G0498|EAP|0280|PROLONG CHEMO INFUSE W/PUMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||5.02||| G0498|EAP|0280|PROLONG CHEMO INFUSE W/PUMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||5.02||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.44||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|ChampVA|CHAMPVA OF CO DENVER|||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|ChampVA|CHAMPVA OF CO DENVER|||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|1.76||||||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO|BCBS WALMART|2.44||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO|BCBS TRANE PPO|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross PPO|BLUE CROSS PPO|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|2.44||||||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross PPO|BCBS WALMART|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO|BLUE CROSS POS|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross PPO|BLUE CROSS POS|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO Select|BCBS UTHCT|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross PPO Select|BCBS UTHCT|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.44||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Aetna|AETNA EL PASO CLAIMS OFFICE|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Aetna|AETNA EL PASO CLAIMS OFFICE|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|United Healthcare|UMR|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|United Healthcare|GOLDEN RULE INSURANCE|||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|PHCS|WEB TPA|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|United Healthcare|GOLDEN RULE INSURANCE|||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.44||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|PHCS|WEB TPA|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|United Healthcare|UMR|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Multiplan|WEB TPA|||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Blue Cross PPO|BCBS TRANE PPO|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Multiplan|WEB TPA|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO|BLUE CROSS PPO|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Medicare|MEDICARE A & B|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Medicare|MEDICARE RAILROAD|1.76||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Medicare|MEDICARE RAILROAD|2.44||||2.44||| G0659|EAP|0301|AMITRYPTYLINE|Medicare|MEDICARE A & B|1.76||||1.31||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Medicare|MEDICARE PART A|2.44||||||| G0659|EAP|0301|SALICYLATE, SERUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.76||||1.76||| G0659|EAP|0301|DRUG SCREEN QUAL; SINGLE DRUG|Medicare|MEDICARE A & B|1.76||||1.91||| G0659|EAP|0301|SALICYLATE, SERUM|Medicare|MEDICARE PART A|1.76||||||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|NON CONTRACTED|COMMERCIAL OTHER|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|NON CONTRACTED|COMMERCIAL OTHER|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Medicaid|MEDICAID|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Medicaid|MEDICAID|||||2.44||| G0659|EAP|0301|NICOTINE & COTININE METABOLITE|Medicare|MEDICARE A & B|1.76||||169.60||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Medicare|MEDICARE A & B|2.44||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Managed Medicaid|SUPERIOR STAR MCD|||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Managed Medicaid|MOLINA MEDICAID|||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.76||||1.76||| G0659|EAP|0301|SALICYLATE, SERUM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.44||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|SUPERIOR STAR MCD|||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|MOLINA MEDICAID|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|2.44||||||| G0659|EAP|0301|SALICYLATE, SERUM|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|1.76||||||| G0659|EAP|0301|SALICYLATE, SERUM|Cigna|CIGNA OF TN CHATTANOOGA|||||1.76||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Cigna|CIGNA OF TN CHATTANOOGA|||||2.44||| G0659|EAP|0301|ACETAMINOPHEN (TYLENOL)|Cigna|CIGNA OPEN ACCESS PLUS|||||2.44||| G0659|EAP|0301|SALICYLATE, SERUM|Cigna|CIGNA OPEN ACCESS PLUS|||||1.76||| G9035|EAP|0250|OSELTAMIVIR PHOS 60MG/10ml PO|Medicare|MEDICARE A & B|121.20||||||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Medicaid|MEDICAID|54.90||||||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Medicare|MEDICARE A & B|54.90||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Medicare|MEDICARE PART A|54.90||||||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Medicare|MEDICARE RAILROAD|54.90||||||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|NON CONTRACTED|COMMERCIAL OTHER|54.90||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|54.90||||||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|United Healthcare|UMR|||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Aetna|AETNA EL PASO CLAIMS OFFICE|||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Blue Cross PPO|BLUE CROSS PPO|54.90||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Cigna|CIGNA OPEN ACCESS PLUS|||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Humana Medicare Advantage|HUMANA MEDICARE PPO|54.90||||54.90||| G9035|EAP|0250|OSELTAMIVIR PHOS 60MG/10ml PO|Managed Medicaid|MOLINA MEDICAID|||||121.20||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Managed Medicaid|SUPERIOR STAR MCD|||||54.90||| G9035|EAP|0252|OSELTAMIVIR 75 CAPSULE 1 EA *T|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|54.90||||54.90||| J0132|EAP|0636|ACETYLCYSTEINE 6GM/30ML|Medicaid|MEDICAID|||||822.50||| J0132|EAP|0636|ACETYLCYSTEINE 6GM/30ML|Medicare|MEDICARE A & B|554.60||||||| J0133|EAP|0636|ACYCLOVIR SODIUM 500MG/20ML VI|Medicare|MEDICARE A & B|80.10||||||| J0133|EAP|0636|ACYCLOVIR 1000MG|Medicare|MEDICARE A & B|126.75||||||| J0153|EAP|0636|ADENOSINE INJ 6MG SDV|Blue Cross PPO Select|BCBS UTHCT|||||38.90||| J0153|EAP|0636|ADENOSINE INJ 6MG SDV|Medicare|MEDICARE A & B|||||38.90||| J0153|EAP|0636|ADENOSINE INJ 6MG SDV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||38.90||| J0153|EAP|0636|ADENOSINE INJ 6MG SDV|Blue Cross PPO|BLUE CROSS PPO|||||38.90||| J0171|EAP|0636|EPINEPHRINE INJ 1:1000 (1MG/ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|62.15||||62.15||| J0171|EAP|0510|REVISE BREAST RECONSTRUCTION|Medicare|MEDICARE A & B|||||87.95||| J0171|EAP|0510|REMOVAL OF TISSUE FOR GRAFT|Medicare|MEDICARE A & B|||||84.24||| J0171|EAP|0636|EPINEPHRINE INJ 1:1000 (1MG/ML|Medicare|MEDICARE A & B|62.15||||62.15||| J0171|EAP|0636|EPINEPHRINE INJ 1:1000 (1MG/ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||62.15||| J0171|EAP|0636|EPINEPHRINE 0.1MG/ML 10ML SYR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.10||| J0171|EAP|0636|EPINEPHRINE 0.1MG/ML 10ML SYR|Blue Cross PPO|BLUE CROSS PPO|31.10||||31.10||| J0171|EAP|0636|EPINEPHRINE INJ 1:1000 (1MG/ML|Blue Cross PPO|BLUE CROSS PPO|31.10||||62.15||| J0171|EAP|0636|EPINEPHRINE 0.1MG/ML 10ML SYR|Medicare|MEDICARE A & B|31.10||||31.10||| J0290|EAP|0636|AMPICILLIN SODIUM 1 G VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|17.75||||||| J0290|EAP|0636|AMPICILLIN INJ 2GM SDV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|56.55||||||| J0295|EAP|0636|AMPICILLIN SODIUM PER 1.5 GM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23.10||| J0295|EAP|0636|AMPICILLIN SODIUM PER 1.5 GM|Blue Cross PPO|BLUE CROSS PPO|18.25||||||| J0295|EAP|0636|AMPICILLIN SODIUM PER 1.5 GM|Medicare|MEDICARE PART A|23.10||||||| J0295|EAP|0636|AMPICILLIN SODIUM PER 1.5 GM|Medicare|MEDICARE A & B|0.27||||||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Workers Compensation|WC OTHER|||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|46.45||||||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Medicare|MEDICARE A & B|46.45||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Blue Cross PPO|BLUE CROSS PPO|||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Blue Cross PPO Select|BCBS UTHCT|||||46.45||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Humana Medicare Advantage|HUMANA MEDICARE PPO|46.45||||||| J0360|EAP|0636|HYDRALAZINE HCL 20MG/ML 1 ML V|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||46.45||| J0401|EAP|0636|ABILIFY MAINTENA ARIPIPR 400MG|Blue Cross PPO|BCBS WALMART|0.00||||||| J0401|EAP|0636|ABILIFY MAINTENA ARIPIPR 400MG|Medicare|MEDICARE A & B|4,094.55||||||| J0401|EAP|0636|ABILIFY MAINTENA ARIPIPR 400MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.00||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Medicare|MEDICARE PART A|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|PHCS|TML GRP INS|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|17.75||||39.05||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||17.75||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|17.75||||17.75||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Multiplan|TML GRP INS|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Medicare|MEDICARE RAILROAD|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|United Healthcare|UMR|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Medicare|MEDICARE A & B|17.75||||17.75||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|NON CONTRACTED|COMMERCIAL OTHER|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|17.75||||17.75||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Blue Cross PPO Select|BCBS UTHCT|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|39.05||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Blue Cross PPO|BLUE CROSS PPO|17.75||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Blue Cross PPO|BCBS WALMART|39.05||||||| J0456|EAP|0636|AZITHROMYCIN INJ 500MG VIAL|Blue Cross PPO|BLUE CROSS POS|17.75||||||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Blue Cross PPO|BLUE CROSS POS|||||39.05||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Blue Cross PPO|BCBS WALMART|||||39.05||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Medicare|MEDICARE A & B|||||39.05||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||39.05||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||39.05||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||42.90||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Managed Medicaid|MOLINA MEDICAID|||||39.05||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||42.90||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||42.90||| J0461|EAP|0636|ATROPINE INJ 1 MG/ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||39.05||| J0490|EAP|0636|INJ, BELIMUMAB 400 MG|Blue Cross PPO Select|BCBS UTHCT|||||3,667.95||| J0490|EAP|0636|BELIMUMAB (BENYLSTA)120 MG|Blue Cross PPO Select|BCBS UTHCT|||||1,121.45||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||298.45||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|Managed Medicaid|SUPERIOR STAR MCD|||||298.45||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||298.45||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|Multiplan|WEB TPA OF GRAND PRAIRIE|||||298.45||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|Medicare|MEDICARE A & B|||||298.20||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|Blue Cross PPO|BLUE CROSS PPO|298.20||||298.45||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|Blue Cross PPO Select|BCBS UTHCT|||||298.20||| J0500|EAP|0636|DICYCLOMINE HCL 10MG/ML 10ML V|PHCS|WEB TPA OF GRAND PRAIRIE|||||298.45||| J0515|EAP|0636|BENZTROPINE MESTLATE1MG/2ML AM|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.13||||||| J0515|EAP|0636|BENZTROPINE MESTLATE1MG/2ML AM|Medicare|MEDICARE PART A|2.13||||||| J0515|EAP|0636|BENZTROPINE MESTLATE1MG/2ML AM|Medicare|MEDICARE A & B|||||2.13||| J0517|EAP|0636|BENRALIZUMAB 30MG INJ|Medicare|MEDICARE A & B|||||0.01||| J0517|EAP|0636|BENRALIZUMAB 30MG INJ|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| J0517|EAP|0636|BENRALIZUMAB 30MG INJ|Blue Cross PPO|BLUE CROSS POS|||||0.00||| J0517|EAP|0636|BENRALIZUMAB 30MG INJ|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||13,416.80||| J0517|EAP|0636|BENRALIZUMAB 30MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||13,416.80||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|ChampVA|CHAMPVA OF CO DENVER|||||696.40||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|Blue Cross PPO|BLUE CROSS POS|||||464.25||| J0561|EAP|0636|BICILLIN LA 2.4MMU SYRINGE|Blue Cross PPO|BLUE CROSS PPO|952.55||||||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|Managed Medicaid|SUPERIOR STAR MCD|||||580.33||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||696.40||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||696.40||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|NON CONTRACTED|COMMERCIAL OTHER 2|||||696.40||| J0561|EAP|0636|PENICILLIN G, BENZ 1.2MU/2MLTB|NON CONTRACTED|COMMERCIAL OTHER|696.40||||||| J0561|EAP|0636|BICILLIN LA 2.4MMU SYRINGE|NON CONTRACTED|COMMERCIAL OTHER|829.05||||||| J0574|EAP|0636|BUPRENORPHIN 8-2MG SL TAB PO|Blue Cross PPO|BLUE CROSS PPO|30.05||||||| J0574|EAP|0636|BUPRENORPHIN 8-2MG SL TAB PO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|30.05||||||| J0574|EAP|0636|BUPRENORPHIN 8-2MG SL TAB PO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|30.05||||||| J0585|EAP|0636|BOTULINUM TOXIN A IM /J0585|Blue Cross PPO Select|BCBS UTHCT|||||0.10||| J0585|EAP|0636|BOTULINUM TOXIN A IM /J0585|Blue Cross PPO|BLUE CROSS PPO|||||0.10||| J0585|EAP|0636|BOTULINUM TOXIN A IM /J0585|United Healthcare|UMR|||||0.10||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Medicare|MEDICARE A & B|32.50||||32.50||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|NON CONTRACTED|COMMERCIAL OTHER|||||32.50||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||32.50||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Medicaid|MEDICAID|32.50||||||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|32.50||||32.50||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|32.50||||||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Blue Cross PPO|BLUE CROSS PPO|32.50||||||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Blue Cross PPO|BLUE CROSS POS|32.50||||32.50||| J0610|EAP|0636|CALCIUM GLUCONATE INJ TO 10 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|32.50||||32.50||| J0630|EAP|0636|CALCITONIN-SALMON,SYNTHETIC 20|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7,622.65||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Cigna|CIGNA OF TN CHATTANOOGA|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||26.60||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Blue Cross PPO|BLUE CROSS PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Blue Cross PPO|BLUE CROSS POS|||||29.08||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Blue Cross PPO|BLUE CROSS PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Blue Cross PPO|BLUE CROSS POS|||||29.08||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Blue Cross PPO|BCBS TRANE PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Blue Cross PPO|BLUE CROSS PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Blue Cross PPO|BLUE CROSS POS|||||33.23||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Blue Cross PPO|BCBS TRANE PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Blue Cross PPO|BLUE CROSS PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Blue Cross PPO|BCBS TRANE PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Blue Cross PPO|BCBS TRANE PPO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Medicare|MEDICARE A & B|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Medicare|MEDICARE A & B|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Medicare|MEDICARE A & B|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Medicare|MEDICARE A & B|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Cigna|CIGNA OF TN CHATTANOOGA|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||31.55||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 200MG VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||39.85||| J0640|EAP|0636|LEUCOVORIN 100MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50MG INJ 500MG VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||39.85||| J0640|EAP|0636|LEUCOVORIN 50 MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||35.70||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|United Healthcare|UMR|24.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|PHCS|TML GRP INS|21.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|21.30||||21.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|18.85||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Multiplan|TML GRP INS|21.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Medicare|MEDICARE RAILROAD|24.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Medicare|MEDICARE A & B|21.30||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|NON CONTRACTED|COMMERCIAL OTHER|18.85||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|NON CONTRACTED|COMMERCIAL OTHER 2|18.85||||18.85||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21.30||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Managed Medicaid|SUPERIOR STAR MCD|||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Medicaid|MEDICAID|24.30||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Aetna|AETNA EL PASO CLAIMS OFFICE|18.85||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Veterans Affairs|VETERANS CHOICE - TRI WEST|24.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|21.30||||21.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Blue Cross PPO|BLUE CROSS PPO|21.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Blue Cross PPO|BCBS WALMART|18.85||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Blue Cross PPO|BCBS TRANE PPO|24.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Medicare|MEDICARE PART A|21.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|24.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Blue Cross PPO|BLUE CROSS POS|21.30||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.30||||24.30||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|18.85||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|ChampVA|CHAMPVA OF CO DENVER|18.85||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Cigna|NALC HLTH BENEFIT|24.30||||||| J0692|EAP|0636|CEFEPIME *MAXIPIME* INJ 1G VIA|Blue Cross PPO Select|BCBS UTHCT|24.30||||||| J0694|EAP|0636|MEFOXIN 2GM CEFOXITIN|Managed Medicaid|SUPERIOR STAR MCD|127.80||||||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Cigna|CIGNA OF TN CHATTANOOGA|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Cigna|CIGNA OPEN ACCESS PLUS|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Blue Cross PPO Select|BCBS UTHCT|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Blue Cross PPO Select|BCBS UTHCT|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Humana Medicare Advantage|HUMANA MEDICARE PPO|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|ChampVA|CHAMPVA OF CO DENVER|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||17.75||| J0696|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|12.25||||17.75||| J0696|EAP|0636|ROCEPHIN ING 500 /J0696 500|Blue Cross PPO|BLUE CROSS PPO|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Blue Cross PPO|BLUE CROSS PPO|12.25||||17.75||| J0696|EAP|0636|CEFTRIAXONE 2GM *ROCEPHIN*VIAL|Blue Cross PPO|BLUE CROSS POS|12.25||||||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Blue Cross PPO|BLUE CROSS PPO|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|United Healthcare|UMR|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|United Healthcare|UMR|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|PHCS|WEB TPA|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|United Healthcare|GOLDEN RULE INSURANCE|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|ChampVA|CHAMPVA OF CO DENVER|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Multiplan|WEB TPA|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Aetna|AETNA EL PASO CLAIMS OFFICE|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Medicare|MEDICARE A & B|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Medicare|MEDICARE RAILROAD|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Medicare|MEDICARE PART A|17.75||||||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Medicare|MEDICARE A & B|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Humana Medicare Advantage|HUMANA MEDICARE PPO|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE 2GM *ROCEPHIN*VIAL|Medicare|MEDICARE A & B|12.25||||12.25||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|NON CONTRACTED|COMMERCIAL OTHER|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|NON CONTRACTED|COMMERCIAL OTHER|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|NON CONTRACTED|COMMERCIAL OTHER 2|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Managed Medicaid|MEDICAID CSHCN|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Managed Medicaid|MOLINA MEDICAID|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Managed Medicaid|OTHER MEDICAID|||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Managed Medicaid|SUPERIOR STAR MCD|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE 2GM *ROCEPHIN*VIAL|Managed Medicaid|MOLINA MEDICAID|||||12.25||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||17.75||| J0696|EAP|0636|ROCEPHIN ING 500 /J0696 500|Managed Medicaid|SUPERIOR STAR MCD|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Managed Medicaid|SUPERIOR STAR MCD|||||17.75||| J0696|EAP|0636|CEFTRIAXONE SODIUM 250MG/J0696|Medicaid|MEDICAID|17.75||||17.75||| J0696|EAP|0636|CEFTRIAXONE NA 1G /J0696 1G|Medicaid|MEDICAID|17.75||||17.75||| J0712|EAP|0251|CEFTAROLINE(TEFLARO) 600MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|566.80||||||| J0712|EAP|0251|CEFTAROLINE(TEFLARO) 600MG INJ|Medicare|MEDICARE PART A|566.80||||||| J0713|EAP|0636|CEFTAZIDIME NA INJ 0.5 GM/5 ML|Blue Cross PPO|BLUE CROSS PPO|21.84||||||| J0713|EAP|0636|CEFTAZIDIME NA INJ 0.5 GM/5 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.84||||||| J0713|EAP|0636|CEFTAZIDIME NA INJ 0.5 GM/5 ML|Medicare|MEDICARE A & B|21.84||||19.20||| J0713|EAP|0636|CEFTAZIDIME INJ *FORTAZ* 1GM|Medicare|MEDICARE A & B|19.20||||19.20||| J0713|EAP|0636|CEFTAZIDIME INJ *FORTAZ* 1GM|Medicaid|MEDICAID|0.16||||||| J0713|EAP|0636|CEFTAZIDIME NA INJ 0.5 GM/5 ML|Medicaid|MEDICAID|21.84||||||| J0743|EAP|0636|IMIPENEM/CILASTATIN NA, 250MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23.10||| J0743|EAP|0636|IMIPENEM/CILASTATIN NA, 250MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23.10||| J0744|EAP|0636|CIPROFLOXACIN 400 MG IN D5W 20|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|12.60||||||| J0744|EAP|0636|CIPROFLOXACIN 400 MG IN D5W 20|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|12.60||||||| J0744|EAP|0636|CIPROFLOXACIN 400 MG IN D5W 20|Humana Medicare Advantage|HUMANA MEDICARE PPO|12.60||||||| J0770|EAP|0636|COLISTIMETHATE SODIUM 150MG VI|Medicaid|MEDICAID|99.40||||||| J0770|EAP|0636|COLISTIMETHATE SODIUM 150MG VI|Medicare|MEDICARE PART A|99.40||||||| J0770|EAP|0636|COLISTIMETHATE SODIUM 150MG VI|Medicare|MEDICARE A & B|99.40||||||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Blue Cross PPO|BLUE CROSS PPO|63.90||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Aetna|AETNA EL PASO CLAIMS OFFICE|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Cigna|CIGNA OF TN CHATTANOOGA|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|United Healthcare|GOLDEN RULE INSURANCE|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Blue Cross PPO|BCBS WALMART|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|United Healthcare|UMR|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Medicare|MEDICARE A & B|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|NON CONTRACTED|COMMERCIAL OTHER|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|63.90||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Blue Cross PPO Select|BCBS UTHCT|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Managed Medicaid|SUPERIOR STAR MCD|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||63.90||| J0780|EAP|0636|PROCHLORPERAZINE EDISYLATE 10|Medicaid|MEDICAID|||||63.90||| J0834|EAP|0636|COSYNTROPIN INJ 0.25MG SDV.|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|314.45||||||| J0834|EAP|0636|COSYNTROPIN INJ 0.25MG SDV.|Humana Medicare Advantage|HUMANA MEDICARE PPO|314.45||||314.45||| J0834|EAP|0636|COSYNTROPIN INJ 0.25MG SDV.|Aetna|AETNA EL PASO CLAIMS OFFICE|||||314.45||| J0834|EAP|0636|COSYNTROPIN INJ 0.25MG SDV.|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||314.45||| J0834|EAP|0636|COSYNTROPIN INJ 0.25MG SDV.|Medicare|MEDICARE A & B|314.45||||314.45||| J0834|EAP|0636|COSYNTROPIN INJ 0.25MG SDV.|Blue Cross PPO|BLUE CROSS PPO|||||314.45||| J0878|EAP|0636|DAPTOMYCIN 1MG, IV|Managed Medicaid|SUPERIOR STAR MCD|3.80||||||| J0881|EAP|0636|ARANESP 200MCG SYR DARBEPOETIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3,637.80||| J0881|EAP|0636|DARBEPOIETIN 100MCG SC|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,818.90||| J0881|EAP|0636|DARBEPOIETIN 100MCG SC|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1,818.90||| J0881|EAP|0636|DARBEPOETIN A 40MCG NON ESRD|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||631.70||| J0885|EAP|0636|EPOGEN 20,000 UNITS /J0885 20K|Medicare|MEDICARE A & B|||||1,256.10||| J0885|EAP|0636|EPOETIN 40,000 U /J0885 40K|Medicare|MEDICARE A & B|||||2,512.15||| J0885|EAP|0636|EPOGEN 20,000 UNITS /J0885 20K|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1,256.10||||||| J0894|EAP|0636|DECITABINE INJECTION 1MG IV|Blue Cross PPO|BLUE CROSS PPO|||||74.65||| J0894|EAP|0636|DECITABINE INJECTION 1MG IV|Blue Cross PPO|BLUE CROSS PPO|||||68.92||| J0894|EAP|0636|DECITABINE INJECTION 1MG IV|Medicare|MEDICARE A & B|||||74.65||| J0894|EAP|0636|DECITABINE INJECTION 1MG IV|Medicare|MEDICARE A & B|||||68.92||| J0896|EAP|0636|LUSPATERCEPT-AAMT|Medicare|MEDICARE A & B|||||67.65||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||3,005.20||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Blue Cross PPO|BLUE CROSS PPO|||||6,252.60||| J0897|EAP|0949||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||197.62||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Blue Cross PPO Select|BCBS UTHCT|||||3,005.20||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||3,005.20||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||3,005.20||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3,005.20||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Aetna|AETNA EL PASO CLAIMS OFFICE|||||6,252.60||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||3,005.20||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6,252.60||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Blue Cross PPO|BLUE CROSS POS|||||3,005.20||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Blue Cross PPO|BLUE CROSS POS|||||6,252.60||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||6,252.60||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3,005.20||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||2,864.80||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||6,252.60||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||6,252.60||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6,252.60||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Medicare|MEDICARE RAILROAD|||||3,005.20||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|Medicare|MEDICARE A & B|||||3,005.20||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Medicare|MEDICARE RAILROAD|||||6,252.60||| J0897|EAP|0636|DENOSUMAB 120MG/1MG SUB-CUTANE|Medicare|MEDICARE A & B|||||6,252.60||| J0897|EAP|0636||Medicare|MEDICARE A & B|||||3,005.20||| J0897|EAP|0636|PROLIA (DENOSUMAB) 60 MG|NON CONTRACTED|COMMERCIAL OTHER|||||1,502.60||| J1030|EAP|0510||Blue Cross PPO Select|BCBS UTHCT|||||2.50||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|United Healthcare|UMR|||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Multiplan|WEB TPA|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Medicare|MEDICARE RAILROAD|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Medicare|MEDICARE A & B|30.90||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||34.23||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Managed Medicaid|SUPERIOR STAR MCD|||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Medicaid|MEDICAID|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|PHCS|WEB TPA|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|30.90||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|NON CONTRACTED|COMMERCIAL OTHER|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Blue Cross PPO|BLUE CROSS PPO|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Blue Cross PPO|BLUE CROSS POS|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Blue Cross PPO|BCBS WALMART|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Aetna|AETNA EXXON MOBIL|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Aetna|AETNA EL PASO CLAIMS OFFICE|||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||30.90||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||37.55||| J1030|EAP|0636|METHYLPREDNISOLONE ACE. 40MG/M|Blue Cross PPO Select|BCBS UTHCT|||||37.55||| J1030|EAP|0949||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Medicare|MEDICARE A & B|57.98||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Aetna|AETNA EL PASO CLAIMS OFFICE|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Blue Cross PPO Select|BCBS UTHCT|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Cigna|CIGNA OF TN CHATTANOOGA|||||65.15||| J1040|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||6.11||| J1040|EAP|0510||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2.64||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||57.98||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Aetna|TRS COORDINATED CARE|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Cigna|NALC HLTH BENEFIT|50.80||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Blue Cross PPO|BLUE CROSS PPO|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Blue Cross PPO|BLUE CROSS POS|||||57.98||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Blue Cross PPO|BCBS WALMART|||||57.98||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|United Healthcare|UMR|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||65.15||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|NON CONTRACTED|BOONE CHAPMAN|||||50.80||| J1040|EAP|0636|METHYLPREDNISOLONE AC 80/J1040|NON CONTRACTED|COMMERCIAL OTHER|||||57.98||| J1050|EAP|0636||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||433.83||| J1050|EAP|0636||Multiplan|WEB TPA|||||520.60||| J1050|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||520.60||| J1050|EAP|0940||Medicare|MEDICARE A & B|||||197.62||| J1050|EAP|0940||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||181.41||| J1050|EAP|0636||Managed Medicaid|FAMILY PLANNING GRANT|||||520.60||| J1050|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||520.60||| J1050|EAP|0636||Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||520.60||| J1050|EAP|0636||United Healthcare|UMR|||||520.60||| J1050|EAP|0636||PHCS|WEB TPA|||||520.60||| J1050|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||520.60||| J1050|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|||||520.60||| J1050|EAP|0636||Blue Cross PPO|BCBS WALMART|||||520.60||| J1050|EAP|0636||Medicare|MEDICARE A & B|||||520.60||| J1050|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||520.60||| J1050|EAP|0636||Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||520.60||| J1050|EAP|0636||ChampVA|CHAMPVA OF CO DENVER|||||520.60||| J1050|EAP|0636||Cigna|CIGNA OTHER|||||347.05||| J1050|EAP|0636||Cigna|CIGNA OF TN CHATTANOOGA|||||520.60||| J1050|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||520.60||| J1050|EAP|0940||Blue Cross PPO Select|BCBS UTHCT|||||213.82||| J1071|EAP|0636|TESTOSTERONE CYP 200 MG /J1080|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||75.50||| J1071|EAP|0636|TESTOSTERONE CYP 200 MG /J1080|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||86.80||| J1071|EAP|0636|TESTOSTERONE CYP 200 MG /J1080|Medicare|MEDICARE A & B|||||86.80||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|United Healthcare|UMR|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|NON CONTRACTED|COMMERCIAL OTHER|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Blue Cross PPO|BCBS WALMART|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||157.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|ChampVA|CHAMPVA OF CO DENVER|||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|ChampVA|CHAMPVA OF CO DENVER|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|ChampVA|CHAMPVA OF CO DENVER|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Cigna|CIGNA OPEN ACCESS PLUS|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Cigna|CIGNA OF TN CHATTANOOGA|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Cigna|CIGNA OF TN CHATTANOOGA|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||157.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|20.55||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|20.55||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Aetna|AETNA EXXON MOBIL|||||10.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Aetna|AETNA EL PASO CLAIMS OFFICE|20.55||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Blue Cross PPO|BCBS WALMART|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Blue Cross PPO|BLUE CROSS POS|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Blue Cross PPO|BCBS TRANE PPO|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Blue Cross PPO|BLUE CROSS POS|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Blue Cross PPO|BLUE CROSS PPO|20.55||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Blue Cross PPO|BLUE CROSS POS|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Blue Cross PPO|BLUE CROSS PPO|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Managed Medicaid|OTHER MEDICAID|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Managed Medicaid|FAMILY PLANNING GRANT|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Medicaid|MEDICAID|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Medicaid|MEDICAID|||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Medicaid|MEDICAID|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Multiplan|TML GRP INS|11.50||||||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Medicare|MEDICARE A & B|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Medicare|MEDICARE A & B|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Medicare|MEDICARE RAILROAD|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Medicare|MEDICARE PART A|11.50||||||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Medicare|MEDICARE A & B|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE 10MG 1ML SYRINGE|Medicare|MEDICARE A & B|20.55||||20.55||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|NON CONTRACTED|COMMERCIAL OTHER|||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|NON CONTRACTED|COMMERCIAL OTHER 2|11.50||||||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|NON CONTRACTED|COMMERCIAL OTHER|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 10MG 1ML SYRINGE|NON CONTRACTED|COMMERCIAL OTHER 2|20.55||||||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|20.55||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|United Healthcare|GOLDEN RULE INSURANCE|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|United Healthcare|UMR|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 10MG INJ|United Healthcare|UMR|11.50||||157.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|PHCS|TML GRP INS|11.50||||||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J1100|EAP|0636|DEXAMETHASONE NA PHOS 1MG INJ|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||15.76||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J1100|EAP|0636|DEXAMETHASONE 4 MG /J1100 4 MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|20.55||||11.50||| J1120|EAP|0636|ACETAZOLAMIDE NA INJ 500MG SDV|Medicare|MEDICARE A & B|111.85||||||| J1120|EAP|0636|ACETAZOLAMIDE NA INJ 500MG SDV|Humana Medicare Advantage|HUMANA MEDICARE PPO|111.85||||||| J1160|EAP|0636|DIGOXIN INJ 0.5MG/2ML AMP|Medicare|MEDICARE A & B|19.55||||||| J1160|EAP|0636|DIGOXIN INJ 0.5MG/2ML AMP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|19.55||||||| J1160|EAP|0636|DIGOXIN INJ 0.5MG/2ML AMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|19.55||||||| J1160|EAP|0636|DIGOXIN INJ 0.5MG/2ML AMP|Medicare|MEDICARE PART A|19.55||||||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|17.80||||11.75||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Aetna|AETNA EL PASO CLAIMS OFFICE|||||17.30||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Blue Cross PPO Select|BCBS UTHCT|||||19.25||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Medicare|MEDICARE A & B|14.10||||15.18||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|PHCS|WEB TPA|||||17.30||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||14.10||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.25||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.75||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||17.75||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||17.80||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||17.30||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Multiplan|WEB TPA|||||17.30||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Medicare|MEDICARE A & B|17.30||||11.75||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Medicare|MEDICARE A & B|17.80||||17.80||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|NON CONTRACTED|COMMERCIAL OTHER|||||19.25||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Cigna|CIGNA OPEN ACCESS PLUS|||||19.25||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Cigna|CIGNA OF TN CHATTANOOGA|||||14.10||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Cigna|CIGNA OF TN CHATTANOOGA|||||17.80||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Blue Cross PPO Select|BCBS UTHCT|||||17.30||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.10||||11.75||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.10||||17.80||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.10||||14.10||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Blue Cross PPO|BLUE CROSS PPO|16.68||||17.30||| J1170|EAP|0636|HYDROMORPHONE HCL 2MG/ML 1ML A|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.75||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Blue Cross PPO|BLUE CROSS PPO|16.68||||17.80||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||17.80||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Blue Cross PPO|BLUE CROSS PPO|16.68||||14.10||| J1170|EAP|0636|HYDROMORPHONE 0.5MG SYR IV/IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|17.80||||19.25||| J1170|EAP|0636|HYDROMORPHONE 1MG SYR IV/IM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|17.80||||17.80||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Medicaid|MEDICAID|0.11||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Blue Cross PPO|BCBS WALMART|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Blue Cross PPO|BLUE CROSS POS|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Cigna|NALC HLTH BENEFIT|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|NON CONTRACTED|MRAMVA|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Medicare|MEDICARE PART A|11.50||||||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Medicare|MEDICARE A & B|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|United Healthcare|UMR|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|United Healthcare|GOLDEN RULE INSURANCE|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J1200|EAP|0636|DIPHENHYDRAMINE HCL 50MG/ML VI|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.11||| J1205|EAP|0636|CHLOROTHIAZIDE INJ 0.5GM *DIUR|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.72||||||| J1250|EAP|0636|DOBUTAMINE HYDROCHL 250MG BAG|Medicare|MEDICARE A & B|68.35||||68.35||| J1265|EAP|0636|DOPAMINE HCL/DEXTROSE 5% WATER|Blue Cross PPO|BLUE CROSS PPO|0.46||||||| J1335|EAP|0636|ERTAPENEM 1 GRAM IV/IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||345.40||| J1335|EAP|0636|ERTAPENEM 1 GRAM IV/IM|Medicare|MEDICARE A & B|345.40||||||| J1335|EAP|0636|ERTAPENEM 1 GRAM IV/IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||345.40||| J1335|EAP|0636|ERTAPENEM 1 GRAM IV/IM|Blue Cross PPO|BLUE CROSS PPO|||||345.40||| J1410|EAP|0636|ESTROGEN, CONJUGATED IV 25MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||812.65||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Blue Cross PPO Select|BCBS UTHCT|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Medicare|MEDICARE A & B|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Medicaid|MEDICAID|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|United Healthcare|UMR|||||2.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Blue Cross PPO|BLUE CROSS PPO|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||4.60||| J1439|EAP|0636|INJECTAFER CARBOXYMALTOSE 1MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2.60||| J1442|EAP|0636|FILGRASTIM 300 MCG/ML VIAL|Blue Cross PPO|BLUE CROSS PPO|739.90||||||| J1450|EAP|0636|FLUCONAZOLE/SODIUM CHLORIDE 20|Medicare|MEDICARE A & B|21.30||||||| J1450|EAP|0636|FLUCONAZOLE/SODIUM CHLORIDE 20|Blue Cross PPO|BLUE CROSS PPO|21.30||||||| J1450|EAP|0636|FLUCONAZOLE/SODIUM CHLORIDE 20|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.30||||||| J1450|EAP|0636|FLUCONAZOLE 400MG/200ML PREMIX|Medicare|MEDICARE A & B|24.85||||||| J1451|EAP|0636|FOMEPIZOLE 15GM/1.5MG VIAL|NON CONTRACTED|COMMERCIAL OTHER|||||2,895.60||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Blue Cross PPO|BLUE CROSS POS|||||4.45||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|ChampVA|CHAMPVA OF CO DENVER|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Medicaid|MEDICAID|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|NON CONTRACTED|COMMERCIAL OTHER|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Medicare|MEDICARE A & B|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Blue Cross PPO|BLUE CROSS PPO|||||6.70||| J1453|EAP|0636|FOSAPREPITANT 1MG VIAL IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.70||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM 10%|Medicare|MEDICARE A & B|100.65||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM 10%|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM(40gm vl)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||100.65||| J1459|EAP|0260||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||5.69||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM 10%|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM(40gm vl)|Blue Cross PPO|BLUE CROSS PPO|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 10% 5GM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM(40gm vl)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM 10%|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM(40gm vl)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 10% 5GM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 10% 5GM|Blue Cross PPO Select|BCBS UTHCT|||||100.65||| J1459|EAP|0260||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||1.03||| J1459|EAP|0636|IMMUNE GLOBULIN 10% 5GM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 10% 5GM|Medicare|MEDICARE A & B|100.65||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM(40gm vl)|Medicare|MEDICARE A & B|100.65||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM 10%|Blue Cross PPO Select|BCBS UTHCT|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 10% 5GM|Blue Cross PPO|BLUE CROSS PPO|||||100.65||| J1459|EAP|0636|IMMUNE GLOBULIN 0.5GM 10%|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| J1569|EAP|0636|INJ, IMMUNE GLOBULIN 10% 0.5GM|Medicare|MEDICARE A & B|||||135.20||| J1569|EAP|0636|IMMUNE GLOBULIN 0.5GM/5GM VIAL|Medicare|MEDICARE A & B|||||127.40||| J1569|EAP|0636|INJECTION, IMMUNE GLOBULIN 10%|Medicare|MEDICARE A & B|||||127.40||| J1580|EAP|0636|GENTAMICIN SULFATE 40MG/ML 2ML|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.50||| J1580|EAP|0636|GENTAMICIN SULFATE 40MG/ML 2ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| J1580|EAP|0636|GENTAMICIN SULFATE 40MG/ML 2ML|Medicare|MEDICARE A & B|||||11.50||| J1580|EAP|0636|GENTAMICIN SULFATE 40MG/ML 2ML|Cigna|CIGNA OF TN CHATTANOOGA|||||11.50||| J1610|EAP|0636|GLUCAGON INJ 1MG SDV|Medicare|MEDICARE A & B|659.90||||659.90||| J1610|EAP|0636|GLUCAGON INJ 1MG SDV|Aetna|TRS COORDINATED CARE|||||659.90||| J1610|EAP|0636|GLUCAGON INJ 1MG SDV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||659.90||| J1610|EAP|0636|GLUCAGON INJ 1MG SDV|Cigna|CIGNA OF TN CHATTANOOGA|||||659.90||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Blue Cross PPO|BLUE CROSS POS|||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Medicare|MEDICARE RAILROAD|||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Medicare|MEDICARE A & B|11.50||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Medicare|MEDICARE PART A|11.50||||||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Medicaid|MEDICAID|11.50||||||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|United Healthcare|UMR|||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J1630|EAP|0636|HALOPERIDOL INJ 5MG/ML SDV|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||||| J1631|EAP|0636|HALOPERIDOL 100MG INJ IM|Medicare|MEDICARE A & B|217.45||||||| J1642|EAP|0250||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15.40||| J1642|EAP|0636|HEPARIN FLUSH SYRINGE 100UNITS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|15.40||||15.40||| J1642|EAP|0250||Blue Cross PPO|BCBS WALMART|||||15.40||| J1642|EAP|0250||Blue Cross PPO|BLUE CROSS PPO|||||15.40||| J1642|EAP|0636||Blue Cross PPO|BLUE CROSS POS|||||15.40||| J1642|EAP|0250||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||15.40||| J1642|EAP|0636||Humana Medicare Advantage|HUMANA MEDICARE PPO|13.20||||15.40||| J1642|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||13.20||| J1642|EAP|0636||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||15.40||| J1642|EAP|0636||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||15.40||| J1642|EAP|0636||Managed Medicaid|MEDICAID CSHCN|||||15.40||| J1642|EAP|0250||NON CONTRACTED|COMMERCIAL OTHER|||||15.40||| J1642|EAP|0636||Medicare|MEDICARE A & B|13.20||||15.40||| J1642|EAP|0636||NON CONTRACTED|COMMERCIAL OTHER|||||15.40||| J1642|EAP|0636|HEPARIN FLUSH SYRINGE 100UNITS|Medicare|MEDICARE A & B|13.20||||13.20||| J1642|EAP|0250||Medicare|MEDICARE PART A|15.40||||||| J1642|EAP|0250||Medicare|MEDICARE A & B|||||15.40||| J1642|EAP|0636||Medicaid|MEDICAID|15.40||||||| J1642|EAP|0636||Medicare|MEDICARE RAILROAD|||||15.40||| J1642|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|13.20||||15.40||| J1642|EAP|0636||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||13.20||| J1642|EAP|0636||Veterans Affairs|VA BONHAM N TX SAM RAYBURN|13.20||||||| J1642|EAP|0250||United Healthcare|UMR|||||15.40||| J1642|EAP|0250||Veterans Affairs|VETERANS CHOICE - TRI WEST|||||15.40||| J1642|EAP|0636||United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||13.20||| J1642|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||15.40||| J1642|EAP|0636||United Healthcare|UMR|||||13.20||| J1642|EAP|0636||Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||14.30||| J1642|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||15.40||| J1642|EAP|0636||Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||13.20||| J1642|EAP|0636||Blue Cross PPO|BLUE CROSS PPO|15.40||||15.40||| J1642|EAP|0250||Aetna|AETNA EL PASO CLAIMS OFFICE|||||15.40||| J1642|EAP|0250||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||15.40||| J1642|EAP|0636||Blue Cross PPO|BCBS WALMART|||||14.30||| J1642|EAP|0250||Blue Cross PPO|BLUE CROSS POS|||||15.40||| J1642|EAP|0636||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|15.40||||13.20||| J1642|EAP|0250||Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||15.40||| J1642|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|13.20||||15.40||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Medicare|MEDICARE RAILROAD|||||47.45||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.50||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||47.45||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Humana Medicare Advantage|HUMANA MEDICARE PPO|52.40||||||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Blue Cross PPO|BLUE CROSS POS|||||47.45||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Blue Cross PPO|BLUE CROSS POS|||||11.50||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Blue Cross PPO|BLUE CROSS PPO|||||10.50||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Blue Cross PPO|BLUE CROSS PPO|||||47.45||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Aetna|AETNA EL PASO CLAIMS OFFICE|52.40||||||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||11.50||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||11.50||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||67.45||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.50||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||10.50||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||47.45||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||47.45||| J1644|EAP|0636|HEPARIN 5000 UNITS/ML 1 ML VIA|Medicare|MEDICARE A & B|||||11.50||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Medicare|MEDICARE A & B|||||47.45||| J1644|EAP|0636|HEPARIN PREMIX 25000U/D5W 500M|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||47.45||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|79.90||||21.30||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|21.20||||42.60||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Blue Cross PPO|BLUE CROSS PPO|46.88||||46.88||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross PPO|BLUE CROSS POS|28.20||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross PPO|BLUE CROSS PPO|105.85||||21.30||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross PPO Select|BCBS UTHCT|24.75||||||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.60||||28.20||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|42.60||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|21.20||||28.20||| J1650|EAP|0636|ENOXAPARIN 150MG SYRINGE SC|Humana Medicare Advantage|HUMANA MEDICARE PPO|79.90||||79.90||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|21.30||||21.30||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|21.30||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Veterans Affairs|VETERANS CHOICE - TRI WEST|28.20||||42.60||| J1650|EAP|0636|ENOXAPARIN 150MG SYRINGE SC|Veterans Affairs|VETERANS CHOICE - TRI WEST|79.90||||42.60||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|70.60||||70.60||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Multiplan|TML GRP INS|70.60||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Medicare|MEDICARE A & B|28.20||||21.30||| J1650|EAP|0636|ENOXAPARIN 150MG SYRINGE SC|Medicare|MEDICARE A & B|79.90||||105.85||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Medicare|MEDICARE RAILROAD|28.20||||70.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|NON CONTRACTED|COMMERCIAL OTHER|21.30||||21.30||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|NON CONTRACTED|COMMERCIAL OTHER 2|21.30||||||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Medicare|MEDICARE A & B|70.60||||70.60||| J1650|EAP|0636|ENOXAPARIN 30MG/0.3ML DISP|Medicare|MEDICARE PART A|21.20||||||| J1650|EAP|0636|ENOXAPARIN 30MG/0.3ML DISP|Medicare|MEDICARE A & B|21.20||||21.20||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Medicare|MEDICARE PART A|21.30||||||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Medicare|MEDICARE A & B|51.15||||42.60||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Managed Medicaid|SUPERIOR STAR MCD|42.60||||||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Medicare|MEDICARE PART A|51.15||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Managed Medicaid|SUPERIOR STAR MCD|28.20||||||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|51.15||||28.20||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21.20||||28.20||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Medicaid|MEDICAID|28.20||||28.20||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Veterans Affairs|VETERANS CHOICE - TRI WEST|70.60||||42.60||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|70.60||||||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|70.60||||70.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|21.20||||21.30||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||28.20||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|PHCS|TML GRP INS|70.60||||||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Humana Medicare Advantage|HUMANA MEDICARE PPO|70.60||||70.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|21.30||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|United Healthcare|UMR|21.30||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.20||||28.20||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.30||||28.20||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Cigna|NALC HLTH BENEFIT|21.30||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Cigna|CIGNA OF TN CHATTANOOGA|28.20||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|ChampVA|CHAMPVA OF CO DENVER|21.30||||||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Blue Cross PPO|BLUE CROSS PPO|70.60||||70.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross PPO|BCBS TRANE PPO|28.20||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross PPO|BCBS WALMART|21.30||||||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross PPO|BLUE CROSS PPO|21.30||||46.88||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Blue Cross PPO|BLUE CROSS PPO|21.20||||46.88||| J1650|EAP|0636|ENOXAPARIN 100 MG SYRINGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|70.60||||70.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|24.75||||28.20||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|21.30||||42.60||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Blue Cross PPO|BCBS WALMART|51.15||||||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|51.15||||42.60||| J1650|EAP|0636|ENOXAPARIN 80 MG SYRINGE|Aetna|AETNA EL PASO CLAIMS OFFICE|0.16||||42.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Aetna|AETNA EL PASO CLAIMS OFFICE|21.30||||42.60||| J1650|EAP|0636|ENOXAPARIN 40MGG/0.4ML DISP SY|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|21.30||||42.60||| J1720|EAP|0636|HYDROCORTISONE SODIUM PHOSPHAT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||47.70||| J1720|EAP|0636|HYDROCORTISONE SODIUM PHOSPHAT|Medicaid|MEDICAID|||||47.70||| J1720|EAP|0636|HYDROCORTISONE SODIUM PHOSPHAT|Medicare|MEDICARE A & B|||||52.15||| J1745|EAP|0636|INFLIXIMAB *REMICADE* 10 MG (1|United Healthcare|UMR|||||0.00||| J1745|EAP|0636|INFLIXIMAB *REMICADE* 10 MG (1|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.01||| J1745|EAP|0636|INFLIXIMAB *REMICADE* 10 MG (1|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| J1756|EAP|0636|IRON SUCROSE COMP 1MG, IV|PHCS|TML GRP INS|||||2.08||| J1756|EAP|0636|IRON SUCROSE COMP 1MG, IV|Blue Cross PPO Select|BCBS UTHCT|||||2.08||| J1756|EAP|0636|IRON SUCROSE COMP 1MG, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.08||||2.08||| J1756|EAP|0636|IRON SUCROSE COMP 1MG, IV|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||2.08||| J1756|EAP|0636|IRON SUCROSE COMP 1MG, IV|Multiplan|TML GRP INS|||||2.08||| J1756|EAP|0636|IRON SUCROSE COMP 1MG, IV|Medicare|MEDICARE A & B|||||2.08||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Aetna|AETNA EL PASO CLAIMS OFFICE|100.70||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|100.70||||100.70||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Aetna|AETNA EL PASO CLAIMS OFFICE|52.80||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|52.80||||52.80||| J1815|EAP|0257|NPH/REG HUMAN INSULIN 70/30 UN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|52.80||||11.50||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Managed Medicaid|MOLINA MEDICAID|11.50||||||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Cigna|NALC HLTH BENEFIT|52.80||||||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Humana Medicare Advantage|HUMANA MEDICARE PPO|100.70||||100.70||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|PHCS|TML GRP INS|11.50||||||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||52.80||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|52.80||||52.80||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|PHCS|TML GRP INS|100.70||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Veterans Affairs|VETERANS CHOICE - TRI WEST|52.80||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Veterans Affairs|VETERANS CHOICE - TRI WEST|100.70||||11.50||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Medicare|MEDICARE A & B|11.50||||11.50||| J1815|EAP|0257|NPH/REG HUMAN INSULIN 70/30 UN|Medicare|MEDICARE A & B|52.80||||52.80||| J1815|EAP|0257|INSULIN REGULAR HUMAN LOW DOSE|Medicare|MEDICARE A & B|52.80||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Medicaid|MEDICAID|11.50||||11.50||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|NON CONTRACTED|COMMERCIAL OTHER|52.80||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|NON CONTRACTED|COMMERCIAL OTHER|100.70||||11.50||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|NON CONTRACTED|COMMERCIAL OTHER 2|100.70||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Multiplan|TML GRP INS|100.70||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|NON CONTRACTED|COMMERCIAL OTHER 2|11.50||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Multiplan|TML GRP INS|11.50||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Medicaid|MEDICAID|100.70||||11.50||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Medicaid|MEDICAID|52.80||||52.80||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Medicare|MEDICARE PART A|100.70||||||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Medicare|MEDICARE A & B|52.80||||52.80||| J1815|EAP|0257|INSULIN, NPH/LISPRO MIX - 1ML|Medicare|MEDICARE A & B|101.10||||52.80||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Medicare|MEDICARE A & B|100.70||||100.70||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|United Healthcare|UMR|11.50||||||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|United Healthcare|UMR|100.70||||||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|11.50||||100.70||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.50||||11.50||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Medicare|MEDICARE PART A|11.50||||||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||10.50||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|100.70||||100.70||| J1815|EAP|0257|NPH/REG HUMAN INSULIN 70/30 UN|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.50||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Cigna|NALC HLTH BENEFIT|11.50||||||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Cigna|NALC HLTH BENEFIT|100.70||||||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Humana Medicare Advantage|HUMANA MEDICARE PPO|52.80||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Managed Medicaid|SUPERIOR STAR MCD|11.50||||11.50||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|100.70||||100.70||| J1815|EAP|0257|NPH/REG HUMAN INSULIN 70/30 UN|Managed Medicaid|MOLINA MEDICAID|52.80||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Blue Cross PPO|BLUE CROSS PPO|100.70||||100.70||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|Blue Cross PPO|BCBS WALMART|100.70||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Managed Medicaid|SUPERIOR STAR MCD|100.70||||11.50||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Blue Cross PPO|BCBS WALMART|11.50||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Blue Cross PPO|BLUE CROSS POS|11.50||||||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Blue Cross PPO|BCBS TRANE PPO|11.50||||||| J1815|EAP|0257|GLARGINE INSULIN 100UNIT/ML DO|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||100.70||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Blue Cross PPO|BLUE CROSS PPO|52.80||||52.80||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Blue Cross PPO|BLUE CROSS POS|||||52.80||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Blue Cross PPO|BCBS WALMART|||||52.80||| J1815|EAP|0250|INSULIN, HUMAN REG 1 DOSE 100|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|52.80||||52.80||| J1815|EAP|0257|INSULIN ASPART, 5 UNITS, SQ|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Multiplan|WEB TPA OF GRAND PRAIRIE|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Multiplan|WEB TPA|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Multiplan|TML GRP INS|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Multiplan|WEB TPA|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Medicare|MEDICARE A & B|27.30||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Medicare|MEDICARE PART A|13.35||||||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Medicare|MEDICARE A & B|27.30||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|NON CONTRACTED|MRAMVA|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|NON CONTRACTED|MRAMVA|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Medicaid|MEDICAID|11.50||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Managed Medicaid|FAMILY PLANNING GRANT|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|13.35||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|13.35||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Managed Medicaid|MOLINA MEDICAID|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Managed Medicaid|MEDICAID CSHCN|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|27.30||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|10.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|27.30||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Workers Compensation|WC TRAVELERS|||||10.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Workers Compensation|WC OTHER|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Workers Compensation|DO NOT USE----ENABLE COMP|||||10.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|United Healthcare|GOLDEN RULE INSURANCE|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|27.30||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|United Healthcare|GOLDEN RULE INSURANCE|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|United Healthcare|UMR|13.35||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|United Healthcare|UMR|13.35||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|PHCS|WEB TPA|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|PHCS|WEB TPA OF GRAND PRAIRIE|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|PHCS|TML GRP INS|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|PHCS|WEB TPA|||||13.35||| J1885|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|10.50||||11.50||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|NON CONTRACTED|MRAMVA|||||11.90||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|United Healthcare|GOLDEN RULE INSURANCE|||||12.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Workers Compensation|DO NOT USE----ENABLE COMP|||||10.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Medicaid|MEDICAID|27.30||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Workers Compensation|WC OTHER|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|ChampVA|CHAMPVA OF CO DENVER|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|ChampVA|CHAMPVA OF CO DENVER|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|13.35||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Cigna|CIGNA OPEN ACCESS PLUS|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|13.35||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|10.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|||||13.35||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Cigna|CIGNA OPEN ACCESS PLUS|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Cigna|NALC HLTH BENEFIT|||||13.35||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Cigna|CIGNA OTHER|||||10.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Cigna|CIGNA OPEN ACCESS PLUS|||||18.90||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross PPO Select|BCBS UTHCT|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|13.35||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|10.50||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|13.35||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|13.35||||0.11||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|13.35||||13.35||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||11.50||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|13.35||||11.50||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|13.35||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross PPO|BLUE CROSS PPO|27.30||||27.30||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross PPO|BLUE CROSS POS|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|27.30||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Aetna|TRS COORDINATED CARE|||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Medicare|MEDICARE A & B|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|27.30||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Aetna|AETNA EL PASO CLAIMS OFFICE|27.30||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|27.30||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross PPO|BLUE CROSS PPO|27.30||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross PPO|BLUE CROSS POS|||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Aetna|AETNA|||||27.30||| J1885|EAP|0636|KETOROLAC 60MG/2ML /J1885 60MG|Blue Cross PPO|BCBS WALMART|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross PPO|BCBS TRANE PPO|||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross PPO|BCBS WALMART|11.50||||11.50||| J1885|EAP|0636|KETOROLAC INJ 15MG/ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|27.30||||11.50||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross PPO|BCBS TRANE PPO|||||27.30||| J1885|EAP|0636|KETOROLAC INJ 30MG/ML VIAL|Blue Cross PPO|BCBS WALMART|11.50||||27.30||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Blue Cross PPO|BLUE CROSS PPO|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Medicare|MEDICARE RAILROAD|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||23,641.20||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|United Healthcare|UMR|||||21,510.90||| J1930|EAP|0636|LANREOTIDE INJ 120MG (SOM DEP)|Medicare|MEDICARE A & B|||||23,641.20||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Medicaid|MEDICAID|11.50||||14.65||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Medicaid|MEDICAID|11.50||||0.11||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|11.50||||||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Medicare|MEDICARE A & B|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Medicare|MEDICARE PART A|15.10||||||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Medicare|MEDICARE A & B|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|11.50||||13.30||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|14.65||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE INJ 10MG/ML 10 ML V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.55||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|ChampVA|CHAMPVA OF CO DENVER|||||11.50||| J1940|EAP|0636||Medicare|MEDICARE A & B|15.10||||11.50||| J1940|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|||||15.10||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Medicare|MEDICARE PART A|11.50||||||| J1940|EAP|0636|FUROSEMIDE INJ 10MG/ML 10 ML V|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.55||||11.55||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.50||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|United Healthcare|UMR|15.10||||||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||14.65||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.50||||15.10||| J1940|EAP|0636|FUROSEMIDE INJ 10MG/ML 10 ML V|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.55||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|15.10||||11.50||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross PPO|BLUE CROSS POS|||||15.10||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross PPO|BCBS WALMART|15.10||||||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross PPO|BCBS TRANE PPO|||||15.10||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||10.50||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Blue Cross PPO|BLUE CROSS PPO|11.50||||15.10||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross PPO|BLUE CROSS PPO|15.10||||15.10||| J1940|EAP|0636|FUROSEMIDE 20MG VIAL IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||14.65||| J1940|EAP|0636|FUROSEMIDE INJ 10MG/ML 10 ML V|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.55||||11.55||| J1940|EAP|0636|FUROSEMIDE 10MG/ML 4 ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|15.10||||11.50||| J1944|EAP|0636|ARISTADA 882MG/3.2ML SYRINGE|Blue Cross PPO|BLUE CROSS PPO|0.00||||||| J1944|EAP|0636|ARISTADA 675MG/2.4ML SYRINGE|Blue Cross PPO|BLUE CROSS PPO|0.00||||||| J1950|EAP|0636|LEUPROLIDE ACETATE 11.25MG|United Healthcare|UMR|||||10,533.15||| J1950|EAP|0636|LEUPROLIDE ACETATE 11.25MG|Blue Cross PPO Select|BCBS UTHCT|||||10,533.15||| J1950|EAP|0636|LEUPROLIDE ACETATE 11.25MG|Blue Cross PPO|BLUE CROSS PPO|||||10,533.15||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Blue Cross PPO|BLUE CROSS PPO|||||53.50||| J1956|EAP|0636|LEVOFLOXACIN PREMIX PB 750MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|39.05||||39.05||| J1956|EAP|0636|LEVOFLOXACIN PREMIX PB 750MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|39.05||||39.05||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|39.05||||44.60||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Humana Medicare Advantage|HUMANA MEDICARE PPO|39.05||||53.50||| J1956|EAP|0636|LEVOFLOXACIN PREMIX PB 750MG|Medicare|MEDICARE A & B|39.05||||39.05||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Medicare|MEDICARE A & B|39.05||||53.50||| J1956|EAP|0636|LEVAQUIN 250MG/50ML D5W|Managed Medicaid|OTHER MEDICAID|||||24.85||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Managed Medicaid|OTHER MEDICAID|||||53.50||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||53.50||| J1956|EAP|0636|LEVAQUIN 500MG/100ML D5W|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|39.05||||44.60||| J1956|EAP|0636|LEVOFLOXACIN PREMIX PB 750MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|53.50||||39.05||| J2020|EAP|0636|LINEZOLID 600MG/300ML PREMIX|Medicaid|MEDICAID|277.40||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML PREMIX|Medicare|MEDICARE PART A|177.50||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML PREMIX|Humana Medicare Advantage|HUMANA MEDICARE PPO|277.40||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML PREMIX|Medicare|MEDICARE A & B|177.50||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML PREMIX|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|177.50||||||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Blue Cross PPO|BLUE CROSS POS|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Blue Cross PPO|BCBS WALMART|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Blue Cross PPO|BCBS TRANE PPO|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.75||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|ChampVA|CHAMPVA OF CO DENVER|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Blue Cross PPO Select|BCBS UTHCT|11.75||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.75||||||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|United Healthcare|UMR|||||9.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|11.75||||||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|United Healthcare|GOLDEN RULE INSURANCE|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|NON CONTRACTED|MRAMVA|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Medicare|MEDICARE RAILROAD|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Blue Cross PPO|BLUE CROSS PPO|11.75||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Medicare|MEDICARE PART A|11.75||||||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Medicare|MEDICARE A & B|11.75||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|11.75||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Medicaid|MEDICAID|11.75||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.75||| J2060|EAP|0636|LORAZEPAM 2MG/ML 1ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.75||||11.75||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Medicaid|MEDICAID|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Medicare|MEDICARE A & B|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|NON CONTRACTED|COMMERCIAL OTHER|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.99||| J2150|EAP|0636|MANNITOL 25% INJ 12.5GM/50ML|Blue Cross PPO|BLUE CROSS PPO|||||10.99||| J2175|EAP|0636|MEPERIDINE HCL INJ 50MG/ML TBX|Blue Cross PPO|BLUE CROSS PPO|12.75||||13.90||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Blue Cross PPO|BLUE CROSS PPO|12.75||||25.65||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Blue Cross PPO|BCBS WALMART|25.65||||||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||25.65||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Aetna|AETNA EL PASO CLAIMS OFFICE|||||25.65||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||12.75||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Cigna|CIGNA OF TN CHATTANOOGA|||||25.65||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Blue Cross PPO Select|BCBS UTHCT|||||12.75||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||25.65||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||25.65||| J2175|EAP|0636|MEPERIDINE HCL INJ 50MG/ML TBX|NON CONTRACTED|COMMERCIAL OTHER|||||13.05||| J2175|EAP|0636|MEPERIDINE HCL INJ 50MG/ML TBX|Medicare|MEDICARE A & B|13.55||||19.70||| J2175|EAP|0636|MEPERIDINE 25MG/ML 25ML. IV|Medicare|MEDICARE A & B|13.55||||19.20||| J2175|EAP|0636|MEPERIDINE HCL INJ 50MG/ML TBX|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||26.35||| J2182|EAP|0260||Medicare|MEDICARE A & B|||||181.41||| J2182|EAP|0636|MEOPOLIZUMAB(NUCALA 100MG) VL|Medicare|MEDICARE A & B|||||8,157.30||| J2182|EAP|0636||Medicare|MEDICARE A & B|||||8,157.30||| J2182|EAP|0636|MEOPOLIZUMAB(NUCALA 100MG) VL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||0.00||| J2182|EAP|0636|MEOPOLIZUMAB(NUCALA 100MG) VL|Blue Cross PPO|BLUE CROSS PPO|||||8,157.30||| J2185|EAP|0636|MEROPENEM,500MG|Medicare|MEDICARE A & B|120.70||||25.60||| J2185|EAP|0636|MEROPENEM,500MG|Medicare|MEDICARE A & B|25.60||||25.60||| J2185|EAP|0636|MEROPENEM 1G VIAL|Medicare|MEDICARE PART A|120.70||||||| J2185|EAP|0636||Medicare|MEDICARE A & B|25.60||||25.60||| J2185|EAP|0636|MEROPENEM,500MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||25.60||| J2185|EAP|0636||Aetna|AETNA EL PASO CLAIMS OFFICE|25.60||||||| J2185|EAP|0636|MEROPENEM,500MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|25.60||||||| J2185|EAP|0636|MEROPENEM,500MG|Blue Cross PPO|BLUE CROSS PPO|120.70||||92.30||| J2185|EAP|0636|MEROPENEM 1G VIAL|Blue Cross PPO|BLUE CROSS PPO|25.60||||120.70||| J2185|EAP|0636|MEROPENEM,500MG|Cigna|CIGNA OF TN CHATTANOOGA|||||25.60||| J2185|EAP|0636|MEROPENEM,500MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|25.60||||92.30||| J2185|EAP|0636|MEROPENEM,500MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|120.70||||25.60||| J2185|EAP|0636|MEROPENEM 1G VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|120.70||||92.30||| J2185|EAP|0636|MEROPENEM,500MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|25.60||||||| J2185|EAP|0636|MEROPENEM 1G VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|120.70||||||| J2185|EAP|0636|MEROPENEM,500MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|25.60||||||| J2185|EAP|0636||Veterans Affairs|VETERANS CHOICE - TRI WEST|25.60||||||| J2248|EAP|0636|MICAFUNGIN 100MG VIAL IV|Medicare|MEDICARE A & B|3.75||||||| J2248|EAP|0636|MICAFUNGIN 100MG VIAL IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.75||||||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Blue Cross PPO|BLUE CROSS PPO|11.75||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Blue Cross PPO|BLUE CROSS POS|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Blue Cross PPO Select|BCBS UTHCT|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.75||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Workers Compensation|WC OTHER|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 5ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Medicaid|MEDICAID|||||9.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 5ML VIAL|Managed Medicaid|MOLINA MEDICAID|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Managed Medicaid|MOLINA MEDICAID|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|Medicare|MEDICARE A & B|11.75||||11.75||| J2250|EAP|0636|MIDAZOLAM HCL 1MG/ML 2ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|||||11.75||| J2265|EAP|0636|MINOCYCLINE HCL 100MG VIAL|Medicaid|MEDICAID|570.90||||||| J2265|EAP|0636|MINOCYCLINE HCL 100MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|570.90||||||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Aetna|AETNA EL PASO CLAIMS OFFICE|||||12.60||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|12.60||||13.65||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross PPO|BLUE CROSS PPO|12.60||||13.65||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross PPO|BCBS WALMART|14.70||||12.60||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross PPO|BCBS TRANE PPO|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Blue Cross PPO|BLUE CROSS PPO|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Blue Cross PPO|BLUE CROSS POS|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Blue Cross PPO|BCBS TRANE PPO|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|ChampVA|CHAMPVA OF CO DENVER|||||13.65||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Cigna|CIGNA OF TN CHATTANOOGA|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Cigna|CIGNA OF TN CHATTANOOGA|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Blue Cross PPO Select|BCBS UTHCT|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.70||||12.60||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|14.70||||13.65||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|United Healthcare|UMR|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|United Healthcare|UMR|14.70||||12.60||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|United Healthcare|GOLDEN RULE INSURANCE|||||11.85||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|PHCS|WEB TPA|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|PHCS|WEB TPA OF GRAND PRAIRIE|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||11.85||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|12.60||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Workers Compensation|WC TX MUTUAL INS|||||12.60||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross PPO Select|BCBS UTHCT|11.85||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Workers Compensation|WC GALLAGHER BASSETT|||||11.85||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||12.60||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Multiplan|WEB TPA|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Multiplan|WEB TPA OF GRAND PRAIRIE|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|NON CONTRACTED|MRAMVA|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Medicare|MEDICARE PART A|14.70||||12.60||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Medicare|MEDICARE A & B|12.60||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Medicare|MEDICARE PART A|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Medicare|MEDICARE A & B|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Blue Cross PPO|BLUE CROSS POS|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Aetna|AETNA EL PASO CLAIMS OFFICE|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|NON CONTRACTED|COMMERCIAL OTHER|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|NON CONTRACTED|COMMERCIAL OTHER 2|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|NON CONTRACTED|MRAMVA|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|NON CONTRACTED|COMMERCIAL OTHER|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Medicaid|MEDICAID|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Medicaid|MEDICAID|14.70||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|12.60||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Managed Medicaid|FAMILY PLANNING GRANT|||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|14.70||||14.70||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Managed Medicaid|MOLINA MEDICAID|||||14.70||| J2270|EAP|0636|MORPHINE 4 MG SYRINGE, IV|Managed Medicaid|SUPERIOR STAR MCD|14.70||||12.60||| J2270|EAP|0636|MORPHINE 2 MG SYRINGE, IV|Managed Medicaid|SUPERIOR STAR MCD|14.70||||14.70||| J2310|EAP|0636|NALOXONE INJ 0.4MG/ML AMP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|66.50||||66.50||| J2310|EAP|0636|NALOXONE INJ 0.4MG/ML AMP|Medicare|MEDICARE A & B|||||66.50||| J2310|EAP|0636|NALOXONE INJ 0.4MG/ML AMP|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||66.50||| J2310|EAP|0636|NALOXONE INJ 0.4MG/ML AMP|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||66.50||| J2353|EAP|0636|SANDOSTATIN LAR 30MG KIT|Blue Cross PPO|BLUE CROSS PPO|||||15,007.45||| J2353|EAP|0636|SANDOSTATIN LAR 30MG KIT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15,007.45||| J2353|EAP|0636|SANDOSTATIN LAR 30MG KIT|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| J2353|EAP|0636|SANDOSTATIN LAR 30MG KIT|United Healthcare|UMR|||||15,007.45||| J2353|EAP|0636|SANDOSTATIN LAR 20MG KIT|Medicare|MEDICARE A & B|||||10,022.15||| J2354|EAP|0636|OCTREOTIDE ACETAT 0.1MG/ML AMP|Medicare|MEDICARE A & B|||||35.30||| J2354|EAP|0636|OCTREOTIDE 500MCG VIAL IV25MCG|Medicare|MEDICARE A & B|||||176.40||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Cigna|CIGNA OF TN CHATTANOOGA|||||0.00||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.00||| J2357|EAP|0636|OMALIZUMAB 5MG /J2357 X 1|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3,263.80||| J2357|EAP|0636|OMALIZUMAB (XOLAIR) 75MG SYRNG|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| J2357|EAP|0636|OMALIZUMAB (XOLAIR) 75MG SYRNG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||1,631.90||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3,329.05||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Managed Medicaid|MOLINA MEDICAID|||||0.00||| J2357|EAP|0636|OMALIZUMAB (XOLIAR) 150MG SYRN|Medicare|MEDICARE A & B|||||3,296.43||| J2357|EAP|0636|OMALIZUMAB (XOLAIR) 75MG SYRNG|Medicare|MEDICARE A & B|||||1,664.55||| J2357|EAP|0636||Medicare|MEDICARE A & B|||||3,263.80||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Multiplan|WEB TPA|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Multiplan|TML GRP INS|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|NON CONTRACTED|MRAMVA|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|NON CONTRACTED|COMMERCIAL OTHER|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|NON CONTRACTED|PPO OTHER|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Medicaid|MEDICAID|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Managed Medicaid|SUPERIOR STAR MCD|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Workers Compensation|WC OTHER|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|PHCS|WEB TPA|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Medicare|MEDICARE A & B|106.75||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|PHCS|TML GRP INS|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Blue Cross PPO|BLUE CROSS PPO|81.08||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Blue Cross PPO|BLUE CROSS POS|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Aetna|AETNA EL PASO CLAIMS OFFICE|||||81.08||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|106.75||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|ChampVA|CHAMPVA OF CO DENVER|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Cigna|CIGNA OPEN ACCESS PLUS|||||55.40||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Cigna|CIGNA OF TN CHATTANOOGA|||||106.75||| J2360|EAP|0636|ORPHENADRINE CITRATE 30MG/ML 2|Blue Cross PPO Select|BCBS UTHCT|||||106.75||| J2405|EAP|0636|ZOFRAN 1 MG IV|ChampVA|CHAMPVA OF CO DENVER|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|ChampVA|CHAMPVA OF CO DENVER|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Cigna|NALC HLTH BENEFIT|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Cigna|CIGNA OPEN ACCESS PLUS|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Cigna|CIGNA OF TN CHATTANOOGA|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Blue Cross PPO|BLUE CROSS POS|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Blue Cross PPO|BCBS TRANE PPO|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross PPO|BLUE CROSS POS|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross PPO|BCBS WALMART|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross PPO|BCBS TRANE PPO|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Blue Cross PPO|BCBS WALMART|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|United Healthcare|UMR|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|United Healthcare|UMR|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|United Healthcare|GOLDEN RULE INSURANCE|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|PHCS|WEB TPA|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||15.75||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||10.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Blue Cross PPO Select|BCBS UTHCT|10.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Medicaid|MEDICAID|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Medicaid|MEDICAID|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Managed Medicaid|MOLINA MEDICAID|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Managed Medicaid|FAMILY PLANNING GRANT|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Managed Medicaid|MEDICAID CSHCN|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Multiplan|WEB TPA|||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|Medicare|MEDICARE A & B|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Medicare|MEDICARE PART A|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|Medicare|MEDICARE A & B|11.50||||11.50||| J2405|EAP|0636|ZOFRAN 1 MG IV|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 2|||||11.50||| J2426|EAP|0636|PALIPERIDONE SUSTENNA 234MG IM|Medicare|MEDICARE A & B|6,592.60||||||| J2426|EAP|0636|PALIPERIDONE SUSTENNA 234MG IM|Blue Cross PPO|BLUE CROSS PPO|6,592.60||||||| J2426|EAP|0636|PALIPERIDONE SUSTENNA 156MG IM|Blue Cross PPO|BLUE CROSS PPO|4,395.20||||||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|ChampVA|CHAMPVA OF CO DENVER|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Blue Cross PPO|BLUE CROSS PPO|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||718.10||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Blue Cross PPO|BLUE CROSS POS|||||718.10||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|United Healthcare|UMR|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Medicaid|MEDICAID|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|Medicare|MEDICARE A & B|||||7.05||| J2469|EAP|0636|PALONOSETRON 0.25MG/5ML 5ML|NON CONTRACTED|COMMERCIAL OTHER|||||7.05||| J2505|EAP|0636|PEGFILGRASTIM 6MG SYRINGE|Medicare|MEDICARE A & B|16,823.90||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Medicare|MEDICARE A & B|16,823.90||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|NON CONTRACTED|COMMERCIAL OTHER|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Medicaid|MEDICAID|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Managed Medicaid|SUPERIOR STAR MCD|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Blue Cross PPO|BLUE CROSS PPO|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Blue Cross PPO|BLUE CROSS POS|||||12,150.60||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||16,823.90||| J2505|EAP|0636|PEGFILGRAS DEL 6MG(NEULASTA)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||16,823.90||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|ChampVA|CHAMPVA OF CO DENVER|||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Cigna|CIGNA OPEN ACCESS PLUS|||||59.10||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Blue Cross PPO Select|BCBS UTHCT|||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|25.35||||30.43||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|51.50||||59.10||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM NA INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|62.50||||51.50||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Aetna|AETNA EL PASO CLAIMS OFFICE|25.35||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|35.50||||35.50||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Blue Cross PPO|BLUE CROSS PPO|25.35||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Blue Cross PPO|BLUE CROSS POS|59.10||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Blue Cross PPO|BCBS TRANE PPO|25.35||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|Blue Cross PPO|BLUE CROSS PPO|97.85||||80.18||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|Blue Cross PPO|BLUE CROSS POS|97.85||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|Blue Cross PPO|BCBS TRANE PPO|62.50||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|United Healthcare|UMR|25.35||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM NA INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|97.85||||51.50||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|35.50||||30.43||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM NA INJ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|51.50||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|83.05||||97.85||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Workers Compensation|WC GALLAGHER BASSETT|||||59.10||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Humana Medicare Advantage|HUMANA MEDICARE PPO|25.35||||59.10||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|35.50||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|62.50||||97.85||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Veterans Affairs|VETERANS CHOICE - TRI WEST|62.50||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|25.35||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Medicaid|MEDICAID|35.50||||35.50||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Managed Medicaid|MOLINA MEDICAID|||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|51.50||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Managed Medicaid|SUPERIOR STAR MCD|59.10||||||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|97.85||||83.05||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Medicare|MEDICARE PART A|83.05||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Medicare|MEDICARE PART A|25.35||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|Medicare|MEDICARE A & B|25.35||||25.35||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM INJ|Medicare|MEDICARE A & B|83.05||||97.85||| J2543|EAP|0636|PIPERACILLIN/TAZOBACTAM SODIUM|NON CONTRACTED|COMMERCIAL OTHER|25.35||||42.23||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Medicare|MEDICARE RAILROAD|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Medicare|MEDICARE A & B|106.50||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Medicare|MEDICARE A & B|21.30||||21.30||| J2704|EAP|0636|DIPRIVAN (PROPOFOL) 10MG/ML VI|Medicare|MEDICARE A & B|21.30||||106.50||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|NON CONTRACTED|BOONE CHAPMAN|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|||||21.30||| J2704|EAP|0636|DIPRIVAN (PROPOFOL) 10MG/ML VI|NON CONTRACTED|COMMERCIAL OTHER|||||106.50||| J2704|EAP|0636|DIPRIVAN (PROPOFOL) 10MG/ML VI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21.30||||106.50||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Managed Medicaid|MOLINA MEDICAID|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21.30||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Medicaid|MEDICAID|21.30||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||21.30||| J2704|EAP|0636|DIPRIVAN (PROPOFOL) 10MG/ML VI|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||106.50||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|United Healthcare|UMR|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|PHCS|WEB TPA|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO|BLUE CROSS PPO|106.50||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO|BLUE CROSS PPO|21.30||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO|BLUE CROSS POS|21.30||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO|BCBS WALMART|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO|BCBS TRANE PPO|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||21.30||| J2704|EAP|0750||Blue Cross PPO|BLUE CROSS PPO|||||19.98||| J2704|EAP|0370||Blue Cross PPO|BLUE CROSS PPO|||||7.02||| J2704|EAP|0999||Blue Cross PPO|BLUE CROSS PPO|||||0.00||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Aetna|AETNA EXXON MOBIL|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|106.50||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Aetna|AETNA|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Aetna|TRS COORDINATED CARE|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|21.30||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||21.30||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||5.25||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||32.55||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.07||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||4.90||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||4.50||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||11.55||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.06||| J2704|EAP|0272||Blue Cross PPO|BLUE CROSS PPO|||||0.38||| J2704|EAP|0636|DIPRIVAN (PROPOFOL) 10MG/ML VI|Medicare|MEDICARE PART A|106.50||||||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Multiplan|WEB TPA|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Indegent Care (Smith County)|INDIGENT HEALTH SMITH|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.30||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||21.30||| J2704|EAP|0636|DIPRIVAN (PROPOFOL) 10MG/ML VI|Humana Medicare Advantage|HUMANA MEDICARE PPO|106.50||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|ChampVA|CHAMPVA OF CO DENVER|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Cigna|NALC HLTH BENEFIT|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Cigna|CIGNA OTHER|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Cigna|CIGNA OPEN ACCESS PLUS|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Cigna|CIGNA OF TN CHATTANOOGA|||||21.30||| J2704|EAP|0636|PROPOFOL 200MG/20ML VIAL|Blue Cross PPO Select|BCBS UTHCT|||||21.30||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Blue Cross PPO Select|BCBS UTHCT|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.50||||||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Managed Medicaid|SUPERIOR STAR MCD|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|Medicare|MEDICARE A & B|11.50||||11.50||| J2765|EAP|0636|METOCLOPRAMIDE INJ 10MG/2ML|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|NON CONTRACTED|COMMERCIAL OTHER|1,047.25||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Medicare|MEDICARE A & B|1,047.25||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1,047.25||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|1,047.25||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Medicaid|MEDICAID|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|United Healthcare|UMR|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Blue Cross PPO|BLUE CROSS POS|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Blue Cross PPO|BCBS WALMART|1,047.25||||||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Blue Cross PPO|BLUE CROSS PPO|1,047.25||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|1,047.25||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|ChampVA|CHAMPVA OF CO DENVER|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Cigna|CIGNA OF TN CHATTANOOGA|||||1,047.25||| J2785|EAP|0636|REGADENOSON 0.4MG/5ML IV|Blue Cross PPO Select|BCBS UTHCT|||||1,047.25||| J2794|EAP|0636|RISPERIDONE, LONG ACT 37.5MG|Blue Cross PPO|BLUE CROSS PPO|1,792.60||||||| J2794|EAP|0636|RISPERIDONE LONG ACTING 25MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.95||||||| J2794|EAP|0636|RISPERIDONE, LONG ACT 37.5MG|NON CONTRACTED|COMMERCIAL OTHER|1,792.60||||||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||358.15||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Medicare|MEDICARE A & B|||||358.15||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross PPO Select|BCBS UTHCT|||||358.15||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||358.15||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross PPO|BLUE CROSS PPO|||||358.15||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Blue Cross PPO|BLUE CROSS PPO|21.40||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Blue Cross PPO|BLUE CROSS POS|||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|21.40||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|21.40||||||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.40||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Cigna|CIGNA OF TN CHATTANOOGA|||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Cigna|NALC HLTH BENEFIT|21.40||||||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Blue Cross PPO Select|BCBS UTHCT|21.40||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Managed Medicaid|FAMILY PLANNING GRANT|||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|21.40||||||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Managed Medicaid|SUPERIOR STAR MCD|||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Medicaid|MEDICAID|21.40||||||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Medicare|MEDICARE RAILROAD|21.40||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Medicare|MEDICARE PART A|21.40||||||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Medicare|MEDICARE A & B|21.40||||21.40||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|Veterans Affairs|VETERANS CHOICE - TRI WEST|21.40||||||| J2920|EAP|0636|METHYLEPREDNISOLONE NA /J2940|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|21.40||||21.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|United Healthcare|UMR|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Veterans Affairs|VETERANS CHOICE - TRI WEST|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Medicare|MEDICARE PART A|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Medicare|MEDICARE A & B|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|NON CONTRACTED|COMMERCIAL OTHER 2|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|NON CONTRACTED|COMMERCIAL OTHER|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Managed Medicaid|OTHER MEDICAID|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Managed Medicaid|SUPERIOR STAR MCD|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Medicare|MEDICARE RAILROAD|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Medicaid|MEDICAID|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Cigna|NALC HLTH BENEFIT|34.40||||||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Cigna|CIGNA OPEN ACCESS PLUS|||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Blue Cross PPO Select|BCBS UTHCT|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Humana Medicare Advantage|HUMANA MEDICARE PPO|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Aetna|AETNA EL PASO CLAIMS OFFICE|34.40||||||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Blue Cross PPO|BLUE CROSS PPO|34.40||||34.40||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Blue Cross PPO|BLUE CROSS POS|34.40||||||| J2930|EAP|0636|METHYLPREDNISOLONE NA SUCC 125|Blue Cross PPO|BCBS WALMART|||||34.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Blue Cross PPO|BLUE CROSS POS|||||674.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Blue Cross PPO|BLUE CROSS PPO|674.40||||674.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Aetna|AETNA EL PASO CLAIMS OFFICE|674.40||||||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|674.40||||674.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Humana Medicare Advantage|HUMANA MEDICARE PPO|674.40||||674.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Cigna|NALC HLTH BENEFIT|674.40||||||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|674.40||||674.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Medicare|MEDICARE PART A|674.40||||||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Medicare|MEDICARE A & B|674.40||||674.40||| J2997|EAP|0636|ALTEPLASE 2MG, INJ CATHFLO|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||674.40||| J3000|EAP|0510||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||2.50||| J3000|EAP|0636|STREPTOMYCIN INJ 1 GM 2.5 ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|266.25||||266.25||| J3000|EAP|0260||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||213.82||| J3000|EAP|0636|STREPTOMYCIN INJ 1 GM 2.5 ML|Medicare|MEDICARE A & B|||||266.25||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Cigna|CIGNA OF TN CHATTANOOGA|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Blue Cross PPO Select|BCBS UTHCT|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.75||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Blue Cross PPO|BLUE CROSS PPO|11.75||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.75||| J3010|EAP|0636|FENTANYL 500MCG/50ML PCA IV|Medicare|MEDICARE PART A|59.65||||||| J3010|EAP|0636|FENTANYL 500MCG/50ML PCA IV|Medicare|MEDICARE A & B|59.65||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Medicare|MEDICARE A & B|11.75||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|NON CONTRACTED|COMMERCIAL OTHER|||||12.05||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Workers Compensation|WC OTHER|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||9.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|United Healthcare|UMR|||||11.75||| J3010|EAP|0636|FENTANYL 0.05MG/ML 2 ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||11.75||| J3030|EAP|0636|SUMATRIPTAN SUCC INJECTION 6MG|Managed Medicaid|SUPERIOR STAR MCD|||||173.95||| J3030|EAP|0636|SUMATRIPTAN SUCC INJECTION 6MG|Blue Cross PPO|BLUE CROSS PPO|||||173.95||| J3030|EAP|0636|SUMATRIPTAN SUCC INJECTION 6MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|173.95||||||| J3030|EAP|0636|SUMATRIPTAN SUCC INJECTION 6MG|Cigna|CIGNA OTHER|||||173.95||| J3105|EAP|0636|TERBUTALINE INJ 1MG/ML AMP|Medicare|MEDICARE A & B|||||14.20||| J3230|EAP|0636|CHLORPROMAZIN INJ 50MG/2ML AMP|Medicare|MEDICARE A & B|||||106.95||| J3243|EAP|0636|TIGECYCLINE 50MG VIAL, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|498.65||||498.55||| J3260|EAP|0636|TOBRAMYCIN SULFATE 40MG/ML 2 M|Medicaid|MEDICAID|11.50||||||| J3260|EAP|0636|TOBRAMYCIN 80MG IV|Medicaid|MEDICAID|11.50||||||| J3260|EAP|0636|TOBRAMYCIN SULFATE 40MG/ML 2 M|Medicare|MEDICARE A & B|11.50||||11.50||| J3260|EAP|0636|TOBRAMYCIN 80MG IV|Medicare|MEDICARE PART A|11.50||||||| J3260|EAP|0636|TOBRAMYCIN 80MG IV|Medicare|MEDICARE A & B|11.50||||11.50||| J3260|EAP|0636|TOBRAMYCIN 80MG IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| J3260|EAP|0636|TOBRAMYCIN 80MG IV|Aetna|AETNA EL PASO CLAIMS OFFICE|10.50||||||| J3262|EAP|0636|Tocilizumab(Aactemra) 400mg|Blue Cross PPO|BLUE CROSS PPO|13.39||||||| J3262|EAP|0636|Tocilizumab(Aactemra) 400mg|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|20.50||||||| J3262|EAP|0636|Tocilizumab(Aactemra) 400mg|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|13.39||||||| J3301|EAP|0949|THERAP OR DX INJ; SQ OR IM|Medicare|MEDICARE A & B|||||213.82||| J3301|EAP|0510||Medicare|MEDICARE A & B|||||2.09||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Medicare|MEDICARE A & B|36.25||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|NON CONTRACTED|COMMERCIAL OTHER 2|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|NON CONTRACTED|COMMERCIAL OTHER|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|PHCS|WEB TPA|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Multiplan|WEB TPA|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|ChampVA|CHAMPVA OF CO DENVER|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Cigna|CIGNA OPEN ACCESS PLUS|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Cigna|CIGNA OF TN CHATTANOOGA|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Blue Cross PPO Select|BCBS UTHCT|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Aetna|AETNA EL PASO CLAIMS OFFICE|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Blue Cross PPO|BLUE CROSS SECONDARY|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Blue Cross PPO|BLUE CROSS PPO|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Blue Cross PPO|BCBS WALMART|||||36.25||| J3301|EAP|0636|TRIAMCINOLONE ACE. /J3301 40MG|Blue Cross PPO|BCBS TRANE PPO|||||36.25||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|Blue Cross PPO|BLUE CROSS PPO|34.30||||34.30||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Blue Cross PPO|BLUE CROSS PPO|56.45||||34.30||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Blue Cross PPO|BLUE CROSS POS|56.45||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Blue Cross PPO|BCBS TRANE PPO|56.45||||||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|Blue Cross PPO|BLUE CROSS PPO|33.75||||34.30||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Aetna|AETNA EL PASO CLAIMS OFFICE|25.55||||||| J3370|EAP|0636|VANCOMYCIN 1250 mg|Aetna|AETNA EL PASO CLAIMS OFFICE|85.65||||||| J3370|EAP|0636|VANCOMYCIN 750MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|34.40||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|56.45||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|34.40||||25.55||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|34.30||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|56.45||||25.55||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Humana Medicare Advantage|HUMANA MEDICARE PPO|85.65||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Humana Medicare Advantage|HUMANA MEDICARE PPO|25.55||||56.45||| J3370|EAP|0636|VANCOMYCIN 1500MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|102.75||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Cigna|NALC HLTH BENEFIT|25.55||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Cigna|CIGNA OF TN CHATTANOOGA|||||56.45||| J3370|EAP|0636|VANCOMYCIN 750MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|33.75||||56.45||| J3370|EAP|0636|VANCOMYCIN 750MG INJ|Cigna|NALC HLTH BENEFIT|34.40||||||| J3370|EAP|0636|VANCOMYCIN 1500MG|Cigna|CIGNA OF TN CHATTANOOGA|||||102.75||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Workers Compensation|WC GALLAGHER BASSETT|||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Veterans Affairs|VETERANS CHOICE - TRI WEST|34.40||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Veterans Affairs|VETERANS CHOICE - TRI WEST|25.55||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||25.55||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|United Healthcare|UMR|29.50||||||| J3370|EAP|0636|VANCOMYCIN 1250 mg|PHCS|TML GRP INS|85.65||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|85.65||||25.55||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|34.30||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|29.50||||25.55||| J3370|EAP|0636|VANCOMYCIN 750MG INJ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|34.40||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|85.65||||56.45||| J3370|EAP|0636|VANCOMYCIN 1500MG|Blue Cross PPO|BLUE CROSS PPO|85.65||||102.75||| J3370|EAP|0636|VANCOMYCIN 750MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|33.75||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|25.55||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Blue Cross PPO|BLUE CROSS PPO|102.75||||0.41||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|102.75||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Managed Medicaid|MOLINA MEDICAID|||||56.45||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|Medicaid|MEDICAID|34.30||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Medicaid|MEDICAID|56.45||||||| J3370|EAP|0636|VANCOMYCIN 1250 mg|Multiplan|TML GRP INS|85.65||||||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|Medicare|MEDICARE A & B|34.30||||34.30||| J3370|EAP|0636|VANCOMYCIN INJ 500MG VIAL|Medicare|MEDICARE A & B|33.75||||34.30||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Medicare|MEDICARE PART A|56.45||||||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Medicare|MEDICARE A & B|102.75||||56.45||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|Medicare|MEDICARE A & B|29.50||||34.30||| J3370|EAP|0636|VANCOMYCIN 1250 mg|Medicare|MEDICARE A & B|85.65||||85.65||| J3370|EAP|0636|VANCOMYCIN HYDROCHLORIDE|NON CONTRACTED|COMMERCIAL OTHER|||||0.41||| J3380|EAP|0636|VEDOLIZUMAB INJ 300MG VIAL|Medicare|MEDICARE A & B|||||0.00||| J3380|EAP|0636|VEDOLIZUMAB INJ 300MG VIAL|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| J3380|EAP|0636|VEDOLIZUMAB INJ 300MG VIAL|United Healthcare|UMR|||||0.00||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Blue Cross PPO Select|BCBS UTHCT|||||24.55||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||24.55||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|24.55||||15.80||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||24.55||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||24.55||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Managed Medicaid|SUPERIOR STAR MCD|||||15.80||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Medicaid|MEDICAID|||||15.80||| J3420|EAP|0636|CYANOCOBALAMIN 1000MCG /J3420|Medicare|MEDICARE A & B|24.55||||24.55||| J3430|EAP|0636|PHYTONADIONE INJ 10 MG/ML|Managed Medicaid|FAMILY PLANNING GRANT|||||171.30||| J3430|EAP|0636|PHYTONADIONE INJ 10 MG/ML|Blue Cross PPO|BLUE CROSS PPO|||||171.30||| J3430|EAP|0636|PHYTONADIONE INJ 10 MG/ML|Blue Cross PPO|BCBS WALMART|||||171.30||| J3430|EAP|0636|PHYTONADIONE INJ 10 MG/ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|171.30||||||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||28.90||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Humana Medicare Advantage|HUMANA MEDICARE PPO|71.40||||||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|51.80||||11.50||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||11.50||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Cigna|CIGNA OPEN ACCESS PLUS|||||11.50||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||28.90||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Blue Cross PPO Select|BCBS UTHCT|11.50||||||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Aetna|AETNA EL PASO CLAIMS OFFICE|||||71.40||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|71.40||||71.40||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||10.50||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||28.90||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Blue Cross PPO|BLUE CROSS PPO|28.90||||28.90||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Blue Cross PPO|BLUE CROSS PPO|71.40||||11.50||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Blue Cross PPO Select|BCBS UTHCT|71.40||||||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Blue Cross PPO|BLUE CROSS POS|||||0.11||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Humana Medicare Advantage|HUMANA MEDICARE PPO|10.50||||||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Blue Cross PPO Select|BCBS UTHCT|||||28.90||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Veterans Affairs|VETERANS CHOICE - TRI WEST|51.80||||51.80||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Managed Medicaid|OTHER MEDICAID|||||28.90||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.50||||11.50||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||28.90||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|71.40||||71.40||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|71.40||||11.50||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|NON CONTRACTED|COMMERCIAL OTHER|||||28.90||| J3475|EAP|0636|MAGNESIUM SULFATE 2GMS/50ML BG|Medicare|MEDICARE A & B|71.40||||71.40||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Medicare|MEDICARE A & B|11.50||||11.50||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|NON CONTRACTED|COMMERCIAL OTHER|11.50||||11.50||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|71.40||||11.50||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Medicaid|MEDICAID|||||28.90||| J3475|EAP|0636|MAGNESIUM S04 INJ 1GM.2ML SDV|Medicaid|MEDICAID|71.40||||11.50||| J3475|EAP|0250|MAGNESIUM SULFATE 1GM/100ML PR|Medicare|MEDICARE A & B|28.90||||28.90||| J3480|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|12.45||||11.50||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.40||||11.50||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Medicaid|MEDICAID|||||11.50||| J3480|EAP|0636|POTASSIUM CL 40MEG/100 ML PB|Medicare|MEDICARE A & B|18.15||||18.15||| J3480|EAP|0636|POTASSIUM CL 40MEG/100 ML PB|Medicare|MEDICARE A & B|16.05||||18.15||| J3480|EAP|0636|POTASSIUM CHLORIDE 40 MEQ/20ML|Medicare|MEDICARE A & B|11.50||||16.05||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Medicare|MEDICARE A & B|12.45||||11.50||| J3480|EAP|0636|KCL 20 MEQ IN 100 ML PI/BAC/IV|Medicare|MEDICARE A & B|16.05||||12.45||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|NON CONTRACTED|COMMERCIAL OTHER|||||11.50||| J3480|EAP|0636|KCL 20 MEQ IN 100 ML PI/BAC/IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|12.45||||||| J3480|EAP|0636|KCL 20 MEQ IN 100 ML PI/BAC/IV|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||12.45||| J3480|EAP|0636|POTASSIUM CL 40MEG/100 ML PB|Blue Cross PPO|BLUE CROSS PPO|18.15||||11.50||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Blue Cross PPO|BLUE CROSS POS|||||10.50||| J3480|EAP|0636|KCL 20 MEQ IN 100 ML PI/BAC/IV|Blue Cross PPO|BLUE CROSS PPO|12.45||||12.45||| J3480|EAP|0636|KCL 20 MEQ IN 100 ML PI/BAC/IV|Blue Cross PPO|BCBS WALMART|||||12.45||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Blue Cross PPO|BLUE CROSS PPO|11.50||||11.50||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|12.45||||10.50||| J3480|EAP|0636|POTASSIUM CL 40MEG/100 ML PB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||10.50||| J3480|EAP|0636|POTASSIUM CL 40MEG/100 ML PB|Humana Medicare Advantage|HUMANA MEDICARE PPO|18.15||||11.50||| J3480|EAP|0636|POTASSIUM CL 40MEG/100 ML PB|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|12.45||||11.50||| J3480|EAP|0636|POTASSIUM CHLORIDE 20 MEQ/10ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||11.50||| J3480|EAP|0636|KCL 20 MEQ IN 100 ML PI/BAC/IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|12.45||||12.45||| J3486|EAP|0636|ZIPRASIDONE 20MG IM (GEODON)|Blue Cross PPO|BLUE CROSS PPO|1.85||||1.85||| J3486|EAP|0636|ZIPRASIDONE 20MG IM (GEODON)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||176.40||| J3486|EAP|0636|ZIPRASIDONE 20MG IM (GEODON)|Medicare|MEDICARE PART A|1.85||||||| J3486|EAP|0636|ZIPRASIDONE 20MG IM (GEODON)|Medicare|MEDICARE A & B|1.85||||||| J3486|EAP|0636||Medicare|MEDICARE A & B|1.85||||||| J3486|EAP|0636|ZIPRASIDONE 20MG IM (GEODON)|Managed Medicaid|SUPERIOR STAR MCD|||||176.40||| J3489|EAP|0636|ZOLEDRONIC ACID, 4MG/100ML IV|Medicare|MEDICARE A & B|703.62||||796.60||| J3489|EAP|0636|ZOLEDRONIC ACID, 1MG, INJ|Medicare|MEDICARE A & B|703.62||||88.25||| J3489|EAP|0636|ZOLEDRONIC ACID, 1MG, INJ|Medicare|MEDICARE A & B|703.62||||81.50||| J3489|EAP|0636|ZOLEDRONIC ACID, 4MG/100ML IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||796.60||| J3489|EAP|0636|RECLAST 5MG/100ML IV|Medicare|MEDICARE A & B|377.73||||822.50||| J3489|EAP|0636|RECLAST 5MG/100ML IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||822.50||| J3489|EAP|0636|ZOLEDRONIC ACID, 4MG/100ML IV|ChampVA|CHAMPVA OF CO DENVER|||||796.60||| J3489|EAP|0636|RECLAST 5MG/100ML IV|Cigna|CIGNA OF TN CHATTANOOGA|||||822.50||| J3489|EAP|0636|RECLAST 5MG/100ML IV|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||822.50||| J3489|EAP|0636|ZOLEDRONIC ACID, 4MG/100ML IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||504.80||| J3489|EAP|0636|ZOLEDRONIC ACID, 1MG, INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||319.10||| J3489|EAP|0636|ZOLEDRONIC ACID, 1MG, INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||88.25||| J3489|EAP|0636|ZOLEDRONIC ACID, 1MG, INJ|Blue Cross PPO|BLUE CROSS PPO|||||88.25||| J3489|EAP|0636|ZOLEDRONIC ACID, 1MG, INJ|Blue Cross PPO|BLUE CROSS PPO|||||81.50||| J3489|EAP|0636|RECLAST 5MG/100ML IV|Blue Cross PPO|BLUE CROSS POS|||||822.50||| J3490|EAP|0250|PHENOL EZ SWAB|Aetna|AETNA EL PASO CLAIMS OFFICE|21.30||||16.20||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Aetna|AETNA EL PASO CLAIMS OFFICE|96.05||||61.80||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Aetna|AETNA EL PASO CLAIMS OFFICE|7.10||||34.15||| J3490|EAP|0252|RIFAMPIN INJ 600MG VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|451.35||||34.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Aetna|AETNA EL PASO CLAIMS OFFICE|0.04||||3.15||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|3.15||||11.55||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Aetna|AETNA EL PASO CLAIMS OFFICE|3.15||||11.50||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||18.05||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Aetna|AETNA EXXON MOBIL|||||16.20||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||9.75||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Aetna|AETNA EL PASO CLAIMS OFFICE|0.65||||0.65||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Aetna|AETNA EXXON MOBIL|||||16.08||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Aetna|AETNA EL PASO CLAIMS OFFICE|0.65||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Aetna|AETNA US HEALTHCARE PA|||||0.65||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||20.10||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||42.85||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||12.70||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.40||||3.15||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.04||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|81.60||||21.30||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|78.35||||11.50||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||12.70||| J3490|EAP|0251|SODIUM TETRADECYL SULFATE 30MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||332.85||| J3490|EAP|0251|METOPROLOL TARTRATE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||3.15||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||9.75||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Aetna|AETNA EL PASO CLAIMS OFFICE|42.85||||46.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.75||||20.10||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||3.15||| J3490|EAP|0251|LIDOCAINE HCL INJECTION 2% MPF|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.50||||11.50||| J3490|EAP|0251|SCOPOLAMINE HYDROBROMIDE 1.5MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||66.50||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|29.85||||7.10||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||7.50||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|11.55||||0.65||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|47.05||||12.80||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|77.85||||30.20||| J3490|EAP|0251|LIDOCAINE 1:100,000|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||11.50||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||34.40||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||1.05||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||11.55||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||22.80||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|14.20||||47.05||| J3490|EAP|0251|BOTTLE, SOLUTION 8ML, MONSEL'S|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||17.75||| J3490|EAP|0251|HYDRALAZINE TAB 25 MG U/D (APR|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J3490|EAP|0251|TRIAMCINOLONE ACET 0.1% CREAM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||15.80||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||9.75||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||47.80||| J3490|EAP|0251|HYDROCHLOROTHIAZIDE TAB 25MG U|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.75||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.85||||11.50||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.75||||23.15||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J3490|EAP|0251||Aetna|AETNA EL PASO CLAIMS OFFICE|21.80||||121.35||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|6.40||||6.40||| J3490|EAP|0252||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||47.80||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|97.65||||34.15||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.04||||7.10||| J3490|EAP|0252|VALACYCLORVIR HCL 500 MG TABL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|14.10||||7.10||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|12.50||||11.55||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||7.75||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||0.65||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||0.65||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||520.60||| J3490|EAP|0258|SODIUM CHLORIDE 0.9%-KCL 20MEQ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|46.15||||42.85||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||27.30||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||32.20||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||1.05||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Aetna|AETNA US HEALTHCARE PA|||||20.10||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Blue Cross PPO|BCBS TRANE PPO|42.85||||||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Blue Cross PPO|BCBS WALMART|42.85||||21.30||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Blue Cross PPO|BCBS WALMART|0.04||||21.30||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||3.15||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|5.18||||3.15||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Blue Cross PPO|BLUE CROSS PPO|39.70||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|5.18||||21.30||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Blue Cross PPO|BLUE CROSS PPO|0.04||||0.04||| J3490|EAP|0250|ISENTRESS 400 MG|Blue Cross PPO|BLUE CROSS POS|42.85||||93.20||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Blue Cross PPO|BLUE CROSS POS|42.85||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Blue Cross PPO|BLUE CROSS POS|42.85||||3.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Blue Cross PPO|BLUE CROSS PPO|3.15||||0.04||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Blue Cross PPO|BLUE CROSS PPO|61.60||||42.85||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Blue Cross PPO|BCBS WALMART|21.30||||21.30||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Blue Cross PPO|BLUE CROSS PPO|11.96||||21.30||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Blue Cross PPO|BLUE CROSS PPO|137.85||||5.25||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Blue Cross PPO|BLUE CROSS PPO|3.15||||11.50||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Blue Cross PPO|BLUE CROSS POS|40.50||||51.80||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|5.18||||3.15||| J3490|EAP|0250|LACOSAMIDE 50 MG TAB|Blue Cross PPO|BLUE CROSS PPO|5.25||||41.60||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|Blue Cross PPO|BLUE CROSS PPO|4.45||||47.80||| J3490|EAP|0251|CLONIDINE HCL TAB 0.2 MG U.D|Blue Cross PPO|BLUE CROSS PPO|14.20||||3.15||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Blue Cross PPO|BLUE CROSS PPO|3.15||||12.70||| J3490|EAP|0251|LIDOCAINE 1:100,000|Blue Cross PPO|BCBS TRANE PPO|9.75||||11.50||| J3490|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|1.05||||30.20||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Blue Cross PPO|BCBS WALMART|0.26||||14.20||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|Blue Cross PPO|BLUE CROSS POS|20.10||||47.05||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Blue Cross PPO|BLUE CROSS PPO|66.50||||22.80||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross PPO|BCBS TRANE PPO|9.75||||20.10||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|Blue Cross PPO|BLUE CROSS PPO|7.10||||3.15||| J3490|EAP|0251|ACETAMINOPHEN EL 650 MG/25ML U|Blue Cross PPO|BLUE CROSS PPO|121.35||||1.05||| J3490|EAP|0251|LIDOCAINE 1:100,000|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.50||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Blue Cross PPO|BLUE CROSS PPO|3.15||||11.55||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||30.20||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross PPO|BCBS WALMART|3.15||||20.10||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Blue Cross PPO|BLUE CROSS PPO|3.15||||13.50||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Blue Cross PPO|BCBS WALMART|9.75||||11.50||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.65||| J3490|EAP|0251|ALPRAZOLAM TAB .25MG U/D|Blue Cross PPO|BLUE CROSS PPO|3.15||||9.75||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Blue Cross PPO|BCBS TRANE PPO|7.50||||3.15||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Blue Cross PPO|BLUE CROSS PPO|0.00||||9.75||| J3490|EAP|0251|METOPROLOL TARTRATE|Blue Cross PPO|BCBS WALMART|3.15||||11.50||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Blue Cross PPO|BLUE CROSS POS|3.15||||14.20||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.33||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Blue Cross PPO|BLUE CROSS POS|3.15||||9.75||| J3490|EAP|0251|LIDOCAINE 1:100,000|Blue Cross PPO|BLUE CROSS POS|3.15||||11.50||| J3490|EAP|0251|LIDOCAINE 2% 50ML VIAL|Blue Cross PPO|BLUE CROSS PPO|3.15||||26.45||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Blue Cross PPO|BLUE CROSS PPO|64.65||||23.15||| J3490|EAP|0251|LIDOCAINE VISCUOUS 2% 30 ML|Blue Cross PPO|BLUE CROSS POS|3.15||||7.05||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Blue Cross PPO|BCBS WALMART|3.15||||11.50||| J3490|EAP|0251||Blue Cross PPO|BLUE CROSS PPO|21.80||||121.35||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Blue Cross PPO|BLUE CROSS PPO|0.65||||3.15||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|Blue Cross PPO|BLUE CROSS PPO|9.75||||9.75||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Blue Cross PPO|BCBS TRANE PPO|9.75||||3.15||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Blue Cross PPO|BLUE CROSS PPO|9.75||||0.65||| J3490|EAP|0251|HYDROCHLOROTHIAZIDE TAB 25MG U|Blue Cross PPO|BLUE CROSS PPO|7.05||||3.15||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|Blue Cross PPO|BLUE CROSS PPO|9.75||||47.05||| J3490|EAP|0251|BUPIVACAINE W/EPI 0.25%/.005 1|Blue Cross PPO|BLUE CROSS PPO|47.05||||14.20||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Blue Cross PPO|BLUE CROSS POS|3.15||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Blue Cross PPO|BLUE CROSS PPO|1.05||||7.50||| J3490|EAP|0251|BOTTLE, SOLUTION 8ML, MONSEL'S|Blue Cross PPO|BLUE CROSS PPO|3.15||||17.75||| J3490|EAP|0251|METOPROLOL TARTRATE|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Blue Cross PPO|BLUE CROSS PPO|3.15||||7.10||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||20.10||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Blue Cross PPO|BLUE CROSS PPO|3.15||||12.80||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Blue Cross PPO|BLUE CROSS PPO|11.50||||14.20||| J3490|EAP|0251|LIDOCAINE 1:100,000|Blue Cross PPO|BLUE CROSS PPO|287.05||||11.50||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Blue Cross PPO|BLUE CROSS POS|7.10||||3.15||| J3490|EAP|0251|LIDOCAINE VISCUOUS 2% 30 ML|Blue Cross PPO|BLUE CROSS PPO|11.50||||5.25||| J3490|EAP|0251|HYDRALAZINE TAB 25 MG U/D (APR|Blue Cross PPO|BCBS WALMART|7.50||||3.15||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Blue Cross PPO|BLUE CROSS PPO|3.15||||9.75||| J3490|EAP|0251|METOPROLOL TARTRATE TAB 50 MG|Blue Cross PPO|BCBS WALMART|3.15||||3.15||| J3490|EAP|0251|SPIRONOLACTONE TAB 25MG|Blue Cross PPO|BCBS WALMART|3.15||||11.50||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Blue Cross PPO|BLUE CROSS PPO|9.78||||30.20||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||13.63||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO|BCBS TRANE PPO|9.75||||11.50||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO|BLUE CROSS PPO|9.78||||11.50||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Blue Cross PPO|BLUE CROSS PPO|9.78||||5.55||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Blue Cross PPO|BCBS WALMART|14.20||||3.15||| J3490|EAP|0251|SPIRONOLACTONE TAB 25MG|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 3% FOR INHAL|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 10% FOR INHAL|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Blue Cross PPO|BLUE CROSS POS|3.15||||3.15||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Blue Cross PPO|BCBS TRANE PPO|9.75||||36.35||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Blue Cross PPO|BCBS WALMART|3.15||||11.50||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Blue Cross PPO|BLUE CROSS PPO|9.78||||34.40||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO|BLUE CROSS POS|3.15||||11.50||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Blue Cross PPO|BLUE CROSS PPO|9.78||||36.35||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Blue Cross PPO|BLUE CROSS POS|38.75||||61.80||| J3490|EAP|0252||Blue Cross PPO|BLUE CROSS PPO|3.15||||47.80||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Blue Cross PPO|BLUE CROSS PPO|0.04||||61.80||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Blue Cross PPO|BLUE CROSS PPO|14.10||||34.15||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Blue Cross PPO|BLUE CROSS PPO|11.55||||6.40||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||61.80||| J3490|EAP|0252|FLUCONAZOLE 150MG TOPICAL|Blue Cross PPO|BLUE CROSS POS|38.75||||49.75||| J3490|EAP|0252|AMLODIPINE TAB 10 MG U/D|Blue Cross PPO|BLUE CROSS PPO|3.15||||3.15||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Blue Cross PPO|BLUE CROSS PPO|14.10||||7.10||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Blue Cross PPO|BLUE CROSS PPO|14.10||||0.04||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Blue Cross PPO|BCBS WALMART|0.04||||61.80||| J3490|EAP|0252|IMITREX *SUMATRIOTAN* 25 MG TA|Blue Cross PPO|BLUE CROSS PPO|14.10||||96.05||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Blue Cross PPO|BCBS WALMART|0.04||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Aetna|AETNA EL PASO CLAIMS OFFICE|11.55||||12.80||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Aetna|AETNA EL PASO CLAIMS OFFICE|3.15||||9.75||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Blue Cross PPO|BLUE CROSS PPO|0.65||||0.65||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Blue Cross PPO|BLUE CROSS PPO|32.30||||0.65||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Blue Cross PPO|BLUE CROSS POS|0.65||||0.65||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Blue Cross PPO|BLUE CROSS PPO|32.30||||3.15||| J3490|EAP|0257|OXYMETAZOLINE 0.05% NASAL|Blue Cross PPO|BLUE CROSS PPO|32.30||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Blue Cross PPO|BLUE CROSS POS|0.65||||0.65||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Blue Cross PPO|BLUE CROSS PPO|0.65||||7.75||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Blue Cross PPO|BCBS WALMART|0.65||||0.65||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Blue Cross PPO|BLUE CROSS POS|||||8.25||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||42.85||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Aetna|AETNA|||||20.10||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Aetna|AETNA EL PASO CLAIMS OFFICE|9.65||||21.30||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Aetna|AETNA|||||11.50||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||11.55||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Aetna|AETNA|||||21.30||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||34.40||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Aetna|AETNA EL PASO CLAIMS OFFICE|39.80||||5.25||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Aetna|AETNA EL PASO CLAIMS OFFICE|7.50||||7.50||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Aetna|AETNA EL PASO CLAIMS OFFICE|3.15||||3.15||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Blue Cross PPO|BLUE CROSS PPO|||||18.05||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||18.05||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Blue Cross PPO|BLUE CROSS PPO|||||520.60||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Blue Cross PPO Select|BCBS UTHCT|42.85||||5.25||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Blue Cross PPO Select|BCBS UTHCT|42.85||||3.15||| J3490|EAP|0250|PHENOL EZ SWAB|Blue Cross PPO Select|BCBS UTHCT|42.85||||16.20||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Blue Cross PPO Select|BCBS UTHCT|42.85||||42.85||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Blue Cross PPO Select|BCBS UTHCT|42.85||||21.30||| J3490|EAP|0250||Blue Cross PPO Select|BCBS UTHCT|42.85||||3.60||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Blue Cross PPO Select|BCBS UTHCT|9.75||||12.70||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO Select|BCBS UTHCT|9.75||||11.50||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Blue Cross PPO Select|BCBS UTHCT|9.75||||1.05||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Blue Cross PPO Select|BCBS UTHCT|9.75||||36.35||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Blue Cross PPO Select|BCBS UTHCT|9.75||||5.55||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|Blue Cross PPO Select|BCBS UTHCT|9.75||||9.75||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Blue Cross PPO Select|BCBS UTHCT|9.75||||7.10||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Blue Cross PPO Select|BCBS UTHCT|9.75||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Blue Cross PPO Select|BCBS UTHCT|9.75||||14.20||| J3490|EAP|0251||Blue Cross PPO Select|BCBS UTHCT|7.50||||30.20||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Blue Cross PPO Select|BCBS UTHCT|9.75||||9.75||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Blue Cross PPO Select|BCBS UTHCT|9.75||||30.20||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Blue Cross PPO Select|BCBS UTHCT|9.75||||7.50||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Blue Cross PPO Select|BCBS UTHCT|9.75||||3.15||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Blue Cross PPO Select|BCBS UTHCT|9.75||||9.75||| J3490|EAP|0251|SODIUM CHLORIDE 10% FOR INHAL|Blue Cross PPO Select|BCBS UTHCT|9.75||||3.15||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Blue Cross PPO Select|BCBS UTHCT|9.75||||22.80||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Blue Cross PPO Select|BCBS UTHCT|9.75||||11.55||| J3490|EAP|0251|LIDOCAINE 1:100,000|Blue Cross PPO Select|BCBS UTHCT|9.75||||11.50||| J3490|EAP|0251|METOPROLOL TARTRATE|Blue Cross PPO Select|BCBS UTHCT|9.75||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Blue Cross PPO Select|BCBS UTHCT|9.75||||12.80||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Blue Cross PPO Select|BCBS UTHCT|0.04||||11.50||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Blue Cross PPO Select|BCBS UTHCT|0.04||||7.10||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Blue Cross PPO Select|BCBS UTHCT|0.04||||34.15||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Blue Cross PPO Select|BCBS UTHCT|0.04||||0.04||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Blue Cross PPO Select|BCBS UTHCT|0.04||||61.80||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Blue Cross PPO Select|BCBS UTHCT|0.65||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Blue Cross PPO Select|BCBS UTHCT|0.65||||0.65||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Blue Cross PPO Select|BCBS UTHCT|0.65||||7.75||| J3490|EAP|0257|OXYMETAZOLINE 0.05% NASAL|Blue Cross PPO Select|BCBS UTHCT|0.65||||3.15||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||18.50||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||22.80||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||9.50||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||34.40||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Managed Medicaid|MOLINA MEDICAID|||||5.25||| J3490|EAP|0250|PHENOL EZ SWAB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||16.20||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||21.30||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Managed Medicaid|SUPERIOR STAR MCD|42.85||||21.30||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||0.04||| J3490|EAP|0250|PHENOL EZ SWAB|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||16.20||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||42.85||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.25||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Managed Medicaid|OTHER MEDICAID|||||5.25||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||21.30||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||21.30||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||3.15||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Managed Medicaid|SUPERIOR STAR MCD|42.85||||13.52||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||42.85||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Managed Medicaid|MOLINA MEDICAID|||||21.30||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Managed Medicaid|OTHER MEDICAID|||||42.85||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Managed Medicaid|OTHER MEDICAID|||||21.30||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Managed Medicaid|SUPERIOR STAR MCD|42.85||||5.25||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||3.15||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||51.80||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||11.50||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||36.35||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||3.15||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Managed Medicaid|SUPERIOR STAR MCD|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 2% JELLY 5ML TUBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||29.85||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Managed Medicaid|SUPERIOR STAR MCD|3.15||||9.75||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||5.55||| J3490|EAP|0251|METOPROLOL TARTRATE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||14.20||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|MEDICAID CSHCN|||||20.10||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Managed Medicaid|MEDICAID CSHCN|||||7.50||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Managed Medicaid|MOLINA MEDICAID|13.85||||3.15||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||21.45||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||3.15||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.75||||13.50||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|3.15||||12.70||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Managed Medicaid|SUPERIOR STAR MCD|11.50||||14.20||| J3490|EAP|0251|LIDOCAINE 1:100,000|Managed Medicaid|SUPERIOR STAR MCD|3.15||||11.50||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Managed Medicaid|OTHER MEDICAID|||||0.65||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|14.20||||3.15||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Managed Medicaid|OTHER MEDICAID|||||3.15||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||30.20||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||20.10||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE VISCUOUS 2% 30 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||7.05||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||0.65||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Managed Medicaid|MOLINA MEDICAID|13.85||||5.55||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|FAMILY PLANNING GRANT|||||20.10||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|7.10||||0.65||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Managed Medicaid|SUPERIOR STAR MCD|3.15||||0.65||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||12.80||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||11.50||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||5.55||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|Managed Medicaid|SUPERIOR STAR MCD|3.15||||32.20||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Managed Medicaid|SUPERIOR STAR MCD|3.15||||7.50||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||7.50||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|30.20||||7.50||| J3490|EAP|0251|BOTTLE, SOLUTION 8ML, MONSEL'S|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|64.65||||17.75||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||14.20||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Managed Medicaid|MOLINA MEDICAID|3.15||||7.50||| J3490|EAP|0251|ACETAMINOPHEN EL 650 MG/25ML U|Managed Medicaid|MOLINA MEDICAID|9.75||||1.05||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Managed Medicaid|OTHER MEDICAID|||||5.55||| J3490|EAP|0251|LIDOCAINE 1:100,000|Managed Medicaid|FAMILY PLANNING GRANT|||||13.35||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Managed Medicaid|FAMILY PLANNING GRANT|||||0.65||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Managed Medicaid|SUPERIOR STAR MCD|3.15||||1.05||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Managed Medicaid|OTHER MEDICAID|||||7.50||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||20.10||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||22.80||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Managed Medicaid|SUPERIOR STAR MCD|3.15||||13.50||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Managed Medicaid|SUPERIOR STAR MCD|9.75||||3.15||| J3490|EAP|0251|ACETAMINOPHEN EL 650 MG/25ML U|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.05||| J3490|EAP|0251|METOPROLOL TARTRATE TAB 50 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|13.85||||3.15||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Managed Medicaid|SUPERIOR STAR MCD|3.15||||5.55||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||11.50||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Managed Medicaid|MOLINA MEDICAID|13.85||||11.50||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||36.35||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Managed Medicaid|SUPERIOR STAR MCD|3.15||||7.10||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Managed Medicaid|SUPERIOR STAR MCD|11.50||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|MOLINA MEDICAID|13.85||||20.10||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||32.20||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Managed Medicaid|SUPERIOR STAR MCD|3.15||||9.75||| J3490|EAP|0251|CLONIDINE HCL TAB 0.2 MG U.D|Managed Medicaid|FAMILY PLANNING GRANT|||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|20.10||||20.10||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Managed Medicaid|MOLINA MEDICAID|13.85||||3.15||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.50||||9.75||| J3490|EAP|0251|LIDOCAINE 1:100,000|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||11.50||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Managed Medicaid|SUPERIOR STAR MCD|3.15||||36.35||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Managed Medicaid|MOLINA MEDICAID|13.85||||11.55||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J3490|EAP|0251|CLONIDINE HCL TAB 0.2 MG U.D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||12.80||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Managed Medicaid|SUPERIOR STAR MCD|3.15||||20.10||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|23.10||||61.80||| J3490|EAP|0252|FLUMAZENIL 0.1MG/ML 5ML VIAL|Managed Medicaid|SUPERIOR STAR MCD|49.75||||23.10||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|7.10||||7.10||| J3490|EAP|0252||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.85||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|11.55||||3.15||| J3490|EAP|0252|AMLODIPINE TAB 10 MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Managed Medicaid|SUPERIOR STAR MCD|49.75||||7.10||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Managed Medicaid|MOLINA MEDICAID|||||7.10||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|49.75||||11.50||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||34.15||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||7.10||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||7.75||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Managed Medicaid|MOLINA MEDICAID|||||7.75||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Managed Medicaid|SUPERIOR STAR MCD|0.65||||0.65||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.15||| J3490|EAP|0257|ACETAMINOPHEN SUPP 120MG|Managed Medicaid|SUPERIOR STAR MCD|0.65||||6.30||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Managed Medicaid|MOLINA MEDICAID|||||0.65||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Managed Medicaid|SUPERIOR STAR MCD|0.65||||7.75||| J3490|EAP|0258|SODIUM CHLORIDE 0.9%-KCL 20MEQ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|46.15||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|40.50||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.45 1000ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|37.50||||42.85||| J3490|EAP|0258||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|46.15||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Managed Medicaid|SUPERIOR STAR MCD|||||42.85||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Cigna|CIGNA OPEN ACCESS PLUS|||||11.50||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Cigna|NALC HLTH BENEFIT|3.15||||||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Cigna|NALC HLTH BENEFIT|42.85||||||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||42.85||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Cigna|CIGNA OPEN ACCESS PLUS|||||21.30||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||11.50||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||21.30||| J3490|EAP|0250|PHENOL EZ SWAB|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||16.20||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Cigna|CIGNA OPEN ACCESS PLUS|||||42.85||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Cigna|CIGNA OPEN ACCESS PLUS|||||51.80||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Cigna|NALC HLTH BENEFIT|6.75||||||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Cigna|CIGNA OPEN ACCESS PLUS|||||7.50||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Cigna|NALC HLTH BENEFIT|3.15||||20.10||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Cigna|CIGNA OF TN CHATTANOOGA|30.20||||12.80||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||22.80||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Cigna|NALC HLTH BENEFIT|7.50||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Cigna|CIGNA OPEN ACCESS PLUS|||||20.10||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||20.10||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Cigna|CIGNA OPEN ACCESS PLUS|||||14.20||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Cigna|CIGNA OPEN ACCESS PLUS|||||0.65||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Cigna|CIGNA OPEN ACCESS PLUS|||||9.75||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Cigna|CIGNA OF TN CHATTANOOGA|14.20||||0.65||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Cigna|CIGNA OF TN CHATTANOOGA|9.75||||11.55||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Cigna|CIGNA OPEN ACCESS PLUS|||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||14.20||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||9.75||| J3490|EAP|0252|VALACYCLORVIR HCL 500 MG TABL|Cigna|NALC HLTH BENEFIT|14.10||||||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Cigna|NALC HLTH BENEFIT|7.10||||||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Cigna|CIGNA OF TN CHATTANOOGA|||||61.80||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Cigna|CIGNA OPEN ACCESS PLUS|||||3.15||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Cigna|CIGNA OF TN CHATTANOOGA|||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Cigna|CIGNA OPEN ACCESS PLUS|||||0.65||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Cigna|CIGNA OTHER|||||520.60||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Cigna|CIGNA OF TN CHATTANOOGA|||||0.65||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Cigna|CIGNA OPEN ACCESS PLUS|||||36.55||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||3.15||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J3490|EAP|0250|PHENOL EZ SWAB|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.22||||16.20||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|39.70||||51.80||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0250|BUDESONIDE 0.5MG/2ML AMPUL-NEB|Humana Medicare Advantage|HUMANA MEDICARE PPO|39.70||||39.70||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|42.85||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||21.30||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|39.80||||42.85||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.04||||3.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.04||||0.04||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|42.85||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||42.85||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Humana Medicare Advantage|HUMANA MEDICARE PPO|38.95||||3.15||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|78.35||||11.50||| J3490|EAP|0251|LIDOCAINE 2% JELLY 5ML TUBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.10||||29.85||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||34.40||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||7.10||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||11.55||| J3490|EAP|0251|LIDOCAINE HCL INJECTION 2% MPF|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.55||||11.50||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Humana Medicare Advantage|HUMANA MEDICARE PPO|47.05||||9.75||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.05||||12.80||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||11.50||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.50||||3.15||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||7.10||| J3490|EAP|0251|LIDOCAINE 1:100,000|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.75||||11.50||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||22.80||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||11.50||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||21.45||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||34.40||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|29.85||||22.80||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|11.50||||3.15||| J3490|EAP|0251|SPIRONOLACTONE TAB 25MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 3% FOR INHAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||11.50||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|7.50||||7.50||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||3.15||| J3490|EAP|0251|METOPROLOL TARTRATE TAB 50 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J3490|EAP|0251|HYDROCHLOROTHIAZIDE TAB 25MG U|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 10% FOR INHAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||20.10||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||12.70||| J3490|EAP|0636|JUVEDERM VOLUMA XC 1 ML|Blue Cross PPO Select|BCBS UTHCT|||||8.08||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.65||||13.50||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.05||||1.05||| J3490|EAP|0251|SPIRONOLACTONE TAB 25MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.05||||3.15||| J3490|EAP|0636|JUVEDERM ULTRA PLUS XC 1 ML|Blue Cross PPO Select|BCBS UTHCT|||||6.77||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.75||||47.05||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.20||||11.55||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||7.50||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Humana Medicare Advantage|HUMANA MEDICARE PPO|1.05||||7.50||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|7.10||||47.80||| J3490|EAP|0251|SODIUM POLYSTYRENE SULF 15G/60|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||77.85||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.50||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||20.10||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|4.45||||0.65||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|9.75||||9.75||| J3490|EAP|0251|SODIUM CHLORIDE 3% FOR INHAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|77.85||||3.15||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Humana Medicare Advantage|HUMANA MEDICARE PPO|287.05||||3.35||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||20.10||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.85||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Humana Medicare Advantage|HUMANA MEDICARE PPO|30.20||||23.15||| J3490|EAP|0251|BOTTLE, SOLUTION 8ML, MONSEL'S|Humana Medicare Advantage|HUMANA MEDICARE PPO|66.50||||17.75||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|7.10||||61.80||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|61.80||||11.50||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.04||||61.80||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||0.04||| J3490|EAP|0252|ANASTROZOLE TAB 1 MG ARIMIDEX|Humana Medicare Advantage|HUMANA MEDICARE PPO|11.53||||47.40||| J3490|EAP|0252|FLUCONAZOLE 150MG TOPICAL|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|49.75||||61.80||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|47.40||||61.80||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Humana Medicare Advantage|HUMANA MEDICARE PPO|49.75||||11.50||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.10||||7.10||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|96.05||||61.80||| J3490|EAP|0252|AMLODIPINE TAB 10 MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Humana Medicare Advantage|HUMANA MEDICARE PPO|14.10||||7.10||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|7.10||||||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.65||||0.65||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.65||||0.65||| J3490|EAP|0252||Humana Medicare Advantage|HUMANA MEDICARE PPO|3.85||||47.80||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|6.40||||6.40||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.65||||||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.65||||0.65||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.65||||3.15||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|42.85||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|46.15||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|ChampVA|CHAMPVA OF CO DENVER|42.85||||42.85||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|ChampVA|CHAMPVA OF CO DENVER|42.85||||21.30||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|ChampVA|CHAMPVA OF CO DENVER|30.20||||12.80||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||12.80||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|ChampVA|CHAMPVA OF CO DENVER|7.50||||11.55||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|ChampVA|CHAMPVA OF CO DENVER|3.15||||9.75||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|ChampVA|CHAMPVA OF CO DENVER|3.15||||11.50||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|ChampVA|CHAMPVA OF CO DENVER|3.15||||20.10||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|ChampVA|CHAMPVA OF CO DENVER|7.10||||||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|ChampVA|CHAMPVA OF CO DENVER|0.65||||0.65||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Blue Cross PPO Select|BCBS UTHCT|||||18.05||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|ChampVA|CHAMPVA OF CO DENVER|||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Workers Compensation|WC GALLAGHER BASSETT|||||42.85||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Workers Compensation|WC OTHER|||||11.50||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Workers Compensation|WC OTHER|||||36.35||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||30.20||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Workers Compensation|WC OTHER|||||3.15||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|Workers Compensation|WC TX MUTUAL INS|||||21.45||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Workers Compensation|WC OTHER|||||13.50||| J3490|EAP|0251|LIDOCAINE 1:100,000|Workers Compensation|WC TX MUTUAL INS|||||11.50||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||1.05||| J3490|EAP|0251|LIDOCAINE 1:100,000|Workers Compensation|WC OTHER|||||11.50||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Workers Compensation|WC TX MUTUAL INS|||||11.55||| J3490|EAP|0251|METOPROLOL TARTRATE|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Workers Compensation|WC OTHER|||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Workers Compensation|WC OTHER|||||12.80||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|Workers Compensation|WC OTHER|||||21.45||| J3490|EAP|0251|LIDOCAINE 1:100,000|Workers Compensation|DO NOT USE----ENABLE COMP|||||11.50||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||18.05||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|PHCS|TML GRP INS|42.85||||||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.75||||9.75||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|United Healthcare|UMR|18.05||||36.55||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.15||||21.30||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.00||||3.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.04||||0.04||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|3.15||||37.60||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|39.80||||21.30||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|137.85||||3.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.22||||0.04||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|42.85||||0.04||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||3.15||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||11.50||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|3.15||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|21.30||||0.04||| J3490|EAP|0250||United Medicare Advantage|UNITED HEALTHCARE GROUP MA|42.85||||0.22||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|137.85||||51.80||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||0.04||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.75||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||14.20||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||9.75||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||34.40||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||9.75||| J3490|EAP|0251|LIDOCAINE HCL INJECTION 2% MPF|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.50||||11.50||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||47.80||| J3490|EAP|0250|DRONEDARONE 400 MG TAB|Humana Medicare Advantage|HUMANA MEDICARE PPO|40.75||||38.95||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||18.50||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||14.20||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||47.05||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|13.85||||0.00||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||13.50||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||21.45||| J3490|EAP|0251||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.65||||121.35||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|9.75||||3.15||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Humana Medicare Advantage|HUMANA MEDICARE PPO|140.45||||51.80||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||3.15||| J3490|EAP|0251|HYDRALAZINE TAB 25 MG U/D (APR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|7.10||||3.15||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||3.15||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||47.05||| J3490|EAP|0250|NEBIVOLOL 2.5 MC (BYSTOLIC)|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|21.30||||17.80||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||3.15||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|11.55||||9.75||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||32.20||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||11.50||| J3490|EAP|0251|LIDOCAINE 1:100,000|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||11.50||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||22.80||| J3490|EAP|0251|SODIUM POLYSTYRENE SULF 15G/60|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||77.85||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||20.10||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|14.20||||3.15||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Cigna|CIGNA OF TN CHATTANOOGA|||||11.50||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|9.75||||11.55||| J3490|EAP|0251|ACETAMINOPHEN EL 650 MG/25ML U|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|7.50||||1.05||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||20.10||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||11.50||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||11.50||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||22.80||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||36.35||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||9.75||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||20.10||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|47.05||||12.80||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||14.20||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||12.70||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Cigna|NALC HLTH BENEFIT|3.15||||3.15||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||7.10||| J3490|EAP|0251|SODIUM POLYSTYRENE SULF 15G/60|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|18.50||||77.85||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|7.50||||7.50||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||9.75||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Cigna|CIGNA OPEN ACCESS PLUS|||||3.15||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|20.10||||0.65||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|11.50||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||15.75||| J3490|EAP|0252||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||3.85||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Cigna|CIGNA OF TN CHATTANOOGA|3.15||||5.25||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|47.40||||11.50||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||11.50||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||11.50||| J3490|EAP|0252|AMLODIPINE TAB 10 MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||3.15||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||61.80||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.04||||61.80||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Cigna|NALC HLTH BENEFIT|21.30||||||| J3490|EAP|0252|VALACYCLORVIR HCL 500 MG TABL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|14.10||||61.80||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|6.40||||6.40||| J3490|EAP|0250|BUDESONIDE 0.5MG/2ML AMPUL-NEB|Cigna|NALC HLTH BENEFIT|39.70||||||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.65||||7.75||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||3.15||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||0.65||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||0.65||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||72.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|42.85||||42.85||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||18.05||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|PHCS|TML GRP INS|0.65||||0.65||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|United Healthcare|UMR|42.85||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|United Healthcare|UMR|3.15||||21.30||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|United Healthcare|UMR|42.85||||42.85||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|United Healthcare|GOLDEN RULE INSURANCE|||||21.30||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|United Healthcare|GOLDEN RULE INSURANCE|||||14.20||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.65||||0.65||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|United Healthcare|UMR|3.15||||7.10||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|United Healthcare|UMR|3.15||||1.05||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.65||||0.65||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|United Healthcare|UMR|9.75||||12.80||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|United Healthcare|UMR|3.15||||22.80||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Managed Medicaid|SUPERIOR STAR MCD|49.75||||97.65||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|United Healthcare|GOLDEN RULE INSURANCE|||||12.05||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|United Healthcare|UMR|3.15||||9.75||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|42.85||||21.30||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|United Healthcare|GOLDEN RULE INSURANCE|||||7.50||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|42.85||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||42.85||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|United Healthcare|GOLDEN RULE INSURANCE|||||9.75||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Veterans Affairs|VETERANS CHOICE - TRI WEST|39.80||||51.80||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Managed Medicaid|MOLINA MEDICAID|||||34.15||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|42.85||||11.50||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|21.30||||11.50||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| J3490|EAP|0250|DEXTROSE ORAL GEL, 15 GRAM, PO|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||14.05||| J3490|EAP|0251|SODIUM CHLORIDE 3% FOR INHAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||3.15||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||23.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Veterans Affairs|VETERANS CHOICE - TRI WEST|18.50||||11.50||| J3490|EAP|0251|SPIRONOLACTONE TAB 25MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|United Healthcare|UMR|3.15||||20.10||| J3490|EAP|0251|LIDOCAINE 1:100,000|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||13.35||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||13.50||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Veterans Affairs|VETERANS CHOICE - TRI WEST|18.50||||34.40||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Veterans Affairs|VETERANS CHOICE - TRI WEST|7.50||||7.50||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Managed Medicaid|CHIP MOLINA HEALTHCARE|||||3.15||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||36.98||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|United Healthcare|UMR|3.15||||11.50||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||9.75||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Veterans Affairs|VETERANS CHOICE - TRI WEST|9.75||||20.10||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||22.80||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||7.10||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||20.10||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Veterans Affairs|VETERANS CHOICE - TRI WEST|18.50||||3.15||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||1.05||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|Managed Medicaid|OTHER MEDICAID|||||32.20||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||47.05||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||14.20||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|United Healthcare|UMR|11.50||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||12.80||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||3.15||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Veterans Affairs|VETERANS CHOICE - TRI WEST|39.95||||3.15||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||12.70||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||11.50||| J3490|EAP|0251|SILVER NITRATE APPLICATOR|Managed Medicaid|SUPERIOR STAR MCD|3.15||||19.95||| J3490|EAP|0251|METRONIDAZOLE/SODIUM CHLORIDE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||11.50||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||11.55||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 1:100,000|United Healthcare|UMR|3.15||||11.50||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||9.75||| J3490|EAP|0251|METOPROLOL TARTRATE|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||3.15||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|3.15||||9.75||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Veterans Affairs|VETERANS CHOICE - TRI WEST|9.75||||9.75||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|Veterans Affairs|VETERANS CHOICE - TRI WEST|47.05||||47.80||| J3490|EAP|0251|HYDROCHLOROTHIAZIDE TAB 25MG U|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Veterans Affairs|VETERANS CHOICE - TRI WEST|18.50||||36.35||| J3490|EAP|0251|LIDOCAINE VISCUOUS 2% 30 ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||7.05||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|9.75||||7.50||| J3490|EAP|0251|METOPROLOL TARTRATE|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||5.55||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|11.55||||61.80||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||61.80||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Managed Medicaid|SUPERIOR STAR MCD|3.15||||11.50||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.04||||61.80||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||6.40||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Veterans Affairs|VETERANS CHOICE - TRI WEST|7.10||||61.80||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.85||||6.40||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Veterans Affairs|VETERANS CHOICE - TRI WEST|6.40||||61.80||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|United Healthcare|UMR|3.15||||14.20||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|United Healthcare|UMR|3.15||||7.50||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.65||||0.65||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Managed Medicaid|SUPERIOR STAR MCD|3.15||||3.15||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|18.50||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.65||||0.65||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|United Healthcare|GOLDEN RULE INSURANCE|||||16.20||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.65||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.65||||0.65||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.75||||9.75||| J3490|EAP|0257|OXYMETAZOLINE 0.05% NASAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.65||||3.15||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||42.85||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|United Healthcare|GOLDEN RULE INSURANCE|||||3.35||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|United Healthcare|UMR|3.15||||3.15||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|47.05||||3.15||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|United Healthcare|UMR|3.15||||9.75||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|United Healthcare|UMR|0.00||||61.80||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|United Healthcare|UMR|4.78||||61.80||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|United Healthcare|UMR|0.65||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|United Healthcare|UMR|0.65||||0.65||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|United Healthcare|UMR|0.65||||7.75||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|United Healthcare|UMR|||||8.25||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|PHCS|TML GRP INS|0.65||||7.75||| J3490|EAP|0251|LIDOCAINE VISCUOUS 2% 30 ML|Managed Medicaid|SUPERIOR STAR MCD|3.15||||7.05||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Managed Medicaid|SUPERIOR STAR MCD|3.15||||11.55||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Multiplan|TML GRP INS|42.85||||5.25||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Multiplan|WEB TPA OF GRAND PRAIRIE|||||21.30||| J3490|EAP|0250|PHENOL EZ SWAB|Multiplan|GILSBAR INC|||||16.20||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Multiplan|TML GRP INS|0.04||||5.25||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.75||||23.15||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Multiplan|WEB TPA|||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Multiplan|GILSBAR INC|||||20.10||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Multiplan|WEB TPA|||||9.75||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Multiplan|TML GRP INS|||||20.10||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Multiplan|WEB TPA OF GRAND PRAIRIE|||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Multiplan|WEB TPA|||||14.20||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Multiplan|WEB TPA OF GRAND PRAIRIE|||||14.20||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Multiplan|WEB TPA|||||22.80||| J3490|EAP|0250|VOLTAREN 75MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||6.30||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Multiplan|WEB TPA|||||12.80||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Multiplan|WEB TPA|||||20.10||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Multiplan|TML GRP INS|0.65||||7.75||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Multiplan|TML GRP INS|0.65||||0.65||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Managed Medicaid|SUPERIOR STAR MCD|42.85||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Managed Medicaid|MOLINA MEDICAID|||||42.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Multiplan|TML GRP INS|42.85||||||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|NON CONTRACTED|COMMERCIAL OTHER|3.15||||3.15||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|NON CONTRACTED|MRAMVA|||||21.30||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|NON CONTRACTED|COMMERCIAL OTHER 2|42.85||||42.85||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|NON CONTRACTED|COMMERCIAL OTHER|21.30||||11.50||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|NON CONTRACTED|COMMERCIAL OTHER|81.60||||21.30||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|NON CONTRACTED|COMMERCIAL OTHER|3.15||||3.15||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|NON CONTRACTED|BOONE CHAPMAN|||||3.15||| J3490|EAP|0250|INHALER, VENTOLIN HFA|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.04||||78.35||| J3490|EAP|0250|CALCITRIOL 1 MG BOTTLE|NON CONTRACTED|COMMERCIAL OTHER|39.80||||42.40||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|NON CONTRACTED|COMMERCIAL OTHER|42.85||||42.85||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|NON CONTRACTED|COMMERCIAL OTHER|34.40||||22.80||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|NON CONTRACTED|COMMERCIAL OTHER|13.85||||34.40||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Magellan Behaviroal Health|MAGELLAN HEALTHCARE|21.30||||||| J3490|EAP|0251|BOTTLE, SOLUTION 8ML, MONSEL'S|NON CONTRACTED|COMMERCIAL OTHER|9.75||||17.75||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|NON CONTRACTED|COMMERCIAL OTHER|13.85||||30.20||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|NON CONTRACTED|COMMERCIAL OTHER|13.85||||11.50||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|NON CONTRACTED|MRAMVA|||||32.20||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||11.55||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|NON CONTRACTED|COMMERCIAL OTHER|13.85||||3.15||| J3490|EAP|0251||NON CONTRACTED|COMMERCIAL OTHER|1.05||||21.80||| J3490|EAP|0251|MORPHINE SULF 10MG/10ML|NON CONTRACTED|COMMERCIAL OTHER|13.85||||12.75||| J3490|EAP|0251|METOPROLOL TARTRATE TAB 50 MG|NON CONTRACTED|COMMERCIAL OTHER|13.85||||3.15||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Blue Cross PPO Select|BCBS UTHCT|0.04||||12.50||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|NON CONTRACTED|COMMERCIAL OTHER|3.15||||47.05||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|NON CONTRACTED|COMMERCIAL OTHER|3.15||||12.80||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|NON CONTRACTED|COMMERCIAL OTHER|14.20||||3.15||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|NON CONTRACTED|COMMERCIAL OTHER 2|||||21.45||| J3490|EAP|0251|MORPHINE SULF 10MG/10ML|Blue Cross PPO Select|BCBS UTHCT|9.75||||0.12||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|NON CONTRACTED|COMMERCIAL OTHER|13.85||||36.35||| J3490|EAP|0251||NON CONTRACTED|COMMERCIAL OTHER|30.20||||121.35||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|NON CONTRACTED|COMMERCIAL OTHER|13.85||||3.15||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|NON CONTRACTED|COMMERCIAL OTHER|3.15||||9.75||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|NON CONTRACTED|BOONE CHAPMAN|||||12.80||| J3490|EAP|0251|LIDOCAINE 1:100,000|NON CONTRACTED|COMMERCIAL OTHER|3.15||||11.50||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|NON CONTRACTED|COMMERCIAL OTHER|13.85||||5.55||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|NON CONTRACTED|COMMERCIAL OTHER|13.85||||3.15||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Blue Cross PPO Select|BCBS UTHCT|9.75||||23.15||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|3.15||||12.70||| J3490|EAP|0251|LIDOCAINE HCL INJECTION 2% MPF|NON CONTRACTED|COMMERCIAL OTHER|66.50||||11.50||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|Blue Cross PPO Select|BCBS UTHCT|9.75||||21.45||| J3490|EAP|0251|SODIUM CHLORIDE 10% FOR INHAL|NON CONTRACTED|COMMERCIAL OTHER|13.85||||3.15||| J3490|EAP|0251|HYDRALAZINE TAB 25 MG U/D (APR|NON CONTRACTED|COMMERCIAL OTHER|9.75||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross PPO Select|BCBS UTHCT|9.75||||20.10||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|NON CONTRACTED|COMMERCIAL OTHER|9.75||||11.55||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|NON CONTRACTED|COMMERCIAL OTHER|7.50||||5.33||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|NON CONTRACTED|COMMERCIAL OTHER|3.15||||14.20||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|NON CONTRACTED|COMMERCIAL OTHER 2|||||11.50||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Blue Cross PPO Select|BCBS UTHCT|9.75||||3.15||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|NON CONTRACTED|COMMERCIAL OTHER|13.85||||9.75||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|NON CONTRACTED|BOONE CHAPMAN|||||20.10||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|NON CONTRACTED|COMMERCIAL OTHER|3.15||||20.10||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|NON CONTRACTED|COMMERCIAL OTHER|47.05||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|NON CONTRACTED|COMMERCIAL OTHER 2|||||7.50||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|NON CONTRACTED|COMMERCIAL OTHER 2|||||20.10||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|NON CONTRACTED|MRAMVA|||||0.65||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|NON CONTRACTED|COMMERCIAL OTHER|62.90||||11.55||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Blue Cross PPO Select|BCBS UTHCT|42.85||||51.80||| J3490|EAP|0252|AMLODIPINE TAB 10 MG U/D|NON CONTRACTED|COMMERCIAL OTHER|3.15||||3.15||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|NON CONTRACTED|COMMERCIAL OTHER|14.10||||61.80||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Blue Cross PPO Select|BCBS UTHCT|42.85||||3.15||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|NON CONTRACTED|COMMERCIAL OTHER|14.10||||97.65||| J3490|EAP|0252||NON CONTRACTED|COMMERCIAL OTHER|3.15||||47.80||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Blue Cross PPO|BCBS WALMART|||||520.60||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|NON CONTRACTED|COMMERCIAL OTHER|49.75||||6.40||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|NON CONTRACTED|COMMERCIAL OTHER|0.04||||11.50||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|PHCS|TML GRP INS|||||20.10||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|NON CONTRACTED|COMMERCIAL OTHER|0.65||||0.65||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|NON CONTRACTED|COMMERCIAL OTHER|0.65||||7.75||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|NON CONTRACTED|MRAMVA|||||0.65||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|NON CONTRACTED|PPO OTHER|||||0.65||| J3490|EAP|0257|BACITRACIN ZINC UNG 15 GM|NON CONTRACTED|COMMERCIAL OTHER|3.15||||32.30||| J3490|EAP|0257|ACETAMINOPHEN SUPP 120MG|NON CONTRACTED|COMMERCIAL OTHER|3.15||||6.30||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|NON CONTRACTED|COMMERCIAL OTHER 2|0.65||||||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|NON CONTRACTED|COMMERCIAL OTHER|3.15||||3.15||| J3490|EAP|0258|DEXTROSE 10% 1000 ML|NON CONTRACTED|COMMERCIAL OTHER|||||46.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Aetna|AETNA EL PASO CLAIMS OFFICE|3.15||||14.20||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||11.50||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|NON CONTRACTED|COMMERCIAL OTHER|||||8.25||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Medicare|MEDICARE A & B|||||520.60||| J3490|EAP|0258|SODIUM CHLORIDE 0.9%-KCL 20MEQ|Blue Cross PPO|BLUE CROSS PPO|46.15||||46.15||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Medicare|MEDICARE PART A|36.55||||||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Medicare|MEDICARE A & B|||||36.55||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|NON CONTRACTED|COMMERCIAL OTHER|||||520.60||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Optum Behavioral Health|OPTUM|9.75||||||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|PHCS|WEB TPA OF GRAND PRAIRIE|||||21.30||| J3490|EAP|0250|TOPROL XL 50MG TABLET|PHCS|TML GRP INS|0.04||||5.25||| J3490|EAP|0257|ACETAMINOPHEN 160MG/5ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|0.65||||7.75||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|PHCS|WEB TPA|||||3.15||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|PHCS|TML GRP INS|42.85||||5.25||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|PHCS|WEB TPA|||||9.75||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|PHCS|WEB TPA OF GRAND PRAIRIE|||||3.15||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Blue Cross PPO|BLUE CROSS PPO|96.05||||11.50||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|PHCS|WEB TPA|||||22.80||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|PHCS|WEB TPA|||||20.10||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|PHCS|WEB TPA OF GRAND PRAIRIE|||||14.20||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|PHCS|WEB TPA|||||14.20||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Blue Cross PPO|BLUE CROSS PPO|49.75||||11.50||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|PHCS|WEB TPA|||||12.80||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Medicare|MEDICARE A & B|7.10||||7.10||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Medicare|MEDICARE A & B|11.55||||11.50||| J3490|EAP|0252||Medicare|MEDICARE A & B|3.15||||48.29||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Medicare|MEDICARE RAILROAD|3.15||||11.55||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Medicare|MEDICARE A & B|49.75||||11.55||| J3490|EAP|0252|VALACYCLORVIR HCL 500 MG TABL|Medicare|MEDICARE PART A|14.10||||||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Medicare|MEDICARE A & B|14.10||||7.10||| J3490|EAP|0252|BUPIVACAINE INJ 0.25% 10ML SDV|Blue Cross PPO|BCBS WALMART|0.04||||11.50||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Medicare|MEDICARE A & B|34.15||||97.65||| J3490|EAP|0252|AMLODIPINE TAB 10 MG U/D|Medicare|MEDICARE A & B|6.40||||3.15||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Medicare|MEDICARE PART A|6.40||||||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Medicare|MEDICARE A & B|96.05||||61.80||| J3490|EAP|0252|FLUCONAZOLE 150MG TOPICAL|Medicare|MEDICARE A & B|23.10||||49.75||| J3490|EAP|0252||Medicare|MEDICARE A & B|3.15||||3.50||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Medicare|MEDICARE A & B|47.40||||4.78||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Medicare|MEDICARE PART A|0.65||||||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Blue Cross PPO|BLUE CROSS POS|38.75||||0.04||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.55||| J3490|EAP|0257|ASPIRIN 325MG TAB PO|Medicare|MEDICARE A & B|0.65||||0.65||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Medicare|MEDICARE A & B|3.15||||3.15||| J3490|EAP|0257|OXYMETAZOLINE 0.05% NASAL|Medicare|MEDICARE A & B|3.15||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Medicare|MEDICARE A & B|3.15||||0.65||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Blue Cross PPO|BCBS WALMART|3.15||||11.50||| J3490|EAP|0257|OXYMETAZOLINE 0.05% NASAL|Medicare|MEDICARE A & B|0.65||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Medicare|MEDICARE RAILROAD|||||0.65||| J3490|EAP|0257|OXYMETAZOLINE 0.05% NASAL|Medicare|MEDICARE PART A|3.15||||||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.45 1000ML|Medicare|MEDICARE A & B|42.60||||42.85||| J3490|EAP|0251|SCOPOLAMINE HYDROBROMIDE 1.5MG|Blue Cross PPO|BLUE CROSS PPO|9.78||||66.50||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Blue Cross PPO|BLUE CROSS PPO|9.78||||1.05||| J3490|EAP|0258|SODIUM CHLORIDE 0.9%-KCL 20MEQ|Medicare|MEDICARE A & B|46.15||||46.15||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Medicare|MEDICARE A & B|42.85||||42.85||| J3490|EAP|0258|DEXTROSE 10% 1000 ML|Medicare|MEDICARE A & B|42.85||||42.40||| J3490|EAP|0258||Medicare|MEDICARE A & B|42.60||||46.15||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Medicare|MEDICARE A & B|46.15||||42.85||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Managed Medicaid|FAMILY PLANNING GRANT|||||520.60||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.30||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||520.60||| J3490|EAP|0251|LIDOCAINE 2% JELLY 5ML TUBE|Blue Cross PPO|BCBS TRANE PPO|9.75||||29.85||| J3490|EAP|0636|ATROPINL 1MG/10ML ABBOJECT|Managed Medicaid|SUPERIOR STAR MCD|||||31.95||| J3490|EAP|0250|PHENOL EZ SWAB|Medicaid|MEDICAID|42.85||||16.20||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Medicaid|MEDICAID|665.45||||21.30||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Medicaid|MEDICAID|39.80||||5.25||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||9.75||| J3490|EAP|0250|PHENOL EZ SWAB|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||16.20||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicaid|MEDICAID|3.15||||42.85||| J3490|EAP|0250|PALIPERIDONE (INVEGA) 6MG PO|Medicaid|MEDICAID|21.30||||108.50||| J3490|EAP|0251|TUBERCULIN, PPD 5 TU /J349015|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||30.40||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||14.20||| J3490|EAP|0251|LIDOCAINE 1:100,000|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||11.50||| J3490|EAP|0251|PREDNISOLONE NA PHOS /J349025|Medicaid|MEDICAID|3.15||||5.55||| J3490|EAP|0251|CLONIDINE HCL TAB 0.2 MG U.D|Medicaid|MEDICAID|7.50||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Medicaid|MEDICAID|3.15||||14.20||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Medicaid|MEDICAID|11.50||||11.50||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Medicaid|MEDICAID|3.15||||30.20||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||20.10||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||11.55||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||7.10||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Blue Cross PPO|BLUE CROSS POS|3.15||||30.20||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||0.65||| J3490|EAP|0251|ALUMINUM CHLORIDE 20.0% SOLUTI|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||23.15||| J3490|EAP|0251|BOTTLE, SOLUTION 8ML, MONSEL'S|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||17.75||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Medicaid|MEDICAID|30.20||||5.33||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Blue Cross PPO|BLUE CROSS PPO|3.15||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Medicaid|MEDICAID|10.15||||16.20||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||9.75||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Medicaid|MEDICAID|18.50||||37.60||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Medicaid|MEDICAID|11.55||||3.15||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||12.70||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Medicaid|MEDICAID|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross PPO|BLUE CROSS PPO|11.50||||20.10||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Medicaid|MEDICAID|9.75||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Medicaid|MEDICAID|9.75||||11.55||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Medicaid|MEDICAID|7.10||||20.10||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||12.80||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Medicaid|MEDICAID|3.15||||3.15||| J3490|EAP|0252|FLUCONAZOLE 150MG TOPICAL|Medicaid|MEDICAID|38.75||||49.75||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Blue Cross PPO|BLUE CROSS POS|3.15||||20.10||| J3490|EAP|0251|METOPROLOL TARTRATE TAB 50 MG|Blue Cross PPO|BLUE CROSS PPO|9.78||||3.15||| J3490|EAP|0252|AMLODIPINE TAB 5 MG U/D|Medicaid|MEDICAID|3.15||||6.40||| J3490|EAP|0257|BACITRACIN ZINC UNG 15 GM|Medicaid|MEDICAID|0.65||||32.30||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Medicaid|MEDICAID|0.65||||3.15||| J3490|EAP|0257|ACETAMINOPHEN ES TAB 500 MG|Medicaid|MEDICAID|7.75||||0.65||| J3490|EAP|0257|NEOMYCIN/POLYMY/BAC OINT 0.9GM|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.15||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Medicaid|MEDICAID|||||42.85||| J3490|EAP|0636|MEDROXYPROGESTERONE AC 150MG|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||520.60||| J3490|EAP|0636|INJ, LIDOCAINE 1% W/EPI 30ML|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||18.05||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Blue Cross PPO|BLUE CROSS POS|9.75||||14.50||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Medicare|MEDICARE PART A|3.15||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicare|MEDICARE A & B|42.85||||0.04||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||12.80||| J3490|EAP|0250|SODIUM BICARBONATE 0.5MEQ/ML V|Medicare|MEDICARE A & B|3.15||||66.95||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicare|MEDICARE RAILROAD|39.70||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicare|MEDICARE PART A|39.70||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Medicare|MEDICARE A & B|3.15||||0.04||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Medicare|MEDICARE A & B|17.30||||3.15||| J3490|EAP|0250|RIVASTIGMINE PATCH (EXELON)|Medicare|MEDICARE A & B|0.60||||0.04||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Blue Cross PPO|BLUE CROSS PPO|3.15||||3.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Medicare|MEDICARE A & B|21.30||||0.04||| J3490|EAP|0250|LIDOCAINE 1% MPF 2ml VIAL|Medicare|MEDICARE A & B|5.25||||11.50||| J3490|EAP|0250|LIALDA 1.2GM MESALAMINE|Medicare|MEDICARE A & B|9.40||||33.25||| J3490|EAP|0250|PHENOL EZ SWAB|Medicare|MEDICARE A & B|60.30||||16.20||| J3490|EAP|0250|IBUPROFEN 100MG/5ML /J349016|Medicare|MEDICARE A & B|546.20||||5.25||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Medicare|MEDICARE A & B|39.70||||51.80||| J3490|EAP|0250|INHALER, VENTOLIN HFA|Medicare|MEDICARE A & B|40.75||||2.28||| J3490|EAP|0250|QUETIPINE XR 300MG SEROQUEL XR|Medicare|MEDICARE A & B|11.50||||81.60||| J3490|EAP|0250|PHENOL EZ SWAB|Blue Cross PPO|BLUE CROSS PPO|21.30||||16.20||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicare|MEDICARE A & B|0.22||||42.85||| J3490|EAP|0250|PALIPERIDONE (INVEGA) 6MG PO|Medicare|MEDICARE A & B|53.40||||61.60||| J3490|EAP|0250|DESVENLAFAXINE ER 25MG TAB|Medicare|MEDICARE PART A|40.75||||42.85||| J3490|EAP|0250|QUETIPINE XR 300MG SEROQUEL XR|Medicare|MEDICARE A & B|81.60||||0.04||| J3490|EAP|0250|SODIUM CHLORIDE 7%, 3ML, INHL|Blue Cross PPO|BLUE CROSS PPO|42.85||||3.15||| J3490|EAP|0250|TOPROL XL 50MG TABLET|Medicare|MEDICARE A & B|0.04||||0.04||| J3490|EAP|0250|PALIPERIDONE (INVEGA) 6MG PO|Medicare|MEDICARE A & B|61.60||||0.04||| J3490|EAP|0250|ONDANSETRON ODT, 4MG, PO/TUBE|Medicare|MEDICARE A & B|3.15||||21.30||| J3490|EAP|0250|DRONEDARONE 400 MG TAB|Medicare|MEDICARE A & B|140.45||||38.95||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Medicare|MEDICARE A & B|38.95||||3.15||| J3490|EAP|0250|BUDESONIDE 0.5MG/2ML AMPUL-NEB|Medicare|MEDICARE A & B|137.85||||39.70||| J3490|EAP|0250|ORAPRED 30 MG ODT|Blue Cross PPO|BLUE CROSS PPO|0.22||||109.45||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicare|MEDICARE RAILROAD|42.85||||42.85||| J3490|EAP|0250||Medicare|MEDICARE A & B|471.90||||17.80||| J3490|EAP|0251|LIDOCAINE 1:100,000|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||11.50||| J3490|EAP|0250|IPRATROPIUM 0.02% IHN|Medicare|MEDICARE PART A|6.75||||42.85||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Medicare|MEDICARE PART A|42.85||||42.85||| J3490|EAP|0251|SILVER SULFADIAZINE CREAM 1% 2|Medicare|MEDICARE A & B|18.50||||32.08||| J3490|EAP|0251|LIDOCAINE 2% JELLY 5ML TUBE|Medicare|MEDICARE A & B|11.50||||29.85||| J3490|EAP|0258|SOL;IV SOD CHLOR 0.9 INJ 50ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||42.85||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Medicare|MEDICARE A & B|47.05||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Medicare|MEDICARE A & B|1.05||||7.50||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Medicare|MEDICARE RAILROAD|9.75||||20.10||| J3490|EAP|0251|LIDOCAINE 1:100,000|Medicare|MEDICARE A & B|9.75||||11.50||| J3490|EAP|0251|CLONIDINE HCL TAB 0.2 MG U.D|Medicare|MEDICARE A & B|3.15||||3.15||| J3490|EAP|0251|HYDROCHLOROTHIAZIDE TAB 25MG U|Medicare|MEDICARE A & B|0.65||||3.15||| J3490|EAP|0251|LIDOCAINE VISCUOUS 2% 30 ML|Medicare|MEDICARE A & B|3.15||||7.05||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Medicare|MEDICARE A & B|7.10||||9.75||| J3490|EAP|0251|SODIUM CHLORIDE 10% FOR INHAL|Aetna|AETNA EL PASO CLAIMS OFFICE|11.50||||3.15||| J3490|EAP|0251|LIDOCAINE 2% 50ML VIAL|Medicare|MEDICARE A & B|3.15||||26.45||| J3490|EAP|0251|SODIUM CHLORIDE 3% FOR INHAL|Medicare|MEDICARE A & B|18.50||||3.15||| J3490|EAP|0252|GLYCOPYRROLATE 0.2MG/ML 2 ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|49.75||||61.80||| J3490|EAP|0251|BUPIVACAINE W/EPI 0.25%/.005 1|Medicare|MEDICARE A & B|9.75||||14.20||| J3490|EAP|0251|ETHYL ALCOHOL 98% FOR INJ 5ML|Medicare|MEDICARE A & B|3.15||||476.45||| J3490|EAP|0252|XOPENEX 0.63MG/3ML SOL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.10||||7.10||| J3490|EAP|0251|METOPROLOL TARTRATE|Medicare|MEDICARE A & B|32.20||||3.15||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Medicare|MEDICARE A & B|77.85||||3.15||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Medicare|MEDICARE A & B|15.80||||3.15||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Medicare|MEDICARE RAILROAD|9.75||||9.50||| J3490|EAP|0251|PHYTONADIONE TAB 5MG|Medicare|MEDICARE A & B|8.45||||287.05||| J3490|EAP|0251|SODIUM POLYSTYRENE SULF 15G/60|Medicare|MEDICARE PART A|77.85||||3.15||| J3490|EAP|0251|LIDOCAINE 1%W/EPI 50ML VIAL|Medicare|MEDICARE A & B|3.15||||12.70||| J3490|EAP|0251|SODIUM POLYSTYRENE SULF 15G/60|Medicare|MEDICARE A & B|18.50||||77.85||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.50||||9.75||| J3490|EAP|0251|HYDROCODONE/APAP 5/325MG PO|Medicare|MEDICARE PART A|9.75||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Medicare|MEDICARE PART A|7.50||||3.15||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Medicare|MEDICARE PART A|3.15||||3.15||| J3490|EAP|0251|SILVER NITRATE APPLICATOR|Medicare|MEDICARE A & B|18.50||||19.95||| J3490|EAP|0251||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|21.80||||121.35||| J3490|EAP|0251||Medicare|MEDICARE A & B|1.05||||30.20||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Medicare|MEDICARE A & B|29.85||||11.55||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Medicare|MEDICARE A & B|18.50||||1.05||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Medicare|MEDICARE PART A|11.50||||3.15||| J3490|EAP|0251|WATER FOR INJECTION, BACT 10ML|Medicare|MEDICARE PART A|18.50||||3.15||| J3490|EAP|0251|PROMETHAZINE TAB 25MG|Medicare|MEDICARE A & B|18.50||||3.15||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|Medicare|MEDICARE PART A|3.15||||3.15||| J3490|EAP|0251|PANTOPRAZOLE SOD,INJ PER VIAL|Medicare|MEDICARE A & B|3.15||||30.20||| J3490|EAP|0258|SODIUM CHLORIDE 0.9%-KCL 20MEQ|Aetna|AETNA EL PASO CLAIMS OFFICE|46.15||||46.15||| J3490|EAP|0251|ACETAMINOPHEN EL 650 MG/25ML U|Medicare|MEDICARE A & B|121.35||||1.05||| J3490|EAP|0251|LIDOCAINE 2%-MPF AMP 20MG/ML|Medicare|MEDICARE A & B|3.15||||21.45||| J3490|EAP|0251|SODIUM CHLORIDE 0.9% 10 ML VI|Medicare|MEDICARE A & B|18.50||||11.50||| J3490|EAP|0251|PHYTONADIONE TAB 5MG|Medicare|MEDICARE PART A|287.05||||3.15||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Medicare|MEDICARE A & B|3.15||||14.20||| J3490|EAP|0251||Medicare|MEDICARE A & B|30.20||||121.35||| J3490|EAP|0251|FUROSEMIDE TAB 40 MG|Medicare|MEDICARE A & B|3.15||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Medicare|MEDICARE PART A|1.05||||7.50||| J3490|EAP|0251|GREEN DRAGON SUSPENSION 40 ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||14.20||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J3490|EAP|0251|ALBUTEROL/IPRATROPIUM 2.5-0.5M|Medicare|MEDICARE RAILROAD|7.50||||7.50||| J3490|EAP|0251|METRONIDAZOLE/SODIUM CHLORIDE|Medicare|MEDICARE A & B|3.15||||11.50||| J3490|EAP|0251|ALPRAZOLAM TAB .5MG U/D|Medicare|MEDICARE A & B|9.75||||9.75||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Medicare|MEDICARE A & B|3.15||||3.15||| J3490|EAP|0251|LIDOCAINE 1% 5ML INJ /J349013|Medicare|MEDICARE A & B|7.05||||20.10||| J3490|EAP|0251|HYDRALAZINE TAB 25 MG U/D (APR|Medicare|MEDICARE A & B|9.75||||3.15||| J3490|EAP|0251|METOPROLOL TARTRATE TAB 50 MG|Medicare|MEDICARE A & B|11.50||||3.15||| J3490|EAP|0251|SODIUM HYPOCHLORITE 100ML PO|Medicare|MEDICARE A & B|18.50||||8.10||| J3490|EAP|0250|PHENOL EZ SWAB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||16.20||| J3490|EAP|0250|CADEXOMER IODINE GEL 10GM TOP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|39.80||||51.80||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|Medicare|MEDICARE A & B|64.65||||47.80||| J3490|EAP|0251|BUPIVICAINE 0.5% 10M /J349022|Medicare|MEDICARE A & B|3.15||||12.80||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Medicare|MEDICARE A & B|11.55||||0.65||| J3490|EAP|0251|SODIUM CHLORIDE 10% FOR INHAL|Medicare|MEDICARE A & B|18.50||||3.15||| J3490|EAP|0251|BUPIVICAINE 0.25% W/EPI 50ML V|Aetna|AETNA EL PASO CLAIMS OFFICE|9.75||||47.80||| J3490|EAP|0251|FLUORESCEIN NA OPH STRIP|Medicare|MEDICARE A & B|14.20||||3.15||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Medicare|MEDICARE PART A|30.20||||3.15||| J3490|EAP|0251|CLONIDINE HCL 0.1 MG TAB|Medicare|MEDICARE RAILROAD|9.75||||3.15||| J3490|EAP|0251|NACL 0.9% NEB 3ML INHALED|Medicare|MEDICARE PART A|3.15||||3.15||| J3490|EAP|0251|SPIRONOLACTONE TAB 25MG|Medicare|MEDICARE A & B|18.50||||3.15||| J3490|EAP|0251|DEXTROSE 50% 50ML SYR LS|Medicare|MEDICARE A & B|4.45||||47.05||| J3490|EAP|0251|IBUPROFEN TAB 200 MG U/D|Medicare|MEDICARE PART A|0.65||||3.15||| J3490|EAP|0251|HYDROCHLOROTHIAZIDE TAB 25MG U|Medicare|MEDICARE PART A|3.15||||3.15||| J3490|EAP|0252|LIDOCAINE 4% CREAM(GM)/J349012|Aetna|AETNA EL PASO CLAIMS OFFICE|0.04||||34.15||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Medicare|MEDICARE PART A|9.75||||3.15||| J3490|EAP|0251|LIDOCAINE UROJECT, 2%, 10ML|Medicare|MEDICARE A & B|287.05||||22.80||| J3490|EAP|0251|POTASSIUM CHLORIDE TAB 20MEQ|Medicare|MEDICARE RAILROAD|9.75||||3.15||| J3490|EAP|0251|LISINOPRIL TAB 20 MG U/D|Medicare|MEDICARE PART A|3.15||||3.15||| J3490|EAP|0250|SODIUM CHLORIDE 0.9% 100ML|Aetna|AETNA EL PASO CLAIMS OFFICE|42.85||||42.85||| J3490|EAP|0250|VOLTAREN 75MG|Aetna|AETNA EL PASO CLAIMS OFFICE|6.30||||3.15||| J3490|EAP|0251|LIDOCAINE 1:100,000|Medicare|MEDICARE PART A|11.50||||3.15||| J3490|EAP|0251|LORAZEPAM TAB 1MG U/D|Medicare|MEDICARE A & B|66.50||||9.75||| J3490|EAP|0251|LIDOCAINE 2% EPI 1:100000 20ML|Medicare|MEDICARE A & B|3.15||||13.50||| J3490|EAP|0251|LIDOCAINE 1% 10 ml|Medicare|MEDICARE PART A|11.55||||3.15||| J3490|EAP|0251|SODIUM BICARBONATE 1MEQ/ML 50|Medicare|MEDICARE A & B|18.50||||34.40||| J3490|EAP|0251|TETRACAINE HCL 0.5% OPH SOLN|Medicare|MEDICARE A & B|18.50||||36.35||| J3490|EAP|0251|LEVALBUTEROL 1.25MG SOLN INH|Medicare|MEDICARE A & B|20.10||||7.10||| J3490|EAP|0251|ALPRAZOLAM TAB .25MG U/D|Medicare|MEDICARE A & B|7.50||||9.75||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Medicare|MEDICARE A & B|3.15||||0.04||| J3490|EAP|0252|DILATIAZEM HCL 25MG/5ML VIAL|Medicare|MEDICARE PART A|11.55||||||| J3490|EAP|0252|VALACYCLORVIR HCL 500 MG TABL|Medicare|MEDICARE A & B|0.04||||14.10||| J3490|EAP|0252|METOPROLOL SUCCINATE XL 25MG|Medicare|MEDICARE PART A|3.15||||||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Medicare|MEDICARE PART A|42.85||||||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Medicare|MEDICARE A & B|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Medicaid|MEDICAID|0.35||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|NON CONTRACTED|COMMERCIAL OTHER|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||0.35||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|0.35||||||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|42.85||||||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Cigna|CIGNA OPEN ACCESS PLUS|||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Managed Medicaid|SUPERIOR STAR MCD|42.85||||||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Blue Cross PPO Select|BCBS UTHCT|42.85||||||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Aetna|AETNA EL PASO CLAIMS OFFICE|||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||42.85||| J7030|EAP|0258|SOL; IV SOD CHLOR 0.9 1000ML|Blue Cross PPO|BLUE CROSS POS|||||0.45||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Aetna|AETNA EL PASO CLAIMS OFFICE|37.75||||||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||32.90||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||42.85||| J7040|EAP|0258|NORMAL SAL 500ML AVIVA 0.9%|Blue Cross PPO|BLUE CROSS PPO|42.85||||24.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Blue Cross PPO Select|BCBS UTHCT|||||32.90||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Managed Medicaid|SUPERIOR STAR MCD|||||32.60||| J7040|EAP|0258|NORMAL SAL 500ML AVIVA 0.9%|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||24.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||42.85||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||24.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Blue Cross PPO|BLUE CROSS POS|||||9.52||| J7040|EAP|0258|NORMAL SAL 500ML AVIVA 0.9%|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||24.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||32.60||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||22.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|ChampVA|CHAMPVA OF CO DENVER|||||42.85||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||9.52||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|42.85||||37.75||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||22.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|NON CONTRACTED|COMMERCIAL OTHER|||||24.71||| J7040|EAP|0258|NORMAL SAL 500ML AVIVA 0.9%|Medicare|MEDICARE A & B|42.85||||24.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Medicare|MEDICARE A & B|42.85||||32.90||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Medicare|MEDICARE PART A|42.85||||||| J7040|EAP|0258|NORMAL SAL 500ML AVIVA 0.9%|Medicaid|MEDICAID|||||24.71||| J7040|EAP|0258|SOL; IV SOD CHLOR 0.9 500ML|Medicaid|MEDICAID|||||32.60||| J7042|EAP|0258|DEXTROSE 5% - 0.45% NACL 1000|Medicare|MEDICARE PART A|42.85||||||| J7042|EAP|0258|DEXTROSE 5% - 0.45% NACL 500 M|Medicare|MEDICARE A & B|42.85||||42.85||| J7042|EAP|0258|DEXTROSE 5%-0.9% NACL 1000 ML|Medicare|MEDICARE A & B|42.85||||42.85||| J7042|EAP|0258|DEXTROSE 5% - 0.45% NACL 500 M|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||42.85||| J7042|EAP|0258|DEXTROSE 5% - 0.45% NACL 1000|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||||| J7042|EAP|0258|DEXTROSE 5%-0.9% NACL 1000 ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|42.85||||||| J7042|EAP|0258|DEXTROSE 5% - 0.45% NACL 500 M|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||||| J7042|EAP|0258|DEXTROSE 5% - 0.45% NACL 1000|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||42.85||| J7042|EAP|0258|DEXTROSE 5%-0.9% NACL 1000 ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||||| J7042|EAP|0258|DEXTROSE 5%-0.9% NACL 1000 ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||42.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Blue Cross PPO Select|BCBS UTHCT|42.85||||33.08||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross PPO Select|BCBS UTHCT|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||32.60||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|41.10||||46.15||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Aetna|AETNA EL PASO CLAIMS OFFICE|42.85||||23.55||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Aetna|AETNA|||||32.60||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Aetna|AETNA EL PASO CLAIMS OFFICE|42.85||||31.25||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||3.64||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Blue Cross PPO|BLUE CROSS POS|42.85||||11.07||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Blue Cross PPO|BLUE CROSS PPO|41.10||||25.35||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross PPO|BLUE CROSS POS|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||42.85||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross PPO|BCBS TRANE PPO|42.85||||36.18||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Blue Cross PPO|BLUE CROSS POS|42.85||||9.45||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross PPO|BLUE CROSS PPO|42.85||||41.10||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Blue Cross PPO|BLUE CROSS POS|41.10||||25.35||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Managed Medicaid|MOLINA MEDICAID|||||42.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Managed Medicaid|SUPERIOR STAR MCD|41.10||||42.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||32.60||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||41.10||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|41.10||||46.15||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||32.60||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Cigna|CIGNA OF TN CHATTANOOGA|||||31.25||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Cigna|NALC HLTH BENEFIT|41.10||||||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Cigna|CIGNA OF TN CHATTANOOGA|||||42.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|42.85||||24.15||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|41.10||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.00||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Cigna|NALC HLTH BENEFIT|42.85||||||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||24.71||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|41.10||||32.60||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|41.10||||25.35||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||41.10||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|ChampVA|CHAMPVA OF CO DENVER|||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|ChampVA|CHAMPVA OF CO DENVER|||||72.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|ChampVA|CHAMPVA OF CO DENVER|||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Workers Compensation|WC GALLAGHER BASSETT|||||42.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|PHCS|TML GRP INS|23.55||||42.85||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||24.15||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|42.85||||41.10||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Managed Medicaid|SUPERIOR STAR MCD|41.10||||21.33||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross PPO|BCBS WALMART|42.85||||41.10||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|40.50||||11.35||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|42.85||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||22.21||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||31.25||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||31.25||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|42.43||||42.85||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|42.43||||56.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|42.85||||26.71||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Veterans Affairs|VETERANS CHOICE - TRI WEST|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Blue Cross PPO|BCBS WALMART|42.85||||32.60||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|42.85||||25.35||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|United Healthcare|UMR|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|United Healthcare|UMR|42.85||||11.07||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|United Healthcare|UMR|41.10||||46.15||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Multiplan|TML GRP INS|23.55||||42.85||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|NON CONTRACTED|COMMERCIAL OTHER|42.85||||25.35||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|NON CONTRACTED|COMMERCIAL OTHER|42.85||||0.00||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|NON CONTRACTED|COMMERCIAL OTHER|42.85||||32.60||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Aetna|AETNA EL PASO CLAIMS OFFICE|41.10||||46.15||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|NON CONTRACTED|COMMERCIAL OTHER 2|||||24.15||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|NON CONTRACTED|COMMERCIAL OTHER|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Medicare|MEDICARE RAILROAD|42.85||||||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Medicare|MEDICARE A & B|42.85||||41.10||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Medicare|MEDICARE A & B|42.85||||32.60||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Medicare|MEDICARE A & B|42.85||||32.60||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Medicare|MEDICARE PART A|41.10||||||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Medicare|MEDICARE PART A|42.85||||||| J7050|EAP|0258|SOD CHLORIDE 250ML 0.9%, IV|Medicare|MEDICARE A & B|41.10||||46.15||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 150ML|Medicaid|MEDICAID|0.42||||32.60||| J7050|EAP|0258|SODIUM CHLORIDE 0.9% PB 100M|Medicaid|MEDICAID|41.10||||21.33||| J7050|EAP|0258|SOL; IV SOD CHLOR 0.9 250ML|Medicaid|MEDICAID|0.42||||28.38||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Medicare|MEDICARE A & B|42.85||||32.60||| J7060|EAP|0258|SOL; IV D5W 100ML|Medicare|MEDICARE A & B|46.15||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|Medicare|MEDICARE A & B|46.15||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Medicaid|MEDICAID|||||42.85||| J7060|EAP|0258|SOL; IV D5W 500ML|Medicaid|MEDICAID|||||42.85||| J7060|EAP|0258|DEXTROSE 5% 1000 ML|NON CONTRACTED|COMMERCIAL OTHER|||||46.15||| J7060|EAP|0258|DEXTROSE 5% 250 ML|NON CONTRACTED|COMMERCIAL OTHER|||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||42.85||| J7060|EAP|0258|SOL; IV D5W 500ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|United Healthcare|UMR|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Cigna|CIGNA OF TN CHATTANOOGA|||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|42.85||||32.60||| J7060|EAP|0258|DEXTROSE 5% 1000 ML|Medicare|MEDICARE PART A|46.15||||||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|46.15||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|ChampVA|CHAMPVA OF CO DENVER|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Managed Medicaid|SUPERIOR STAR MCD|||||42.85||| J7060|EAP|0258|SOL; IV D5W 500ML|Medicare|MEDICARE A & B|42.85||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|42.85||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|42.85||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|Blue Cross PPO|BCBS WALMART|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Blue Cross PPO|BCBS TRANE PPO|||||32.60||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||32.60||| J7060|EAP|0258|SOL; IV D5W 500ML|Blue Cross PPO|BLUE CROSS POS|||||32.60||| J7060|EAP|0258|SOL; IV D5W 100ML|Blue Cross PPO|BLUE CROSS PPO|42.85||||35.10||| J7060|EAP|0258|SOL; IV D5W 500ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||11.34||| J7060|EAP|0258|DEXTROSE 5% 250 ML|Blue Cross PPO Select|BCBS UTHCT|||||42.85||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|46.15||||55.50||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Blue Cross PPO|BLUE CROSS POS|46.15||||||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Blue Cross PPO|BLUE CROSS PPO|46.15||||46.15||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|46.15||||||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Cigna|CIGNA OF TN CHATTANOOGA|46.15||||||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|46.15||||46.15||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|46.15||||||| J7120|EAP|0258|DEXTROSE 5%-LACTATED RINGERS 1|Medicare|MEDICARE A & B|46.15||||42.85||| J7120|EAP|0258|SOL; IV LACT RING 1000ML|Medicare|MEDICARE A & B|46.15||||46.15||| J7298|EAP|0636|LEVONORGESTREL SYS 5YRS, 52 MG|Managed Medicaid|FAMILY PLANNING GRANT|||||12.30||| J7298|EAP|0636|LEVONORGESTREL SYST, 52 MG 5YR|Managed Medicaid|FAMILY PLANNING GRANT|||||12.30||| J7298|EAP|0636|LEVONORGESTREL SYS 5YRS, 52 MG|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||12.30||| J7298|EAP|0636|LEVONORGESTREL SYST, 52 MG 5YR|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||12.30||| J7298|EAP|0636|LEVONORGESTREL SYST, 52 MG 5YR|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||12.30||| J7300|EAP|0636|INTRAUTERINE COPPER CONTRACEP|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||3.92||| J7325|EAP|0636|SYNVISC-ONE 48MG/6ML SYRINGE|Blue Cross PPO|BLUE CROSS PPO|||||3,218.65||| J7325|EAP|0636|SYNVISC-ONE 48MG/6ML SYRINGE|Medicare|MEDICARE A & B|||||3,218.65||| J7500|EAP|0251|AZATHIOPRINE TAB 50MG|Medicare|MEDICARE A & B|8.35||||8.35||| J7502|EAP|0636|CYCLOSPRORINE CAP 100 MG|Blue Cross PPO|BLUE CROSS PPO|54.85||||||| J7507|EAP|0636|TACROLIMUS *PROGRAF* CAP 1 MG|Medicare|MEDICARE A & B|15.85||||15.85||| J7510|EAP|0636|PREDNISOLONE 10 MG% ORAPREDODT|Blue Cross PPO|BLUE CROSS PPO|||||51.05||| J7510|EAP|0636|PREDNISOLONE 10 MG% ORAPREDODT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||51.05||| J7510|EAP|0636|PREDNISOLONE 10 MG% ORAPREDODT|Managed Medicaid|SUPERIOR STAR MCD|||||51.05||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Multiplan|GILSBAR INC|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|Medicare|MEDICARE A & B|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Medicare|MEDICARE PART A|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Medicare|MEDICARE A & B|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 10 MG|Medicare|MEDICARE PART A|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 10 MG|Medicare|MEDICARE A & B|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|Medicare|MEDICARE PART A|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|NON CONTRACTED|COMMERCIAL OTHER|3.15||||3.15||| J7512|EAP|0257|PREDNISONE TAB 50MG U/D|Medicare|MEDICARE A & B|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 10 MG|Managed Medicaid|MOLINA MEDICAID|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Managed Medicaid|SUPERIOR STAR MCD|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 10 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Managed Medicaid|MOLINA MEDICAID|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Medicaid|MEDICAID|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Workers Compensation|WC TRAVELERS|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Veterans Affairs|VETERANS CHOICE - TRI WEST|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Medicare|MEDICARE RAILROAD|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Cigna|NALC HLTH BENEFIT|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Cigna|CIGNA OF TN CHATTANOOGA|||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Blue Cross PPO Select|BCBS UTHCT|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Humana Medicare Advantage|HUMANA MEDICARE PPO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|3.15||||||| J7512|EAP|0636|PREDNISONE TAB 5MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 5MG|Blue Cross PPO|BLUE CROSS PPO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Blue Cross PPO|BLUE CROSS PPO|3.15||||3.15||| J7512|EAP|0636|PREDNISONE TAB 20MG U/D|Blue Cross PPO|BLUE CROSS POS|||||3.15||| J7515|EAP|0636|CYCLOSPORINE CAP 25 MG|Blue Cross PPO|BLUE CROSS PPO|0.00||||||| J7517|EAP|0636|MYCOPHENULATE MOFETIL ORAL 250|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|28.25||||||| J7517|EAP|0636|MYCOPHENULATE MOFETIL ORAL 250|Medicare|MEDICARE A & B|28.25||||28.25||| J7517|EAP|0636|MYCOPHENULATE MOFETIL ORAL 250|Medicare|MEDICARE A & B|14.10||||28.25||| J7517|EAP|0636|MYCOPHENULATE MOFETIL ORAL 250|Blue Cross PPO|BLUE CROSS PPO|0.00||||||| J7517|EAP|0636|MYCOPHENOLATE 250 MG *CELLCEPT|Blue Cross PPO|BLUE CROSS PPO|0.00||||||| J7518|EAP|0250|MYCOPHENOLATE SODIUM DR TAB PO|Medicare|MEDICARE A & B|||||35.50||| J8540|EAP|0251|DEXAMETHASONE 4MG TAB|Managed Medicaid|SUPERIOR STAR MCD|4.30||||||| J8540|EAP|0251|DEXAMETHASONE 4MG TAB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||4.30||| J8540|EAP|0251|DEXAMETHASONE 4MG TAB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|4.30||||||| J8610|EAP|0251|METHOTREXATE TAB 2.5MG|Medicare|MEDICARE A & B|12.65||||||| J8610|EAP|0251|METHOTREXATE TAB 2.5MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|12.65||||||| J8999|EAP|0636|MEGESTROL 20 MG TAB|Medicare|MEDICARE A & B|3.15||||||| J9000|EAP|0636|DOXORUBICIN INJ 10MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||18.21||| J9000|EAP|0636|DOXORUBICIN INJ 10MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||18.21||| J9000|EAP|0636|DOXORUBICIN INJ 10MG|Medicare|MEDICARE A & B|||||18.21||| J9022|EAP|0636|ATEZOLIZUMAB (TECENTRIQ) 10MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||24,338.40||| J9022|EAP|0636|ATEZOLIZUMAB 1200MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||24,338.40||| J9022|EAP|0636|ATEZOLIZUMAB 1200MG|Medicare|MEDICARE A & B|||||25,957.20||| J9022|EAP|0636|ATEZOLIZUMAB 1200MG|ChampVA|CHAMPVA OF CO DENVER|||||25,957.20||| J9022|EAP|0636|ATEZOLIZUMAB (TECENTRIQ) 10MG|Blue Cross PPO|BLUE CROSS PPO|||||18,179.05||| J9022|EAP|0636|ATEZOLIZUMAB 1200MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||25,957.20||| J9022|EAP|0636|ATEZOLIZUMAB (TECENTRIQ) 10MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||18,179.05||| J9025|EAP|0636|AZACITIDINE 1MG VIAL, SUB Q|Medicare|MEDICARE A & B|||||7.80||| J9025|EAP|0636|AZACITIDINE 1MG VIAL, SUB Q|Medicare|MEDICARE A & B|||||7.23||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Blue Cross PPO|BLUE CROSS PPO|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Blue Cross PPO|BLUE CROSS PPO|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Blue Cross PPO|BLUE CROSS POS|||||9,057.40||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Medicaid|MEDICAID|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|Medicare|MEDICARE A & B|||||9,095.30||| J9035|EAP|0636|BEVACIZUMAB 10 mg(100mg vial)|Medicare|MEDICARE A & B|||||2,585.55||| J9035|EAP|0636|BEVACIZUMAB 10 mg(400mg vial)|NON CONTRACTED|COMMERCIAL OTHER|||||9,095.30||| J9040|EAP|0636|BLEOMYCIN INJ 30 UNITS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||255.45||| J9041|EAP|0636|BORTEZOMIB 0.1 MG, IV|Medicare|MEDICARE A & B|||||107.70||| J9041|EAP|0636|BORTEZOMIB 0.1 MG, IV|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||107.70||| J9041|EAP|0636|BORTEZOMIB 0.1 MG, IV|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||107.70||| J9041|EAP|0636|BORTEZOMIB 0.1 MG, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||107.70||| J9042|EAP|0636|BRENTUXIMAB VEDOTIN 1MG INJ|Medicare|MEDICARE A & B|||||263.59||| J9043|EAP|0636|CABAZITAXEL (JEVTANA) 1MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||454.80||| J9043|EAP|0636|CABAZITAXEL (JEVTANA) 1MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||255.25||| J9043|EAP|0636|CABAZITAXEL (JEVTANA) 1MG|Medicare|MEDICARE A & B|||||454.80||| J9043|EAP|0636|CABAZITAXEL (JEVTANA) 1MG|Medicare|MEDICARE A & B|||||255.25||| J9045|EAP|0636|CARBOPLATIN 50 MG|Blue Cross PPO|BLUE CROSS PPO|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|ChampVA|CHAMPVA OF CO DENVER|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|Managed Medicaid|SUPERIOR STAR MCD|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|Medicaid|MEDICAID|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|Medicare|MEDICARE A & B|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|NON CONTRACTED|COMMERCIAL OTHER|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|United Healthcare|UMR|||||31.50||| J9045|EAP|0636|CARBOPLATIN 50 MG|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||26.25||| J9045|EAP|0636|CARBOPLATIN 50 MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||31.50||| J9047|EAP|0636|CARFILZOMIB 1MG (60MG VIAL)|Blue Cross PPO|BLUE CROSS PPO|||||106.50||| J9047|EAP|0636|INJ; CARFILZUMIB 1MG|Blue Cross PPO|BLUE CROSS PPO|||||106.50||| J9055|EAP|0636|CETUXIMAB 10MG (200MG VIAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||134.00||| J9055|EAP|0636|CETUXIMAB 10MG (100MG VIAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||134.01||| J9055|EAP|0636|CETUXIMAB 10MG (200MG VIAL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||134.00||| J9055|EAP|0636|CETUXIMAB 10MG (100MG VIAL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||134.00||| J9055|EAP|0636|CETUXIMAB 10MG (100MG VIAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||134.00||| J9055|EAP|0636|CETUXIMAB 10MG (200MG VIAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||134.00||| J9055|EAP|0636|CETUXIMAB 10MG (200MG VIAL)|Blue Cross PPO|BLUE CROSS POS|||||134.00||| J9055|EAP|0636|CETUXIMAB 10MG (100MG VIAL)|Blue Cross PPO|BLUE CROSS POS|||||134.00||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Blue Cross PPO|BLUE CROSS POS|||||11.70||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Blue Cross PPO|BLUE CROSS PPO|||||11.70||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11.71||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||11.71||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||11.71||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Medicare|MEDICARE A & B|||||11.70||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|NON CONTRACTED|COMMERCIAL OTHER|||||11.71||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.70||| J9060|EAP|0636|CISPLATIN 10 MG/10 ML AQUEOUS|Medicaid|MEDICAID|||||11.70||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 100MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||161.22||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 2GM 100MG|Medicare|MEDICARE A & B|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 2GM 100MG|Medicare|MEDICARE A & B|||||161.22||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 500 100 MG IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 1GM 100MG|Medicare|MEDICARE A & B|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 100MG INJ|Medicare|MEDICARE A & B|||||161.22||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 500 100 MG IM|Medicare|MEDICARE A & B|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 500 100 MG IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 1GM 100MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 100MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||161.22||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 1GM 100MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||171.95||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 100MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||161.22||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 100MG INJ|Blue Cross PPO|BLUE CROSS POS|||||161.22||| J9070|EAP|0636|CYCLOPHOSPHAMIDE 500 100 MG IM|Blue Cross PPO|BLUE CROSS POS|||||158.75||| J9119|EAP|0636|CEMIPLIMAB-R W/C (LIBTAYO) 1MG|Medicare|MEDICARE A & B|||||47.30||| J9130|EAP|0636|**DACARBAZINE INJ 100 MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||72.60||| J9130|EAP|0636|DACARBAZINE INJ 100MG VIAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||140.90||| J9145|EAP|0636|DARATUMUMAB (DARZALEX) 100MG|Medicare|MEDICARE A & B|||||1,027.20||| J9145|EAP|0636|DARATUMUMAB (DARZALEX) 400MG|Medicare|MEDICARE A & B|||||4,099.84||| J9145|EAP|0636|DARATUMUMAB (DARZALEX) 400MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4,099.84||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|Blue Cross PPO|BLUE CROSS POS|||||8.10||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|Blue Cross PPO|BLUE CROSS PPO|||||8.10||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||8.10||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||7.45||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||8.10||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||8.10||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|Medicare|MEDICARE A & B|||||8.10||| J9171|EAP|0636|DOCETAXEL 1MG (80MG VIAL)|NON CONTRACTED|COMMERCIAL OTHER|||||8.10||| J9173|EAP|0636|DURVALUMAB 500MG|Medicare|MEDICARE A & B|||||5,021.98||| J9173|EAP|0636|DURVALUMAB 120MG|Medicare|MEDICARE A & B|||||2,374.95||| J9173|EAP|0636|DURVALUMAB 500MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||9,749.30||| J9173|EAP|0636|DURVALUMAB 120MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||2,339.85||| J9173|EAP|0636|DURVALUMAB 120MG|Blue Cross PPO|BCBS WALMART|||||1,952.37||| J9179|EAP|0636|ERIBULIN (HALAVEN) 1MG (0.1mg)|Medicare|MEDICARE A & B|||||31.86||| J9181|EAP|0636|ETOPOSIDE 10MG/0.5ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||1.80||| J9181|EAP|0636|ETOPOSIDE 10MG/0.5ML|Blue Cross PPO|BLUE CROSS PPO|||||11.50||| J9181|EAP|0636|ETOPOSIDE 10MG/0.5ML|ChampVA|CHAMPVA OF CO DENVER|||||11.50||| J9181|EAP|0636|ETOPOSIDE 10MG/0.5ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11.50||| J9181|EAP|0636|ETOPOSIDE 10MG/0.5ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||11.50||| J9181|EAP|0636|ETOPOSIDE 10MG/0.5ML|Medicare|MEDICARE A & B|||||4.80||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Medicare|MEDICARE A & B|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Cigna|CIGNA OF TN CHATTANOOGA|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Blue Cross PPO|BCBS TRANE PPO|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||15.38||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Blue Cross PPO|BLUE CROSS POS|||||17.37||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Blue Cross PPO|BLUE CROSS PPO|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.35||| J9190|EAP|0636|5-FLOUROURACIL 500MG/10ML INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||19.35||| J9201|EAP|0636|GEMCITABINE 200MG INJ|United Healthcare|UMR|||||24.30||| J9201|EAP|0636|GEMCITABINE INJ 200MG|Blue Cross PPO|BLUE CROSS POS|||||30.37||| J9201|EAP|0636|GEMCITABINE 2GM 200MG|Blue Cross PPO|BLUE CROSS PPO|||||36.45||| J9201|EAP|0636|GEMZAR 2GM MDV VIAL|Medicare|MEDICARE A & B|||||36.45||| J9201|EAP|0636|GEMCITABINE INJ 200MG|United Healthcare|UMR|||||24.30||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||36.45||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||36.45||| J9201|EAP|0636|GEMCITABINE INJ 200MG|Blue Cross PPO|BCBS WALMART|||||36.45||| J9201|EAP|0636|GEMCITABINE INJ 200MG|Medicare|MEDICARE A & B|||||36.45||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Blue Cross PPO|BLUE CROSS PPO|||||36.45||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||36.45||| J9201|EAP|0636|GEMCITABINE INJ 200MG|Blue Cross PPO|BLUE CROSS PPO|||||36.45||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Blue Cross PPO|BLUE CROSS POS|||||30.37||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Blue Cross PPO|BCBS WALMART|||||36.45||| J9201|EAP|0636|GEMCITABINE 2GM 200MG|Medicare|MEDICARE A & B|||||36.45||| J9201|EAP|0636|GEMCITABINE 200MG INJ|Medicare|MEDICARE A & B|||||36.45||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross PPO|BCBS WALMART|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|Blue Cross PPO|BLUE CROSS POS|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|Blue Cross PPO|BCBS WALMART|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG WASTAGE|Medicare|MEDICARE A & B|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||12.75||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||17.24||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Medicare|MEDICARE A & B|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross PPO|BLUE CROSS POS|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross PPO|BLUE CROSS POS|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG WASTAGE|Blue Cross PPO|BLUE CROSS POS|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Blue Cross PPO|BCBS WALMART|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|Medicare|MEDICARE A & B|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG WASTAGE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||25.10||| J9206|EAP|0636|IRINOTECAN INJ 40MG VIAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||25.10||| J9206|EAP|0636|IRINOTECAN 20MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||25.10||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||11,283.55||| J9217|EAP|0331||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.67||| J9217|EAP|0636|LEUPROLIDE (ELIGARD)22.5MG|Cigna|NALC HLTH BENEFIT|||||0.00||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Medicare|MEDICARE PART B|||||23,466.50||| J9217|EAP|0636|LEUPROLIDE ACETATE 7.5MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4,878.25||| J9217|EAP|0636|LEUPROLIDE ACETATE 7.5MG|Aetna|AETNA|||||0.00||| J9217|EAP|0636|LEUPROLIDE ACETATE 7.5MG|Medicare|MEDICARE A & B|||||6,368.85||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||21,849.60||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|Medicare|MEDICARE A & B|||||11,283.55||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Medicare|MEDICARE A & B|||||23,466.50||| J9217|EAP|0636|LEUPROLIDE ACETATE 30 MG KIT|Medicare|MEDICARE A & B|||||15,644.10||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|Medicare|MEDICARE RAILROAD|||||11,283.55||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||11,283.55||| J9217|EAP|0636|LEUPROLIDE ACETATE 30 MG KIT|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||15,644.10||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||23,466.50||| J9217|EAP|0636|LEUPROLIDE ACETATE 30 MG KIT|NON CONTRACTED|COMMERCIAL OTHER|||||0.00||| J9217|EAP|0636|LEUPROLIDE ACETATE 7.5MG KIT|Aetna|AETNA EL PASO CLAIMS OFFICE|||||3,641.60||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|NON CONTRACTED|COMMERCIAL OTHER|||||11,283.55||| J9217|EAP|0636|LEUPROLIDE ACETATE 7.5MG KIT|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||3,911.05||| J9217|EAP|0636|LEUPROLIDE (ELIGARD)22.5MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||3,184.45||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||23,466.50||| J9217|EAP|0636|LEUPROLIDE ACETATE 30 MG KIT|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||15,644.10||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||11,283.55||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||23,466.50||| J9217|EAP|0636|LEUPROLIDE ACETATE 30 MG KIT|Blue Cross PPO|BLUE CROSS POS|||||15,644.10||| J9217|EAP|0636|LEUPROLIDE ACETATE DP 45MG IM|Blue Cross PPO|BLUE CROSS PPO|||||22,658.05||| J9217|EAP|0636|LEUPROLIDE ACETATE 22.5 MG|Aetna|AETNA|||||11,283.55||| J9217|EAP|0636|LEUPROLIDE ACETATE 7.5MG KIT|Blue Cross PPO|BLUE CROSS PPO|||||3,911.05||| J9263|EAP|0636|OXALIPLATIN WASTGE 0.5MG(50MG)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.40||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.10||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Medicare|MEDICARE A & B|||||6.10||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Medicare|MEDICARE A & B|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.10||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Cigna|CIGNA OF TN CHATTANOOGA|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Cigna|CIGNA OF TN CHATTANOOGA|||||6.10||| J9263|EAP|0636|OXALIPLATIN WASTGE 0.5MG(50MG)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||4.40||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Medicare|MEDICARE A & B|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.10||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Blue Cross PPO|BLUE CROSS PPO|||||6.10||| J9263|EAP|0636|OXALIPLATIN WASTGE 0.5MG(50MG)|Blue Cross PPO|BLUE CROSS PPO|||||4.40||| J9263|EAP|0636|OXALIPLATIN WASTGE 0.5MG(50MG)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||4.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Blue Cross PPO|BLUE CROSS PPO|||||6.10||| J9263|EAP|0636|OXALIPLATIN WASTGE 0.5MG(50MG)|Blue Cross PPO|BCBS TRANE PPO|||||4.40||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||4.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (50MG VIAL)|Blue Cross PPO|BCBS TRANE PPO|||||6.10||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Blue Cross PPO|BLUE CROSS PPO|||||6.10||| J9263|EAP|0636|OXALIPLATIN 0.5MG (100MG VIAL)|Blue Cross PPO|BCBS TRANE PPO|||||6.10||| J9263|EAP|0636|OXALIPLATIN 100MG 0.5MG IV|Blue Cross PPO|BCBS TRANE PPO|||||6.10||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Blue Cross PPO|BLUE CROSS PPO|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Blue Cross PPO|BCBS WALMART|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Medicare|MEDICARE A & B|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|NON CONTRACTED|COMMERCIAL OTHER|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|NON CONTRACTED|COMMERCIAL OTHER|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Medicare|MEDICARE A & B|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Blue Cross PPO|BLUE CROSS PPO|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|United Healthcare|UMR|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|United Healthcare|UMR|||||27.66||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||27.70||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Blue Cross PPO|BCBS WALMART|||||29.95||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||27.70||| J9264|EAP|0636|PACLITAXEL PROT-BOUND 1MG IV|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||27.66||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.80||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Medicaid|MEDICAID|||||22.76||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|United Healthcare|UMR|||||19.80||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||22.76||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Aetna|AETNA EL PASO CLAIMS OFFICE|||||19.80||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||19.80||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Blue Cross PPO|BLUE CROSS PPO|||||22.76||| J9267|EAP|0636|PACLITAXEL 30MG/5ML INJ|Medicare|MEDICARE A & B|||||19.80||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Medicaid|MEDICAID|||||76.48||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||127.45||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||152.95||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||152.95||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||152.95||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Blue Cross PPO|BLUE CROSS PPO|||||152.95||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.00||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||101.95||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||152.95||| J9271|EAP|0636|PEMBROLIZUMAB 1MG(100MG)|Medicare|MEDICARE A & B|||||152.95||| J9280|EAP|0636|MITOMYCIN 20MG INJ|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||552.05||| J9299|EAP|0636|NIVOLUMAB 1MG ENTRY|Medicare|MEDICARE A & B|||||87.55||| J9299|EAP|0636|NIVOLUMAB 1MG ENTRY|Cigna|CIGNA OF TN CHATTANOOGA|||||87.55||| J9299|EAP|0636|NIVOLUMAB(OPDIVO)1MG 40MG VIAL|Medicare|MEDICARE A & B|||||87.55||| J9299|EAP|0636|NIVOLUMAB 1MG ENTRY|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||71.11||| J9299|EAP|0636|NIVOLUMAB(OPDIVO)1MG 100MG VIA|Medicare|MEDICARE A & B|||||87.55||| J9299|EAP|0636|NIVOLUMAB 1MG ENTRY|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||87.55||| J9299|EAP|0636|NIVOLUMAB 1MG ENTRY|Aetna|AETNA EL PASO CLAIMS OFFICE|||||87.55||| J9301|EAP|0636|OBINUTUZUMAB(GAZYVA)|Medicare|MEDICARE A & B|||||179.55||| J9303|EAP|0636|PANITUMUMAB 400MG 10MG IV|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||231.76||| J9303|EAP|0636|PANITUMUMAB 400MG 10MG IV|Blue Cross PPO|BLUE CROSS POS|||||231.76||| J9305|EAP|0636|PEMETREXED 10MG (500MG VIAL)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||134.42||| J9305|EAP|0636|PEMETREXED 10MG (100MG VIAL)|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||137.10||| J9305|EAP|0636|PEMETREXED 10MG (100MG VIAL)|Managed Medicaid|SUPERIOR STAR MCD|||||137.10||| J9305|EAP|0636|PEMETREXED 10MG (500MG VIAL)|Medicaid|MEDICAID|||||134.42||| J9305|EAP|0636|PEMETREXED 10MG (100MG VIAL)|Medicaid|MEDICAID|||||137.10||| J9305|EAP|0636|PEMETREXED 100MG VIAL 10MG, IV|Medicaid|MEDICAID|||||148.50||| J9305|EAP|0636|PEMETREXED 100MG VIAL 10MG, IV|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||148.50||| J9305|EAP|0636|PEMETREXED 10MG (500MG VIAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||134.42||| J9305|EAP|0636|PEMETREXED 10MG (100MG VIAL)|Blue Cross PPO|BLUE CROSS PPO|||||137.10||| J9305|EAP|0636|PEMETREXED 100MG VIAL 10MG, IV|Blue Cross PPO|BLUE CROSS PPO|||||148.50||| J9305|EAP|0636|PEMETREXED 10MG (500MG VIAL)|Blue Cross PPO|BLUE CROSS PPO|||||134.42||| J9305|EAP|0636|PEMETREXED 10MG (100MG VIAL)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||137.10||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FRM 100MG V|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FR 500MG VI|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FRM 100MG V|Aetna|AETNA EL PASO CLAIMS OFFICE|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FR 500MG VI|Aetna|AETNA EL PASO CLAIMS OFFICE|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FRM 100MG V|Medicare|MEDICARE A & B|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FR 500MG VI|Medicare|MEDICARE A & B|||||188.63||| J9312|EAP|0636|WASTAGE -RITUXIMAB 10 MG INCRE|Medicare|MEDICARE A & B|||||203.80||| J9312|EAP|0636|WASTAGE -RITUXIMAB 10 MG INCRE|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||203.80||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FR 500MG VI|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FR 500MG VI|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FR 500MG VI|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||188.63||| J9312|EAP|0636|RITUXIMAB 10MG/ML (FRM 100MG V|Veterans Affairs|VETERANS CHOICE - TRI WEST|||||188.63||| J9315|EAP|0636|ROMIDEPSIN (ISTODAX) 1MG IV|Medicare|MEDICARE A & B|||||576.76||| J9354|EAP|0636|ADO-TRASTUZUMAB 1MG IVPB|Blue Cross PPO|BLUE CROSS PPO|||||0.01||| J9354|EAP|0636|ADO-TRASTUZUMAB EMT 1MG INJ|Aetna|AETNA EL PASO CLAIMS OFFICE|||||66.90||| J9354|EAP|0636|ADO-TRASTUZUMAB 1MG IVPB|Aetna|AETNA EL PASO CLAIMS OFFICE|||||69.95||| J9354|EAP|0636|ADO-TRASTUZUMAB 1MG IVPB|Aetna|AETNA EL PASO CLAIMS OFFICE|||||68.40||| J9354|EAP|0636|ADO-TRASTUZUMAB 1MG IVPB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||69.95||| J9354|EAP|0636|ADO-TRASTUZUMAB EMT 1MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||66.90||| J9354|EAP|0636|ADO-TRASTUZUMAB EMT 1MG INJ|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||67.40||| J9354|EAP|0636|ADO-TRASTUZUMAB 1MG IVPB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||68.40||| J9354|EAP|0636|ADO-TRASTUZUMAB EMT 1MG INJ|Medicare|MEDICARE A & B|||||67.40||| J9354|EAP|0636|ADO-TRASTUZUMAB EMT 1MG INJ|Medicare|MEDICARE A & B|||||66.90||| J9354|EAP|0636|ADO-TRASTUZUMAB 1MG IVPB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||69.95||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Medicare|MEDICARE A & B|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|NON CONTRACTED|COMMERCIAL OTHER|||||0.01||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Aetna|AETNA EL PASO CLAIMS OFFICE|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Aetna|AETNA|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||336.65||| J9355|EAP|0636|TRASTUZUMAB 10 MG, HERCEPTIN|Blue Cross PPO|BLUE CROSS PPO|||||336.65||| J9360|EAP|0636|VINBLASTINE INJ 1MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||10.16||| J9370|EAP|0636|VINCRISTINE SULFATE 1MG INJ|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||94.15||| J9370|EAP|0636|VINCRISTINE SULFATE 1MG INJ|Medicare|MEDICARE A & B|||||94.15||| J9395|EAP|0636|FULVESTRANT 250MG/25MG SYRING|Blue Cross PPO|BLUE CROSS POS|||||2,650.25||| J9395|EAP|0636|FULVESTRANT 250MG/25MG SYRING|Medicare|MEDICARE A & B|||||2,650.25||| J9999|EAP|0636||Medicare|MEDICARE A & B|||||47.30||| L0120|EAP|0274|CERVICAL COLLAR MED/LONG FIRM|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||44.10||| L0120|EAP|0274|CERVICAL COLLAR MED XLG (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||0.18||| L0120|EAP|0274|CERVICAL COLLAR LG (ER)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||44.10||| L0120|EAP|0274|CERVICAL COLLAR MED/LONG FIRM|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||44.10||| L0120|EAP|0274|CERVICAL COLLAR MED/LONG FIRM|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||44.10||| L0120|EAP|0274|CERVICAL COLLAR SMALL (ER)|Medicare|MEDICARE A & B|||||23.10||| L0120|EAP|0274|CERVICAL COLLAR LARGE (ER)|Medicare|MEDICARE A & B|||||0.38||| L0120|EAP|0274|CERVICAL COLLAR MED/LONG FIRM|Medicare|MEDICARE A & B|||||44.10||| L0120|EAP|0274|CERVICAL COLLAR LG (ER)|NON CONTRACTED|COMMERCIAL OTHER|||||44.10||| L0172|EAP|0274|COLLAR PHIL SMALL (ER)|Medicare|MEDICARE A & B|56.70||||56.70||| L0172|EAP|0274|CERVICAL COLLAR,HARD,SML|Medicare|MEDICARE A & B|56.70||||56.70||| L0172|EAP|0274||Workers Compensation|WC OTHER|||||0.51||| L0172|EAP|0274|COLLAR PHIL SMALL (ER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||56.70||| L0172|EAP|0274||Blue Cross PPO|BLUE CROSS PPO|||||0.51||| L0172|EAP|0274|COLLAR PHIL LARGE (ER)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||32.55||| L0172|EAP|0274|COLLAR PHIL LARGE (ER)|Medicare|MEDICARE A & B|56.70||||32.55||| L0172|EAP|0274||Aetna|AETNA EL PASO CLAIMS OFFICE|||||0.51||| L0172|EAP|0274||Medicare|MEDICARE A & B|0.51||||0.51||| L0172|EAP|0274|COLLAR PHIL LARGE (ER)|Blue Cross PPO Select|BCBS UTHCT|||||32.55||| L0172|EAP|0274||NON CONTRACTED|COMMERCIAL OTHER|||||0.51||| L0172|EAP|0274|COLLAR PHIL SMALL (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||56.70||| L0172|EAP|0274|COLLAR PHIL LARGE (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||32.55||| L0172|EAP|0274||NON CONTRACTED|MRAMVA|||||0.51||| L0172|EAP|0274|COLLAR PHIL SMALL (ER)|NON CONTRACTED|MRAMVA|||||56.70||| L0172|EAP|0274||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||0.51||| L1830|EAP|0274|IMMOBIL KNEE UNI (ER)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||0.48||| L1830|EAP|0274|IMMOBIL KNEE UNI (ER)|Medicare|MEDICARE A & B|||||0.48||| L1830|EAP|0274|IMMOBIL KNEE UNI (ER)|Blue Cross PPO|BLUE CROSS PPO|||||0.48||| L1830|EAP|0274|IMMOBIL KNEE UNI (ER)|Managed Medicaid|SUPERIOR STAR MCD|||||0.48||| L1830|EAP|0274|IMMOBIL KNEE UNI (ER)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.48||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|United Healthcare|UMR|||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Medicare|MEDICARE A & B|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|NON CONTRACTED|COMMERCIAL OTHER|||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Blue Cross PPO|BLUE CROSS POS|||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Medicaid|MEDICAID|9.34||||||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Blue Cross PPO|BLUE CROSS PPO|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Veterans Affairs|VETERANS CHOICE - TRI WEST|9.34||||||| P9016|EAP|0390||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Aetna|AETNA EL PASO CLAIMS OFFICE|9.34||||||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Managed Medicaid|SUPERIOR STAR MCD|||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|9.34||||9.34||| P9016|EAP|0390|RBC, LEUKOCYTES REDUCED BLOOD|Humana Medicare Advantage|HUMANA MEDICARE PPO|9.34||||9.34||| P9017|EAP|0390|FRESH FROZEN PLASMA - EACH UNI|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.95||||||| P9017|EAP|0390|FRESH FROZEN PLASMA - EACH UNI|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||2.95||| P9017|EAP|0390|FRESH FROZEN PLASMA - EACH UNI|Medicare|MEDICARE A & B|2.95||||2.95||| P9035|EAP|0390|PLATELETS PHERESIS, LEUKOREDUC|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||19.94||| P9035|EAP|0390|PLATELETS PHERESIS, LEUKOREDUC|Medicare|MEDICARE A & B|19.94||||19.94||| P9035|EAP|0390|PLATELETS PHERESIS, LEUKOREDUC|Blue Cross PPO|BLUE CROSS PPO|||||19.94||| P9035|EAP|0390|PLATELETS PHERESIS, LEUKOREDUC|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||19.94||| P9045|EAP|0636|ALBUMIN 5%, 250ML, IV|Medicare|MEDICARE A & B|322.35||||322.35||| P9046|EAP|0636|ALBUMIN 100 ML 25% 25GM 20ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|410.85||||||| P9046|EAP|0636|ALBUMIN 100 ML 25% 25GM 20ML|NON CONTRACTED|COMMERCIAL OTHER|||||410.85||| P9046|EAP|0636|ALBUMIN 100 ML 25% 25GM 20ML|Medicare|MEDICARE A & B|410.85||||410.85||| P9046|EAP|0636|ALBUMIN 100 ML 25% 25GM 20ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|410.85||||||| P9046|EAP|0636|ALBUMIN 100 ML 25% 25GM 20ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|410.85||||||| P9046|EAP|0636|ALBUMIN 100 ML 25% 25GM 20ML|Blue Cross PPO|BLUE CROSS POS|410.85||||410.85||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Medicare|MEDICARE PART A|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Medicaid|MEDICAID|||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Medicare|MEDICARE A & B|24.40||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Medicare|MEDICARE PART A|24.40||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Multiplan|TML GRP INS|24.40||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|NON CONTRACTED|COMMERCIAL OTHER 2|24.40||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|NON CONTRACTED|COMMERCIAL OTHER|24.40||||24.40||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|NON CONTRACTED|COMMERCIAL OTHER|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|PHCS|TML GRP INS|24.40||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|24.40||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Veterans Affairs|VETERANS CHOICE - TRI WEST|24.40||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|24.40||||24.40||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Veterans Affairs|VETERANS CHOICE - TRI WEST|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|United Healthcare|UMR|24.40||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Blue Cross PPO Select|BCBS UTHCT|24.40||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Blue Cross PPO|BLUE CROSS PPO|24.40||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|24.40||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|27.65||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Blue Cross PPO|BCBS TRANE PPO|24.40||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Blue Cross PPO|BCBS TRANE PPO|0.15||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Blue Cross PPO|BLUE CROSS PPO|27.65||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Aetna|AETNA EL PASO CLAIMS OFFICE|24.40||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.15||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Cigna|CIGNA OF TN CHATTANOOGA|||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Humana Medicare Advantage|HUMANA MEDICARE PPO|24.40||||24.40||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|24.40||||24.40||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Humana Medicare Advantage|HUMANA MEDICARE PPO|27.65||||21.33||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|ChampVA|CHAMPVA OF CO DENVER|24.40||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Medicare|MEDICARE A & B|0.15||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|United Healthcare|UMR|27.65||||||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|ChampVA|CHAMPVA OF CO DENVER|0.15||||||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Managed Medicaid|SUPERIOR STAR MCD|24.40||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|24.40||||24.40||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||24.40||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|27.65||||27.65||| Q0144|EAP|0251|AZITHROMYCIN 500MG, ORAL|Managed Medicaid|SUPERIOR RSA CHIP PLAN|||||24.40||| Q0144|EAP|0252|AZITHROMYCIN 250 MG TAB|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|0.15||||||| Q0161|EAP|0636|CHLORPROMAZINE HCL TAB 25MG|Blue Cross PPO|BLUE CROSS PPO|||||27.15||| Q0161|EAP|0636|CHLORPROMAZINE 50MG TAB PO|Blue Cross PPO|BLUE CROSS PPO|||||36.30||| Q0161|EAP|0636|CHLORPROMAZINE HCL TAB 25MG|Medicare|MEDICARE A & B|27.15||||||| Q0161|EAP|0636|CHLORPROMAZINE 50MG TAB PO|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||36.30||| Q0161|EAP|0636||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||55.35||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Veterans Affairs|VETERANS CHOICE - TRI WEST|21.30||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|17.75||||21.30||| Q0162|EAP|0636|ONDANSETRON 4 MG TABLET *ZOFRA|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|17.75||||17.75||| Q0162|EAP|0636|ONDANSETRON 4 MG TABLET *ZOFRA|Managed Medicaid|SUPERIOR STAR MCD|||||17.75||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Managed Medicaid|SUPERIOR STAR MCD|||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Medicare|MEDICARE A & B|21.30||||21.30||| Q0162|EAP|0636|ONDANSETRON 4 MG TABLET *ZOFRA|Medicare|MEDICARE A & B|17.75||||17.75||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|17.75||||21.30||| Q0162|EAP|0636||Medicare|MEDICARE A & B|21.30||||21.30||| Q0162|EAP|0636|ONDANSETRON 4 MG TABLET *ZOFRA|NON CONTRACTED|COMMERCIAL OTHER|17.75||||17.75||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Veterans Affairs|VETERANS CHOICE - TRI WEST|17.75||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Humana Medicare Advantage|HUMANA MEDICARE PPO|21.30||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Blue Cross PPO Select|BCBS UTHCT|||||21.30||| Q0162|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|17.75||||21.30||| Q0162|EAP|0636|ONDANSETRON 4 MG TABLET *ZOFRA|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|17.75||||17.75||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|17.75||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Blue Cross PPO|BLUE CROSS PPO|||||21.30||| Q0162|EAP|0636|ONDANSETRON ODT, 8MG, PO/TUBE|Blue Cross PPO|BCBS WALMART|21.30||||21.30||| Q0162|EAP|0636|ONDANSETRON 4 MG TABLET *ZOFRA|Blue Cross PPO|BLUE CROSS PPO|||||17.75||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Blue Cross PPO Select|BCBS UTHCT|||||0.65||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|13.35||||12.15||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Blue Cross PPO|BLUE CROSS PPO|0.65||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||0.65||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||13.35||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Blue Cross PPO|BLUE CROSS PPO|13.35||||12.15||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Aetna|AETNA EL PASO CLAIMS OFFICE|0.65||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Cigna|NALC HLTH BENEFIT|0.65||||||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.65||||0.65||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Humana Medicare Advantage|HUMANA MEDICARE PPO|13.35||||||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Managed Medicaid|STAR HLTH SUPERIOR FOSTER CARE|||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Managed Medicaid|SUPERIOR STAR MCD|||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|||||0.65||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Managed Medicaid|SUPERIOR STAR MCD|||||12.15||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|NON CONTRACTED|COMMERCIAL OTHER|0.65||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.65||||0.65||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Medicare|MEDICARE A & B|13.35||||||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Medicaid|MEDICAID|0.65||||||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|Medicaid|MEDICAID|||||12.15||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Medicare|MEDICARE A & B|0.65||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|0.65||||0.65||| Q0163|EAP|0251|DIPHENHYDRAMINE HCL CAP 25MG|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|||||0.65||| Q0163|EAP|0257|DIPHENHYDRAMINE ELIXIR/J349017|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||13.35||| Q0164|EAP|0251|PROCHLORPERAZINE MALEATE 5MG T|Medicare|MEDICARE A & B|3.15||||3.15||| Q0164|EAP|0251|PROCHLORPERAZINE MALEATE 5MG T|NON CONTRACTED|COMMERCIAL OTHER|3.15||||||| Q0164|EAP|0251|PROCHLORPERAZINE MALEATE 5MG T|Blue Cross PPO|BCBS WALMART|3.15||||||| Q0164|EAP|0251|PROCHLORPERAZINE MALEATE 5MG T|Blue Cross PPO|BLUE CROSS PPO|3.15||||||| Q0167|EAP|0636|DRONABINOL 5MG, CAP|Humana Medicare Advantage|HUMANA MEDICARE PPO|0.17||||||| Q0167|EAP|0636|DRONABINOL 5MG, CAP|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|0.17||||||| Q0167|EAP|0636|DRONABINOL 5MG, CAP|Medicare|MEDICARE PART A|0.17||||||| Q0167|EAP|0636|DRONABINOL 5MG, CAP|Medicare|MEDICARE A & B|0.17||||||| Q0167|EAP|0252|DRONABINOL 2.5 MG CAP|Medicare|MEDICARE A & B|23.35||||||| Q0181|EAP|0251|DEXAMETHASONE 1MG TABLET|Medicare|MEDICARE A & B|3.15||||||| Q0181|EAP|0251|DEXAMETHASONE 1MG TABLET|Blue Cross PPO|BLUE CROSS PPO|3.15||||||| Q2009|EAP|0636|FOSPHENYTOIN, 500MG/10ML, IV|NON CONTRACTED|COMMERCIAL OTHER|||||79.90||| Q2038|EAP|0636||Blue Cross PPO Select|BCBS UTHCT|||||45.15||| Q2038|EAP|0771||Blue Cross PPO Select|BCBS UTHCT|||||160.36||| Q2038|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| Q2038|EAP|0301||Medicare|MEDICARE A & B|||||3.14||| Q2038|EAP|0301||Medicare|MEDICARE A & B|||||2.45||| Q2038|EAP|0301|CALCITONIN (REF)|Medicare|MEDICARE A & B|||||2.60||| Q2038|EAP|0305||Medicare|MEDICARE A & B|||||1.68||| Q2038|EAP|0510||Medicare|MEDICARE A & B|||||2.50||| Q2038|EAP|0771|ADM OF INFLUENZA VACC (IMC)|Medicare|MEDICARE A & B|||||160.36||| Q2038|EAP|0771||Medicare|MEDICARE A & B|||||160.36||| Q5103|EAP|0636|INFLIXIMAB BIOSIMILAR 10 MG|Medicare|MEDICARE A & B|||||170.83||| Q5104|EAP|0636|INFLIXIMAB ABDA PER 10MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||203.45||| Q5104|EAP|0636|INFLIXIMAB ABDA PER 10MG|United Healthcare|UMR|||||203.45||| Q5104|EAP|0636|INFLIXIMAB ABDA PER 10MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||203.45||| Q5104|EAP|0636|INFLIXIMAB ABDA PER 10MG|Medicaid|MEDICAID|||||203.45||| Q5104|EAP|0636|INFLIXIMAB ABDA PER 10MG|Medicare|MEDICARE A & B|||||203.45||| Q5106|EAP|0636|Epoetin Alpha-EPBX 10,000|Medicare|MEDICARE A & B|9.75||||325.40||| Q5106|EAP|0636|EPOETIN ALFA 40,000 UNIT/Q5106|Medicare|MEDICARE A & B|9.75||||1,036.85||| Q5106|EAP|0636|Diazepam 10 mg tablet|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|9.75||||||| Q5106|EAP|0636|EPOETIN ALFA 40,000 UNIT/Q5106|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|||||1,036.85||| Q5106|EAP|0636|Epoetin Alpha-EPBX 10,000|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||325.40||| Q5106|EAP|0636|EPOETIN ALFA 40,000 UNIT/Q5106|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|||||1,036.85||| Q5106|EAP|0636|Epoetin Alpha-EPBX 10,000|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|325.40||||||| Q5111|EAP|0636|PEGFILGRASTIM 6MG/0.6ML SYR|Blue Cross PPO|BLUE CROSS PPO|||||11,272.50||| Q5111|EAP|0636|PEGFILGRASTIM 6MG/0.6ML SYR|Medicare|MEDICARE A & B|||||11,272.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Workers Compensation|WC OTHER|||||7.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|United Medicare Advantage|UNITED HEALTHCARE GROUP MA|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|United Medicare Advantage|DONT USE - CARE IMP PLUS MCR|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|PHCS|TML GRP INS|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Veterans Affairs|VETERANS CHOICE - TRI WEST|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|PHCS|WEB TPA|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|United Healthcare|GOLDEN RULE INSURANCE|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|United Healthcare|UMR|5.25||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Medicare|MEDICARE PART B|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Medicare|MEDICARE A & B|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Medicare|MEDICARE A & B|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Medicare|MEDICARE PART A|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Medicare|MEDICARE RAILROAD|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-349 MG/ML IODIN,100ML|Medicare|MEDICARE A & B|5.25||||1.16||| Q9967|EAP|0255||Medicaid|MEDICAID|||||2.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Medicaid|MEDICAID|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Medicaid|MEDICAID|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Multiplan|TML GRP INS|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Multiplan|WEB TPA OF GRAND PRAIRIE|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|NON CONTRACTED|COMMERCIAL OTHER|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|NON CONTRACTED|MRAMVA|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|NON CONTRACTED|COMMERCIAL OTHER|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Cigna|CIGNA OF TN CHATTANOOGA|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Cigna|NALC HLTH BENEFIT|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Cigna|CIGNA OF TN CHATTANOOGA|5.25||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Cigna|CIGNA OPEN ACCESS PLUS|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Cigna|CIGNA OF TN CHATTANOOGA|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.25||| Q9967|EAP|0255||Humana Medicare Advantage|HUMANA MEDICARE PPO|5.25||||2.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Multiplan|WEB TPA|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|ChampVA|CHAMPVA OF CO DENVER|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|ChampVA|CHAMPVA OF CO DENVER|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-349 MG/ML IODIN,100ML|ChampVA|CHAMPVA OF CO DENVER|7.50||||1.16||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Indegent Care (Smith County)|USE THIS FOR GENERIC INDIGENT|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Indegent Care (Smith County)|INDIGENT HEALTH RUSK|||||5.25||| Q9967|EAP|0255|LOCM 300-349 MG/ML IODIN,100ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|5.25||||1.16||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Medicare|MEDICARE PART A|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Managed Medicaid|SUPERIOR STAR MCD|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Managed Medicaid|MOLINA MEDICAID|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Managed Medicaid|MOLINA MEDICAID|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Medicare|MEDICARE RAILROAD|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Managed Medicaid|FAMILY PLANNING GRANT|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Managed Medicaid|SUPERIOR STAR MCD|5.25||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Aetna|AETNA|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|United Healthcare|UMR|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Aetna|AETNA EL PASO CLAIMS OFFICE|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Aetna|AETNA EL PASO CLAIMS OFFICE|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|5.25||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross PPO|BCBS TRANE PPO|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross PPO|BLUE CROSS POS|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross PPO|BCBS OF TX FED EMP OF DALLAS|||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|PHCS|WEB TPA OF GRAND PRAIRIE|||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross PPO|BLUE CROSS POS|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross PPO|BCBS WALMART|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross PPO|BLUE CROSS PPO|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross PPO|BCBS WALMART|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross PPO|BLUE CROSS PPO|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-349 MG/ML IODIN,100ML|Blue Cross PPO|BLUE CROSS PPO|5.25||||1.16||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross PPO|BCBS TRANE PPO|7.50||||5.25||| Q9967|EAP|0255|LOCM 300-349 MG/ML IODIN,100ML|Blue Cross PPO Select|BCBS UTHCT|5.25||||1.16||| Q9967|EAP|0255|LOCM 300-399MG/ML IODINE,320MG|Blue Cross PPO Select|BCBS UTHCT|7.50||||7.50||| Q9967|EAP|0255|LOCM 300-399 IODIN,300MG/100ML|Blue Cross PPO Select|BCBS UTHCT|7.50||||5.25||| S0039|EAP|0251|SULFAMETHOXAZOLE/TRIMETHOPRIM|NON CONTRACTED|COMMERCIAL OTHER|||||44.55||| S0166|EAP|0636|OLANZAPINE 10MG|Aetna|AETNA EL PASO CLAIMS OFFICE|||||133.80||| S0166|EAP|0636|OLANZAPINE 10MG|Humana Medicare Advantage|HUMANA MEDICARE PPO|133.80||||||| S0166|EAP|0636|OLANZAPINE 10MG|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|133.80||||133.80||| S0166|EAP|0636|OLANZAPINE 10MG|Veterans Affairs|VETERANS CHOICE - TRI WEST|133.80||||||| S0166|EAP|0636|OLANZAPINE 10MG|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|133.80||||||| S0166|EAP|0636|OLANZAPINE 10MG|Medicare|MEDICARE PART A|133.80||||||| S0166|EAP|0636|OLANZAPINE 10MG|Medicare|MEDICARE A & B|121.85||||121.85||| S3620|EAP|0300|NB SCREEN TEST KIT W/POSTAGE|Managed Medicaid|SUPERIOR STAR MCD|||||0.00||| S3620|EAP|0300|NB SCREEN TEST KIT W/POSTAGE|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|||||0.00||| S3620|EAP|0300|NB SCREEN TEST KIT W/POSTAGE|Blue Cross PPO|BLUE CROSS PPO|||||0.00||| U0001|EAP|0300|2019-NCOV DIAGNOSTIC P|Blue Cross PPO Select|BCBS UTHCT|||||1.08||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Medicaid|MEDICAID WOMENS HEALTH PROGRAM|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|PHCS|TML GRP INS|||||1.40||| U0002|EAP|0300||United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.17||||1.17||| U0002|EAP|0300||Veterans Affairs|VETERANS CHOICE - TRI WEST|1.17||||||| U0002|EAP|0300||United Healthcare|GEHA-UHC INTERGRATED SERVICES|||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|United Healthcare|UMR|1.40||||1.40||| U0002|EAP|0300||Cigna|NALC HLTH BENEFIT|1.17||||||| U0002|EAP|0300||Cigna|CIGNA OPEN ACCESS PLUS|||||1.17||| U0002|EAP|0300||Cigna|CIGNA OF TN CHATTANOOGA|||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.40||| U0002|EAP|0300||Humana Medicare Advantage|HUMANA MEDICARE PPO|||||1.17||| U0002|EAP|0300||ChampVA|CHAMPVA OF CO DENVER|||||1.17||| U0002|EAP|0301||Managed Medicaid|MOLINA MEDICAID|||||0.19||| U0002|EAP|0300|SARS-CoV-2(Covid19)|ChampVA|CHAMPVA OF CO DENVER|||||1.40||| U0002|EAP|0300||Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.17||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Managed Medicaid|TEXAS CHILDREN'S HLT PLAN|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|1.17||||1.40||| U0002|EAP|0300||Managed Medicaid|SUPERIOR STAR MCD|||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Managed Medicaid|MOLINA MEDICAID|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Managed Medicaid|FAMILY PLANNING GRANT|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Cigna|CIGNA OPEN ACCESS PLUS|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Aetna|TRS COORDINATED CARE|||||1.40||| U0002|EAP|0300||Aetna|AETNA EL PASO CLAIMS OFFICE|||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.17||||1.40||| U0002|EAP|0300||Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|1.17||||1.17||| U0002|EAP|0300||Blue Cross PPO|BLUE CROSS PPO|1.40||||1.17||| U0002|EAP|0300||Blue Cross PPO|BLUE CROSS POS|||||1.17||| U0002|EAP|0300||Blue Cross PPO|BCBS WALMART|||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|1.40||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Medicaid|MEDICAID|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Blue Cross PPO|BLUE CROSS POS|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Blue Cross PPO|BCBS WALMART|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Blue Cross PPO|BLUE CROSS PPO|1.40||||1.40||| U0002|EAP|0301||Blue Cross PPO|BLUE CROSS PPO|||||0.19||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Blue Cross PPO Select|BCBS UTHCT|1.40||||1.40||| U0002|EAP|0300||Blue Cross PPO Select|BCBS UTHCT|1.40||||1.17||| U0002|EAP|0301||Blue Cross PPO Select|BCBS UTHCT|||||0.19||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Multiplan|TML GRP INS|||||1.40||| U0002|EAP|0300|SARS-CoV-2(Covid19)|NON CONTRACTED|COMMERCIAL OTHER|1.17||||1.40||| U0002|EAP|0300|COVID19|NON CONTRACTED|COMMERCIAL OTHER|1.17||||1.17||| U0002|EAP|0300||Medicare|MEDICARE A & B|1.17||||1.17||| U0002|EAP|0300|SARS-CoV-2(Covid19)|Medicare|MEDICARE A & B|1.40||||1.40||| U0002|EAP|0300|COVID19|Medicare|MEDICARE A & B|1.40||||1.17||| U0002|EAP|0300||Medicare|MEDICARE RAILROAD|||||1.17||| U0002|EAP|0301||Medicare|MEDICARE A & B|||||0.19||| U0003|EAP|0300|COVID19|Blue Cross PPO Select|BCBS UTHCT|||||2.00||| U0003|EAP|0300|COVID19|Aetna|AETNA EL PASO CLAIMS OFFICE|2.00||||2.00||| U0003|EAP|0300|COVID19|Blue Cross Advantage HMO|BCBS BLUE ADVANTAGE HMO|2.00||||2.00||| U0003|EAP|0300|COVID19|Blue Cross PPO|BLUE CROSS PPO|2.00||||2.00||| U0003|EAP|0300|COVID19|Blue Cross PPO|BLUE CROSS POS|2.00||||2.00||| U0003|EAP|0300|COVID19|Blue Cross PPO|BCBS TRANE PPO|||||2.00||| U0003|EAP|0300|COVID19|Managed Medicaid|MOLINA MEDICAID|||||2.00||| U0003|EAP|0300|COVID19|Managed Medicaid|OTHER MEDICAID|||||2.00||| U0003|EAP|0300|COVID19|Managed Medicaid|MEDICAID CSHCN|||||2.00||| U0003|EAP|0300|COVID19|Managed Medicaid|CIGNA-HEALTHSPRING STAR+PLUS|2.00||||2.00||| U0003|EAP|0300|COVID19|Cigna|CIGNA OPEN ACCESS PLUS|||||2.00||| U0003|EAP|0300|COVID19|Humana Medicare Advantage|HUMANA MEDICARE PPO|2.00||||2.00||| U0003|EAP|0300|COVID19|Humana Medicare Advantage|HUMANA MEDICARE TRS AND ERS|2.00||||2.00||| U0003|EAP|0300|COVID19|Humana Medicare Advantage|HUMANA COMMERCIAL PPO|2.00||||||| U0003|EAP|0300|COVID19|Cigna|CIGNA OF TN CHATTANOOGA|||||2.00||| U0003|EAP|0300|COVID19|ChampVA|CHAMPVA OF CO DENVER|2.00||||||| U0003|EAP|0300|COVID19|PHCS|WEB TPA|||||2.00||| U0003|EAP|0300|COVID19|PHCS|TML GRP INS|2.00||||||| U0003|EAP|0300|COVID19|United Medicare Advantage|UNITED HEALTHCARE DUAL HMO|2.00||||2.00||| U0003|EAP|0300|COVID19|Veterans Affairs|VA BONHAM N TX SAM RAYBURN|2.00||||||| U0003|EAP|0300|COVID19|Veterans Affairs|VETERANS CHOICE - TRI WEST|2.00||||2.00||| U0003|EAP|0300|COVID19|United Healthcare|UMR|2.00||||2.00||| U0003|EAP|0300|COVID19|Medicare|MEDICARE A & B|2.00||||2.00||| U0003|EAP|0300|COVID19|Blue Cross PPO|BCBS WALMART|2.00||||||| U0003|EAP|0300||Medicare|MEDICARE A & B|2.00||||2.00||| U0003|EAP|0300|COVID19|Medicare|MEDICARE RAILROAD|||||2.00||| U0003|EAP|0300|COVID19|Medicare|MEDICARE PART A|2.00||||||| U0003|EAP|0301||Medicare|MEDICARE A & B|||||0.30||| U0003|EAP|0300|COVID19|Aetna|AETNA|||||2.00||| U0003|EAP|0301||Medicare|MEDICARE A & B|||||0.96||| U0003|EAP|0301||Medicare|MEDICARE A & B|||||0.00||| U0003|EAP|0305||Medicare|MEDICARE A & B|||||0.25||| U0003|EAP|0300|COVID19|Multiplan|WEB TPA|||||2.00||| U0003|EAP|0300|COVID19|Multiplan|TML GRP INS|2.00||||||| U0003|EAP|0300|COVID19|NON CONTRACTED|COMMERCIAL OTHER|2.00||||2.00||| U0003|EAP|0300|COVID19|NON CONTRACTED|COMMERCIAL OTHER 2|2.00||||||| U0003|EAP|0300|COVID19|NON CONTRACTED|BOONE CHAPMAN|||||2.00|||